Immune Globulin Intravenous (IGIV)

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Immune Globulin Intravenous (IGIV)

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(ih-MYOON GLAH-byoo-lin intravenous)

Gamimune N, Gammagard S/D, Gammar-P I.V., Iveegam, Polygam, Polygam S/D, Sandoglobulin, Venoglobulin-I, Venoglobulin-S, Iveegam Immuno

Class: Immune serum

Action Replaces normal human IgG antibodies. Promotes opsonization, fixes complement, and neutralizes bacteria, viruses, fungi, and parasites, and their toxins.

Indications Treatment of primary immunodeficiency states in patients unable to produce sufficient amounts of IgG antibodies; prevention of bacterial infections in patients with hypogamma globulinemia, recurrent bacterial infections associated with B-cell chronic lymphocytic leukemia or Kawasaki disease, children with AIDS, and bone-marrow transplant patients; treatment of immune thrombocytopenia purpura. Unlabeled use(s): Chronic fatigue syndrome; quinidine-induced thrombocytopenia.

Contraindications Immediate hypersensitivity to human antibody product; circulating anti-IgA antibodies; possible aseptic meningitis syndrome.

Route/Dosage

Immunodeficiency Syndrome

ADULTS AND CHILDREN: Gammagard: IV 200 to 400 mg/kg initially; then monthly doses of ³ 100 mg/kg are recommended.

Gammar S/D: IV Initial dose of 0.5 mL/kg/hr. Eventual: 5%: 4 mL/kg/hr; 10%: 8 mL/kg/hr.

Gammar-P: IV Initial dose: 0.6 mL/kg/hr × 15 to 30 min. Eventual: 1.2 to 3.6 mL/kg/hr.

Gammar-IV: IV Initial loading dose of ³ 200 mg/kg; then 100 to 200 mg/kg q 3 to 4 wk.

Gamimune N: IV 100 to 200 mg/kg monthly. If clinical response or level of IgG is insufficient, increase dose to 400 mg/kg or repeat infusion more frequently. Pediatric HIV infection: 400 mg (8 mL/kg) q 28 days.

Iveegam: IV 200 mg/kg monthly. If clinical response or level of IgG is insufficient, increase dose 4-fold or repeat infusion more frequently. Doses up to 800 mg/kg monthly have been tolerated.

Polygam: IV 200 to 400 mg/kg recommended initially; then 100 mg/kg monthly. Doses based on monitoring clinical response.

Polygam S/D: IV Initial: 0.5 mL/kg/hr. Eventual: 5%: 4 mL/kg/hr; 10%: 8 mL/kg/hr.

Sandoglobulin: IV 200 mg/kg monthly. If clinical response or level of IgG is insufficient, increase dose to 300 mg/kg or repeat infusion more frequently.

Venoglobulin-I: IV 200 mg/kg monthly. If clinical response or level of IgG is insufficient, increase dose to 300 to 400 mg/kg or repeat infusion more frequently.

Immune Thrombocytopenic Purpura

ADULTS AND CHILDREN: Gammagard: IV 1000 mg/kg. Give up to 3 doses on alternate days if required, based on clinical response and platelet count.

Gammagard S/D: IV Initial dose of 0.5 ml/kg/hr. Eventual: 5%: 4 mL/kg/hr; 10%: 8 mL/kg/hr.

Gamimune N: IV 400 mg/kg for 5 consecutive days.

Polygam: IV 1000 mg/kg recommended initially; then additional doses determined by clinical response and platelet count. Up to 3 doses may be given on alternate days if needed.

Polygam S/D: IV Initial: 0.5 mL/kg/hr. Eventual: 5%: 4 mL/kg/hr; 10%: 8 mL/kg/hr.

Sandoglobulin: IV 400 mg/kg for 2 to 5 consecutive days.

Venoglobulin-I: IV Induction: 500 mg/kg/day for 2 to 7 consecutive days. Patients responding to induction therapy by manifesting platelet count of 30,000 to 50,000/mm³ may be discontinued after 2 to 7 daily doses. Maintenance: If platelet count falls below 30,000/mm³ or patient manifests significant bleeding, infuse 500 to 2000 mg/kg as single dose q 2 wk or less as needed to maintain platelet count above 30,000/mm³ in children and 20,000/mm³ in adults.

B-Cell Chronic Lymphocytic Leukemia

ADULTS AND CHILDREN: Gammagard: IV 400 mg/kg q 3 to 4 wk.

Polygam: IV 400 mg/kg q 3 to 4 wk.

Interactions

Live vaccines: To avoid inactivating vaccines containing live viruses or bacteria, give live vaccines 2 to 4 wk before or 3 to 11 mo after IGIV depending on dose. INCOMPATIBILITIES: Admixture: Do not mix IGIV with other medications.

Lab Test Interferences Blood type: Blood-group antibodies may be transferred to IGIV recipients, causing confusion regarding recipient's blood type.

Adverse Reactions

CV: Palpitations; hypotension; hypertension. CNS: Anxiety; dizziness; headache. GI: Nausea; vomiting; abdominal cramps. RESP: Shortness of breath; wheezing. OTHER: Pallor; cyanosis; immediate anaphylactic and hypersensitivity reactions; back pain; chills; muscle or joint pain; arthralgia; malaise; flushing; chest tightness.

Precautions

Pregnancy: Category C. Lactation: Undetermined. Renal: Has been associated with renal dysfunction, acute renal failure, osmotic nephrosis, and death. Hypersensitivity: Hypersensitivity, including anaphylaxis, may occur.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer via IV infusion only. Use separate IV line and electronic infusion device.
Proceed with infusion only if reconstituted solution is clear and is at approximate body temperature.
Store Gamimune N and Iveegam in refrigerator.
Store Sandoglobulin, Gammagard S/D, Gammar-P, Polygam S/D, and Venoglobulin-I at room temperature.
Discard any unused solution.
Avoid freezing. Do not use solution that has been frozen.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Keep epinephrine (1:1000) and resuscitation equipment readily available.
Monitor vital signs continuously and observe for adverse symptoms (eg, anaphylaxis, fever, chills, nausea, vomiting) throughout infusion.
If adverse reactions such as fever, chills, nausea, or vomiting develop, slowing infusion rate will usually eliminate reaction.

Patient/Family Education

Instruct patient to notify physician immediately of nausea, chills, shortness of breath, headache, and chest tightness during infusion.