Gamma-GlobulinRx

Trade Names: Gammaked, Gammagard, Gammaplex, Flebogamma, Bivigam

Synonyms: Intravenous immunoglobulin, IVIG

Drug Class: Immunoglobulin

Preparations
Different brands have preparations containing : 1.0-, 2.5-, 5-, 10-, 20g

Dose
Administered intravenously at the rate specified by the manufacturer ’s instructions; generally, start at a slow rate 0.5–1.0 mL/min and increase.
Primary immunodeficiencies: 200–400 mg/kg every 4 weeks
Kawasaki disease: 2 g/kg in one dose, or 400 mg/kg/day for 4 days. Concomitant aspirin therapy is indicated.
Chronic idiopathic thrombocytopenic purpura: 400 mg/kg/day for 5 days
Inflammatory myositis: 1 g/kg/day for 2 days once monthly
Other autoimmune disease: 400 mg/kg/day for 1–4 days per month

Indications: Primary immunodeficiencies associated with hypogammaglobulinemia or agammaglobulinemia; also used in idiopathic thrombocytopenic purpura, Kawasaki disease, Guillain-Barré syndrome, and chronic inflammatory demyelinating polyneuropathy. Uncontrolled reports suggest efficacy in some autoimmune diseases refractory to other treatment.

Mechanism of Action: In primary immunodeficiencies, intravenous immunoglobulin replaces IgG; in autoimmune disease, mechanism unknown. Theories include blockade of Fc receptors, T cell inhibition, and solubilization of immune complexes.

Contraindications: Hypersensitivity to immunoglobulin. In patients with profound IgA deficiency (serum IgA <5 mg/dL), many intravenous immunoglobulin products containing larger amounts of IgA are contraindicated as they may cause anaphylactic reactions.

Precautions: Patients with profound IgA deficiency may develop anaphylactic reactions. If intravenous immunoglobulin is required in these patients, use an IgA-deficient preparation (consult your pharmacy). Avoid high dose regimes (1g/kg/day) in fluid intolerant patients. Caution in renal impairment, diabetes, heart failure and the elderly.

Monitoring: For autoimmune disease, intravenous immunoglobulin is usually administered in the hospital on an outpatient basis, with monitoring of vital signs.

Pregnancy Risk: C

Adverse Effects
Common: Flushing, tachycardia, chills, dyspnea: may respond to slowing the rate of infusion
Less common: Hypotension, anaphylaxis, aseptic meningitis, hyperviscosity, thrombosis, nephritic syndrome, acute renal failure (more likely with sucrose containing preparations), hemolysis, pulmonary edema. Transmission of viral infection is uncommon. In the past, rare cases of transmission of hepatitis C occurred with inadequately treated preparations.

Drug Interactions: May interfere with the action of live virus vaccines

Comments: Prepared from pooled plasma. Few controlled trials exist to guide appropriate use of intravenous immunoglobulin in the rheumatic diseases.

Cost: $$$$$

BIBLIOGRAPHY

Gelfand EW. Intravenous immune globulin in autoimmune and inflammatory diseases. N Engl J Med. 2012 Nov 22;367(21):2015-25.PMID: 23171098