Recommended Dosing for Octagam (IVIG)
The recommended dose of Octagam for immune thrombocytopenia (ITP) is 1 g/kg as a one-time dose, which may be repeated if necessary. 1
Dosing Guidelines by Indication
Primary Immune Thrombocytopenia (ITP)
- Initial dose: 1 g/kg as a one-time dose 1
- This dosage may be repeated if necessary based on clinical response
- For patients requiring rapid increase in platelet count, IVIG should be used with corticosteroids 1
Primary Immunodeficiency Diseases (PID)
- 400-600 mg/kg every 28 days OR
- 300-450 mg/kg every 21 days 2
Multisystem Inflammatory Syndrome in Children (MIS-C)
- 2 g/kg based on ideal body weight 1
- In patients with cardiac dysfunction, may be given in divided doses (1 g/kg daily over 2 days) 1
Kawasaki Disease
- 2 g/kg as a single infusion 1
Administration Considerations
Pre-administration Assessment
- Check serum IgA levels before administration, as IgA deficiency may lead to infusion reactions or anaphylaxis 3
- Assess cardiac function and fluid status before administration, especially in patients with cardiac dysfunction 1
- For patients with depressed cardiac function, close monitoring and diuretics may be required during IVIG administration 1
Administration Rate
- Begin infusion at a slow rate and gradually increase as tolerated
- Monitor vital signs during infusion
- Be alert for infusion reactions (headache, fever, chills)
Monitoring
- Monitor platelet count response in ITP patients
- For PID patients, monitor IgG levels to ensure adequate trough concentrations
- The half-life of total IgG with Octagam is approximately 41 days 2
Safety Profile
- Octagam is generally well-tolerated with adverse events occurring in approximately 5% of infusions 2
- Most common adverse reaction is headache 4
- In real-world studies, Octagam showed a frequency of only 0.04 adverse events per treatment course 4
Special Populations
Pregnant Patients
- IVIG (including Octagam) is recommended for pregnant patients with ITP requiring treatment 1
- For pregnant women with ITP, the mode of delivery should be based on obstetric indications rather than platelet count alone 1
Secondary ITP
- For HCV-associated ITP, IVIG is recommended as initial treatment if treatment is required 1
- For HIV-associated ITP, IVIG is recommended as initial treatment along with corticosteroids or anti-D 1
Clinical Efficacy
- In PID patients, Octagam treatment resulted in only 0.1 serious infections per subject per year, meeting FDA efficacy requirements 2
- In CIDP patients, 41.7% showed improved functional status after 4 months of Octagam treatment 4
Remember that dosing should be calculated based on the specific indication, with ITP requiring higher doses (1 g/kg) compared to maintenance therapy for PID (400-600 mg/kg). Always monitor patients during infusion for potential adverse reactions.