Does Intravenous Immunoglobulin (IVIG) cause nausea?

From the Guidelines

Yes, IVIG (intravenous immunoglobulin) can cause nausea as a side effect, as reported in the most recent and highest quality study 1. Nausea is one of the more common adverse reactions associated with IVIG therapy, typically occurring in patients receiving treatment. This side effect usually develops during or shortly after the infusion and is often temporary. The nausea is believed to result from the body's response to the introduction of foreign proteins or from the rate of infusion. Some key points to consider about IVIG and nausea include:

• Slowing the infusion rate can often reduce this side effect, as noted in various studies 1.
• Other strategies to manage IVIG-related nausea include pre-medication with antiemetics like ondansetron or promethazine about 30 minutes before infusion.
• Ensuring proper hydration before treatment and administering IVIG preparations with lower osmolality may also help.
• Most patients find that nausea diminishes with subsequent infusions as their body becomes accustomed to the treatment.
• If nausea persists or becomes severe, healthcare providers may consider switching to a different IVIG preparation or adjusting the treatment protocol, as suggested by the evidence 1.

From the Research

Intravenous Immunoglobulin (IVIG) and Nausea

• IVIG can cause nausea as a side effect, as reported in several studies 2, 3, 4, 5, 6
• The frequency and severity of nausea as an adverse reaction to IVIG vary across different studies
• A study published in 2015 found that IVIG treatment led to transient side effects such as headache and nausea during and after the infusion 2
• Another study published in 2017 reported that immediate adverse events, including nausea, occurred in 25.2% of patients receiving IVIG infusions 3
• A 2005 review of IVIG adverse effects listed nausea as one of the immediate adverse effects associated with IVIG administration 4
• A 2007 review of IVIG safety also mentioned nausea as a mild and transient adverse effect 5
• A 2018 study on adverse reactions to IVIG reported that delayed-type reactions, including nausea, occurred in one patient 6

Factors Influencing Nausea as an Adverse Reaction to IVIG

• Infusion rate: faster infusion rates may increase the risk of adverse reactions, including nausea 6
• Patient characteristics: certain patient populations, such as those with primary immunodeficiency diseases, may be more prone to adverse reactions, including nausea 3
• IVIG preparation: the use of sucrose-containing products may increase the risk of adverse reactions, including nausea 4, 5

Management of Nausea as an Adverse Reaction to IVIG

• Slowing or temporary discontinuation of the infusion 4, 6
• Symptomatic therapy with medications such as antihistamines and glucocorticoids 4
• Administration of medications such as paracetamol and steroids 6