Typical Dosage of Intravenous Immunoglobulin (IVIG)
The typical dosage of IVIG ranges from 1 to 2 g/kg of ideal body weight, usually administered over 2-5 consecutive days, with the specific dosage depending on the condition being treated.
General Dosing Guidelines by Indication
Immunodeficiency Disorders
- Initial dose of 300-400 mg/kg IV monthly for replacement therapy 1
- Dose may be increased to 600 mg/kg and frequency adjusted to every 2-3 weeks based on clinical response 2
- Maintenance trough IgG levels typically targeted between 9.6-11.2 g/L 2
Idiopathic Inflammatory Myopathies (IIM)
- 1-2 g/kg of ideal body weight, usually given over 2 consecutive days (1 g/kg each on day 1 and day 2) 1
- Administered once monthly for 1-6 months 1
- For doses exceeding 80 g, consider administering over 3-5 days at 0.4 g/kg daily 1
Immune Thrombocytopenic Purpura (ITP)
- 1 g/kg as a one-time dose, which may be repeated if necessary 1
- Alternative regimen: 0.4 g/kg daily for 2-5 consecutive days 3
- Maintenance therapy may consist of repeated doses of 0.4 g/kg as needed 3
Kawasaki Disease
- Standard dose of 2 g/kg IV as a single infusion 1
- For patients weighing ≥25 kg, 1 g/kg may be equally effective with lower costs 4
Administration Considerations
Pre-administration Assessment
- Check serum IgA level before administering IVIG 1
- IgA deficiency may lead to fever, infusion reactions, or severe anaphylaxis 1
- If IgA deficiency is detected, use an IVIG preparation with reduced IgA levels 1
Weight-Based Dosing Strategies
- Traditional dosing uses actual body weight (ABW) 5
- Precision-dosing strategies using ideal body weight (IBW) or adjusted body weight (adjBW) show similar efficacy with cost savings 5
- No differences in infection rates or IgG-level response were found between precision and traditional dosing strategies 5
Dose Titration
- For chronic conditions like CIDP, dose reductions (mean 63.3%, range 42.4-88%) from initial dose may be possible 6
- Lowest effective dose varies considerably between patients (18-108 g per course) 6
- Treatment frequency tends to remain fixed for each individual patient 6
Special Considerations
Adverse Effects
- Most common adverse experience is headache, associated with approximately 6.9% of infusions 2
- Initial infusions should proceed with caution in previously untreated immunodeficient patients due to risk of complement-mediated adverse reactions 3
Cost Considerations
- Using precision-dosing strategies (IBW or adjBW) can provide significant cost savings without compromising efficacy 5
- For certain conditions like Kawasaki disease in heavier patients, lower doses may be equally effective with substantial cost savings 4
Contraindications
- IVIG is contraindicated in patients with selective IgA deficiency who have detectable IgA antibodies 3
Remember that while these are typical dosages, the optimal dose may vary based on the specific condition, patient characteristics, and clinical response. Monitoring for efficacy and adverse effects is essential throughout treatment.