Intravenous Immunoglobulin (IVIG) Administration Protocol
IVIG should be administered at 1-2 g/kg of ideal body weight, usually given over 2 consecutive days (1 g/kg each on day 1 and day 2) for most autoimmune conditions, with dosing adjusted based on specific indications. 1, 2
Pre-Administration Assessment
- Check serum IgA level before administering IVIG to prevent fever, infusion reactions, or severe anaphylaxis in patients with IgA deficiency 1, 2
- If IgA deficiency is detected, use an IVIG preparation with reduced IgA levels 1, 2
- Review patient's medical history for risk factors such as renal dysfunction, thrombotic risk, or history of previous infusion reactions 1
Dosing Guidelines by Indication
- Immunodeficiency disorders: 300-400 mg/kg IV monthly for replacement therapy 2, 3
- Idiopathic Inflammatory Myopathies: 1-2 g/kg of ideal body weight, usually given over 2 consecutive days 1, 2
- Immune Thrombocytopenic Purpura (ITP): 1 g/kg as a one-time dose, which may be repeated if necessary 2, 4
- Kawasaki Disease: 2 g/kg IV as a single infusion 1, 2
- Myasthenia Gravis: Initial infusion of 400 mg/kg/day for 5 days followed by maintenance therapy of 400 mg/kg for 1 day every 3-4 months 5
- Antibody-mediated rejection in cardiac transplantation: Varies by center protocol, typically 500 mg/kg IV once daily for 4 days or 2 g/kg divided into 2 doses over 2 consecutive days 1
Administration Technique
- For standard doses (≤80 g), administer over 2 consecutive days 1, 2
- For higher doses (>80 g), consider administering over 3-5 days at 0.4 g/kg per day 1
- Begin infusion at a slow rate and gradually increase if well tolerated 6
- Monitor vital signs regularly during infusion, especially during the first 30 minutes 6
Premedication Recommendations
- Diphenhydramine (Benadryl) 1 mg/kg 1
- Acetaminophen (Tylenol) 10-15 mg/kg 1
- Consider corticosteroids for patients with history of infusion reactions 1
Monitoring During Administration
- Vital signs: temperature, blood pressure, heart rate, and respiratory rate 6
- Signs of infusion reactions: headache, flushing, chills, nausea, chest tightness 4, 6
- Renal function: urine output and serum creatinine 1
Management of Adverse Reactions
- For mild reactions (headache, nausea): temporarily slow or pause infusion 4
- For moderate reactions (fever, vomiting): pause infusion, administer additional antipyretics/antihistamines, resume at slower rate when symptoms resolve 4
- For severe reactions (anaphylaxis, severe hypotension): stop infusion immediately, administer epinephrine, notify physician 1, 4
Special Considerations
- Patients receiving first-time infusions require closer monitoring due to higher risk of adverse reactions 6
- Elderly patients and those with renal impairment may require slower infusion rates and lower doses 3
- For patients with fluid overload risk, consider more concentrated IVIG preparations (10%) and slower infusion rates 3
- The half-life of IVIG is approximately 21-36 days, which guides dosing frequency for maintenance therapy 3