IVIG Administration Protocol for 1 g/day in a 65 kg Patient
For a 65 kg patient receiving IVIG at 1 g/day, administer 65 grams (1 g/kg) as a single infusion on Day 1, followed by an identical 65-gram dose on Day 2, for a total cumulative dose of 2 g/kg over 2 consecutive days. 1
Dosing Calculation and Schedule
- Total dose per day: 65 grams (1 g/kg × 65 kg) 1
- Administration schedule: Two consecutive days 1
- Total cumulative dose: 130 grams (2 g/kg) 1
- Use ideal body weight (IBW) for dosing calculations, particularly if the patient has BMI ≥30 kg/m², rather than actual body weight 1, 2
Pre-Administration Requirements
Mandatory Screening
- Check serum IgA levels before first infusion to identify IgA deficiency, which predisposes to severe anaphylaxis 1, 3
- If IgA deficiency is detected, use an IVIG preparation with reduced IgA content 1
Risk Factor Assessment
- Renal function: Obtain baseline serum creatinine and assess for preexisting renal insufficiency (increased risk of renal failure, especially with sucrose-containing preparations) 1, 3
- Thrombotic risk factors: Evaluate for immobility, increased serum viscosity, preexisting vascular disease, or hypercoagulable states 3
- History of migraine: Increases risk of aseptic meningitis 3
- Previous infusion reactions: Document any prior IVIG reactions 1
Premedication Protocol
- Acetaminophen 650-1000 mg PO 30-60 minutes before infusion 1, 4
- Diphenhydramine 25-50 mg PO or IV 30 minutes before infusion 1
- Consider corticosteroids (e.g., methylprednisolone 125 mg IV) for patients with history of infusion reactions 1
Infusion Administration
Day 1: First 65-gram Dose
- Start infusion at a slow initial rate to monitor for immediate reactions 5, 3
- Gradually increase infusion rate as tolerated per manufacturer's guidelines 3
- Monitor continuously during infusion for signs of reaction 1
Day 2: Second 65-gram Dose
- Repeat identical 65-gram infusion 1
- Use same premedication protocol 1
- Continue monitoring as on Day 1 1
Special Consideration for Cardiac Dysfunction
- If patient has cardiac dysfunction or risk of fluid overload, the divided dosing over 2 days (1 g/kg daily) is preferred over single-day administration 1
- Evaluate cardiac function before initiating IVIG 1
Monitoring During Infusion
Vital Signs
- Monitor blood pressure, heart rate, respiratory rate, and temperature every 15-30 minutes during infusion 1
- Watch for signs of anaphylaxis, hypotension, or respiratory distress 1
Renal Monitoring
Management of Adverse Reactions
Mild Reactions (headache, nausea, flushing)
- Slow or temporarily stop the infusion 3
- Administer additional acetaminophen or antihistamines 4
- Resume at slower rate once symptoms resolve 3
Severe Reactions (anaphylaxis, severe hypotension, respiratory distress)
- Immediately stop the infusion 1
- Administer epinephrine 0.3-0.5 mg IM for anaphylaxis 1
- Notify physician immediately 1
- Provide supportive care and do not restart infusion 1
Post-Administration Monitoring
- Assess clinical response based on the specific indication (e.g., platelet count for ITP, muscle strength for myositis) 1, 4
- Monitor for delayed adverse effects including:
Common Pitfalls to Avoid
- Do not use actual body weight in obese patients (BMI ≥30); use IBW or adjusted body weight to avoid overdosing and unnecessary cost 1, 2
- Do not skip IgA screening in treatment-naive patients, as this is the primary risk factor for life-threatening anaphylaxis 1, 3
- Do not use sucrose-containing IVIG preparations in patients with renal insufficiency due to increased risk of osmotic nephropathy 3
- Do not infuse too rapidly in first-time recipients or those who haven't received IVIG in the past 8 weeks, as they are at higher risk for complement-mediated reactions 5