Side Effects of Intravenous Immunoglobulin (IVIg) in Guillain-Barré Syndrome
IVIg causes common infusion-related reactions (chills, tachycardia, hypertension, muscle pains, fever, nausea, and headache) that are self-limited and respond to slowing the infusion rate, while serious complications including thrombosis, renal failure, aseptic meningitis, and anaphylaxis occur in less than 5% of patients. 1, 2, 3
Common Infusion-Related Side Effects
The most frequent adverse effects occur during or shortly after IVIg administration and include: 1
- Chills and fever - occur commonly during infusion 1
- Tachycardia and hypertension - cardiovascular responses to infusion 1
- Muscle pains (myalgias) - transient musculoskeletal discomfort 1
- Headache - can be significant enough to require additional medical interventions, including CT scans to rule out intracranial hemorrhage 1
- Nausea - gastrointestinal upset during infusion 1
These reactions are self-limited and typically resolve by slowing the infusion rate without requiring discontinuation of therapy. 1
Serious Adverse Events (Occurring in <5% of Patients)
Black Box Warnings
IVIg carries FDA black box warnings for two life-threatening complications: 1
- Thrombosis - arterial and venous thrombotic events including myocardial infarction, stroke, pulmonary embolism, and deep vein thrombosis 1
- Renal failure - acute renal dysfunction or failure, particularly in patients with pre-existing renal insufficiency, diabetes, volume depletion, sepsis, or those receiving nephrotoxic drugs 1
Aseptic Meningitis
- Occurs rarely but is well-documented in GBS patients receiving IVIg 3
- Presents with severe headache, neck stiffness, photophobia, and fever typically within 24-48 hours of infusion 3
- CSF analysis shows elevated lymphocytic cell counts, raised protein, normal glucose, and negative cultures 3
- Resolves with supportive care (IV fluids and analgesics) without neurological sequelae 3
Hypersensitivity Reactions
- Anaphylactic shock - extremely rare but documented in isolated cases 2
- Angioneurotic edema - rare allergic reaction 2
- Sensitization to repeated injections is extremely rare 2
Other Rare Complications
- Nephrotic syndrome - isolated occurrences reported 2
- Slight soreness at injection site and temperature elevation may occur 2
Clinical Implications for GBS Management
IVIg Remains Preferred First-Line Treatment
Despite these side effects, IVIg is preferred over plasma exchange because it has higher completion rates, better tolerability, and fewer complications overall - particularly important in children and pregnant women. 4, 5
Monitoring Requirements During IVIg Administration
When administering IVIg for GBS, monitor for: 1
- Vital signs - blood pressure, heart rate, temperature
- Infusion reactions - slow rate if symptoms develop
- Renal function - baseline and post-treatment creatinine, particularly in high-risk patients
- Thrombotic risk factors - immobility, advanced age, cardiovascular disease
- Severe headache - may require neuroimaging to exclude intracranial hemorrhage
Contraindications and Special Populations
IVIg may not be acceptable to Jehovah's Witnesses and other patients who refuse blood products, as it is derived from pooled human plasma. 1
Patients at higher risk for complications include those with: 1
- Pre-existing renal disease
- Advanced age
- Diabetes mellitus
- Volume depletion
- Concurrent nephrotoxic medications
Comparison to Alternative Treatments
IVIg and plasma exchange have similar efficacy but different side effect profiles. 6 Plasma exchange carries risks of: 1
- Septicemia from central venous access
- Fluid and electrolyte imbalances
- Technical complications requiring specialized equipment
The significantly higher completion rate of IVIg (due to better tolerability) makes it the preferred option despite the potential for serious but rare complications. 6