IVIg Dose for Guillain-Barré Syndrome
The recommended dose of intravenous immunoglobulin (IVIg) for Guillain-Barré Syndrome is 0.4 g/kg body weight daily for 5 consecutive days, totaling 2 g/kg over the treatment course. 1
Standard Dosing Protocol
Administer 0.4 g/kg/day for 5 consecutive days as the first-line treatment for GBS, which is equally effective as plasma exchange but preferred due to easier administration and better completion rates 1
The total cumulative dose is 2 g/kg (or approximately 100 g for a 50 kg patient) distributed over the 5-day period 1
When the total dose exceeds 80 grams, it may be administered over 3-5 days at 0.4 g/kg to improve tolerability 1
Dosing Considerations by Body Weight
Use ideal body weight rather than actual body weight for dosing calculations in obese patients, as IVIg distributes in plasma and extracellular fluid spaces that correlate with lean body mass, not adipose tissue 1
Using actual body weight in obese patients would result in supraphysiologic dosing without additional therapeutic benefit and dramatically increase costs 1
Pediatric Dosing
Children should receive the same 5-day regimen (0.4 g/kg/day for 5 days) rather than accelerated 2-day protocols, as treatment-related fluctuations occurred more frequently with shorter regimens 1
IVIg is preferred over plasma exchange in children due to better tolerability and fewer complications 1
Pre-Treatment Safety Screening
Verify serum IgA levels before the first infusion, as IgA deficiency increases the risk of anaphylaxis 1
If IgA deficiency is confirmed, use IVIg preparations with reduced IgA levels 1
Treatment Timing and Initiation
Treatment should be initiated as early as possible in the disease course to maximize effectiveness 1
Initiate IVIg immediately in patients exhibiting moderate to severe weakness, rapid progression, or any signs of respiratory compromise, dysphagia, facial weakness, or bulbar weakness 1
Monitoring During Treatment
Monitor rigorously during and after each infusion for neurological function, including motor strength, reflexes, and bulbar symptoms 1
Watch for potential adverse reactions to the infusion 1
Avoid medications that worsen neuromuscular function during treatment, including β-blockers, IV magnesium, fluoroquinolones, aminoglycosides, and macrolides 1
Expected Response and Management of Inadequate Response
Approximately 40% of patients do not show improvement within the first 4 weeks following standard IVIg treatment, which doesn't necessarily indicate treatment ineffectiveness 1, 2
Treatment-related fluctuations (TRFs) occur in 6-10% of patients within 2 months of initial improvement, and repeating the full course of IVIg is common practice for TRFs 1, 2
Research suggests that patients with a low increase in serum IgG levels (ΔIgG) 2 weeks after IVIg treatment recover significantly more slowly and may benefit from a second course 3, 4
Consider repeat treatment or switching to plasma exchange if no improvement is seen by 4 weeks 2
Special Populations
In pregnant women, IVIg is preferred over plasma exchange because it requires fewer monitoring considerations and additional precautions, though neither treatment is contraindicated during pregnancy 1
For Miller-Fisher Syndrome, treatment is generally not recommended as most recover completely within 6 months without intervention, though close monitoring is essential 1