Immune Globulin Intravenous Dosage

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Usual Adult Dose for Bone Marrow Transplantation

20 years or older: 400 to 500 mg/kg/dose IV, given as an infusion, every week for 3 months, then once a month

Usual Adult Dose for Chronic Lymphocytic Leukemia

400 mg/kg/dose IV, given as an infusion, every 3 weeks

Usual Adult Dose for Idiopathic (Immune) Thrombocytopenic Purpura

Initial dose: 400 to 1000 mg/kg/day IV, given as an infusion, for 2 to 5 days
Maintenance: 400 to 1000 mg/kg/dose IV, given as an infusion, every 3 to 6 weeks based on clinical response and platelet count

Usual Adult Dose for Kawasaki Disease

2000 mg/kg IV, given as an infusion, over 10 to 12 hours
The dose may need to be repeated if response is inadequate.

Usual Adult Dose for Primary Immunodeficiency Syndrome

300 to 600 mg/kg/dose IV, given as an infusion, once every 3 to 4 weeks

Usual Adult Dose for Chronic Inflammatory Demyelinating Polyradiculoneuropathy

Loading dose: 2 g/kg IV, given as an infusion, in divided doses over 2 to 4 consecutive days
Maintenance dose: 1 g/kg IV, given as an infusion, over 1 day or 0.5 g/kg IV infusion on 2 consecutive days, every 3 weeks

Usual Adult Dose for Polymyositis/Dermatomyositis

Study (n=35)
1 g/kg/day IV, given as an infusion, for 2 consecutive days per month, for 4 to 6 months

Usual Pediatric Dose for Chronic Lymphocytic Leukemia

400 mg/kg/dose IV, given as an infusion, every 3 to 4 weeks

Usual Pediatric Dose for HIV Infection

400 mg/kg/dose every 2 to 4 weeks in those patients with hypogammaglobulinemia (IgG less than 400 mg/dL). Consider IGIV for HIV-infected children who have recurrent, serious bacterial infections during a 1 year period.

Usual Pediatric Dose for Idiopathic (Immune) Thrombocytopenic Purpura

Initial dose: 400 to 1000 mg/kg/day IV, given as an infusion, for 2 to 5 consecutive days (total dose: 2 g/kg)

Maintenance: 400 to 1000 mg/kg/dose IV, given as an infusion, every 3 to 6 weeks based on clinical response and platelet count

Usual Pediatric Dose for Kawasaki Disease

2000 mg/kg IV, given as a single dose, over 10 to 12 hours; should be used in combination with aspirin. If signs and symptoms persist greater than or equal to 36 hours after completion of the infusion, retreatment with a second 2000 mg/kg infusion should be considered.

Usual Pediatric Dose for Primary Immunodeficiency Syndrome

Primary immunodeficiency disorders: Adjust dose/frequency based on desired IgG concentration and clinical response. Manufacturers dosing recommendations vary based on individual product used.
General dosing range: 200 to 800 mg/kg IV every 3 to 4 weeks; maintain a trough IgG concentration of 500 mg/dL.

Usual Pediatric Dose for Chronic Inflammatory Demyelinating Polyradiculoneuropathy

400 mg/kg/day for 5 days once each month or 1 g/kg/day for 2 days once each month

Renal Dose Adjustments

Immune globulin intravenous products (IGIV) have been associated with renal dysfunction, acute renal failure, osmotic nephrosis and death. Patients predisposed to acute renal failure include those with any degree of preexisting renal insufficiency, diabetes mellitus, age greater than 65, volume depletion, sepsis, paraproteinemia, or patients receiving known nephrotoxic drugs.

Liver Dose Adjustments

Data not available

Dose Adjustments

Data not available

Precautions

An aseptic meningitis syndrome has occurred infrequently in association with IGIV treatment. The syndrome usually begins within several hours to 2 days and is characterized by severe headache, nuchal rigidity, drowsiness, fever, photophobia, painful eye movements, and nausea and vomiting.

Immune globulin intravenous is made from human plasma and may contain infectious agents, such as viruses, that can cause disease.

Immune globulin intravenous should be administered IV only. The IM and subcutaneous routes have not been evaluated.

Dialysis

Data not available

Other Comments

The different products of immune globulin IV differ in their content, production, composition, and properties. These factors can influence the tolerability, rate of infusion, stability, associated adverse effects, and efficacy of a product.

Adequate comparative studies between different IGIV products are not presently available. An expert panel reviewing the off-label uses of IGIV has recommended that the available products are therapeutically equivalent and interchangeable. Interproduct pharmaceutical differences (i.e., osmolarity, pH, electrolyte and sugar content, IGIV concentration, and IgA content) should be considered prior to selecting a brand product and based upon the patient's clinical status.

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