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Immune Globulin Intravenous Dosage

Applies to the following strength(s): 5% ; 10% ; 1 g ; 2.5 g ; 5 g ; 10 g ; 3 g ; 6 g ; 12 g ; 0.5 g

The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.

Usual Adult Dose for Chronic Lymphocytic Leukemia

Gammagard S/D(R):

400 mg/kg, IV, every 3 to 4 weeks

Use: Prevention of bacterial infections in hypogammaglobulinemia and/or recurrent bacterial infections associated with B-cell chronic lymphocytic leukemia (CLL).

Usual Adult Dose for Idiopathic (Immune) Thrombocytopenic Purpura

Carimune(R): 400 mg/kg, IV, daily for 2 to 5 consecutive days
-Initial infusion rate is 0.5 mg/kg/min for 30 minutes.
-If initial infusion is tolerated, may increase to 1 mg/kg/min, and gradually increased step-wise as tolerated.
-Maximum infusion rate is 3 mg/kg/min.
-Chronic ITP maintenance: if, after induction therapy, platelet count falls to less than 30,000/microliter and/or there is clinically significant bleeding, 400 mg/kg may be given as a single infusion. If response is inadequate, dose can be increased to 800 to 1,000 mg/kg given as a single infusion.

Gammagard S/D(R): 1 gram/kg, IV
Maximum dose: Up to 3 separate doses on alternate days

Gammaplex(R): 1 gram/kg, IV, daily for 2 consecutive days
-Initial infusion rate is 0.5 mg/kg/min.
-May increase rate gradually every 15 minutes.
-Maximum infusion rate is 4 mg/kg/min.

Octagam(R): 1 gram/kg, IV, daily for 2 consecutive days
-Initial infusion rate is 1 mg/kg/min.
-Maximum infusion rate is 12 mg/kg/min.

Privigen(R): 1 gram/kg, IV, daily for 2 consecutive days (total dose of 2 grams/kg)
-Initial infusion rate is 0.5 mg/kg/min.
-Maximum infusion rate is 4 mg/kg/min.

Comments:
-The need for additional doses is determined by clinical response and platelet count.

Use: Prevention and/or control of bleeding in adult chronic idiopathic purpura (ITP) patients.

Usual Adult Dose for Primary Immunodeficiency Syndrome

Bivigam(R): 300 to 800 mg/kg, IV, every 3 to 4 weeks
-Infuse at 0.5 mg/kg/min for the first 10 minutes of the infusion.
-If tolerated, may increase infusion rate by 0.8 mg/kg/min every 20 minutes.
-Maximum infusion rate is 6 mg/kg/min.

Carimune(R): 400 to 800 mg/kg, IV, every 3 to 4 weeks
-Initial infusion rate is 0.5 mg/kg/min for 30 minutes.
-If tolerated, may increase to 1 mg/kg/min; gradually increase step-wise as tolerated.
-Maximum infusion rate is 3 mg/kg/min.

Flebogamma(R): 300 to 600 mg/kg, IV, every 3 to 4 weeks
-Initial infusion rate is 0.5 mg/kg/min.
-Maximum infusion rate is 5 mg/kg/min.

Gammaplex(R): 300 to 800 mg/kg, IV, every 3 to 4 weeks
-Initial infusion rate is 0.5 mg/kg/min.
-May increase rate gradually every 15 minutes.
-Maximum infusion rate is 4 mg/kg/min.

Gammagard S/D(R): 300 to 600 mg/kg, IV, every 3 to 4 weeks

Privigen(R): 200 to 800 mg/kg, IV, every 3 to 4 weeks
-Initial infusion rate is 0.5 mg/kg/min.
-Maximum infusion rate is 8 mg/kg/min


Comments:
-Adjust dose according to clinical response.
-Dose and dosing frequency may vary from patient to patient.
-No optimum target serum IgG level has been determined.
-Target a trough level of 600 mg/dL or higher of IgG; consider dose adjustments if trough IgG levels are less than 500 mg/dL.

Use: Treatment of primary immunodeficiency

Usual Pediatric Dose for Idiopathic (Immune) Thrombocytopenic Purpura

Carimune(R): 400 mg/kg, IV, daily for 2 to 5 consecutive days
-Initial infusion rate is 0.5 mg/kg/min for 30 minutes.
-If initial infusion is tolerated, may increase to 1 mg/kg/min, and gradually increased step-wise as tolerated.
-Maximum infusion rate is 3 mg/kg/min.
-Acute Childhood ITP: if platelet count response to the first 2 doses is adequate (30 to 50,000/microliter), may discontinue after the second day.
-Chronic ITP maintenance: if, after induction therapy, platelet count falls to less than 30,000/microliter and/or there is clinically significant bleeding, 400 mg/kg may be given as a single infusion. If response is inadequate, dose can be increased to 800 to 1,000 mg/kg given as a single infusion.

Gammaplex(R): 1 gram/kg, IV, daily for 2 consecutive days
-Initial infusion rate is 0.5 mg/kg/min.
-May increase rate gradually every 15 minutes.
-Maximum infusion rate is 4 mg/kg/min.

Privigen(R) (15 years and older): 1 gram/kg, IV, daily for 2 consecutive days (total dose of 2 grams/kg)
-Initial infusion rate is 0.5 mg/kg/min.
-Maximum infusion rate is 4 mg/kg/min.

Comments:
-The need for additional doses is determined by clinical response and platelet count.

Use: Prevention and/or control of bleeding in chronic idiopathic purpura (ITP) patients.

Usual Pediatric Dose for Primary Immunodeficiency Syndrome

Bivigam(R): 300 to 800 mg/kg, IV, every 3 to 4 weeks
-Infuse at 0.5 mg/kg/min for the first 10 minutes of the infusion.
-If tolerated, may increase infusion rate by 0.8 mg/kg/min every 20 minutes.
-Maximum infusion rate is 6 mg/kg/min.

Carimune(R): 400 to 800 mg/kg, IV, every 3 to 4 weeks
-Initial infusion rate is 0.5 mg/kg/min for 30 minutes.
-If tolerated, may increase to 1 mg/kg/min; gradually increase step-wise as tolerated.
-Maximum infusion rate is 3 mg/kg/min.

Flebogamma(R) (2 years and older): 300 to 600 mg/kg, IV, every 3 to 4 weeks
-Initial infusion rate is 0.5 mg/kg/min.
-Maximum infusion rate is 5 mg/kg/min.

Gammaplex(R) (2 years and older): 300 to 800 mg/kg, IV, every 3 to 4 weeks
-Initial infusion rate is 0.5 mg/kg/min.
-May increase rate gradually every 15 minutes.
-Maximum infusion rate is 4 mg/kg/min.

Gammagard S/D(R) (2 years and older): 300 to 600 mg/kg, IV, every 3 to 4 weeks

Privigen(R): 200 to 800 mg/kg, IV, every 3 to 4 weeks
-Initial infusion rate is 0.5 mg/kg/min.
-Maximum infusion rate is 8 mg/kg/min


Comments:
-Adjust dose according to clinical response.
-Dose and dosing frequency may vary from patient to patient.
-No optimum target serum IgG level has been determined.
-Target a trough level of 600 mg/dL or higher of IgG; consider dose adjustments if trough IgG levels are less than 500 mg/dL.

Use: Treatment of primary immunodeficiency

Usual Pediatric Dose for Kawasaki Disease

Gammagard S/D(R):

1 gram/kg, IV, once
or
400 mg/kg, IV, for 4 consecutive days

Comments:
-Begin within 7 days of onset of fever.
-Administer concomitant aspirin (80 to 100 mg/kg/day in 4 divided doses).

Use: Prevention of coronary artery aneurysms associated with Kawasaki syndrome in pediatric patients.

Renal Dose Adjustments

Data not available for preexisting renal impairment.
-For patients at risk of renal dysfunction or failure, administer at the minimum concentration available and the minimum infusion rate practicable.
-Consider discontinuation for renal impairment that develops during treatment.

Liver Dose Adjustments

Data not available

Precautions

BOXED WARNINGS:
THROMBOSIS, RENAL DYSFUNCTION, and ACUTE RENAL FAILURE
-THROMBOSIS may occur with immune globulin products.
-Thrombosis risk factors include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling vascular catheters, hyperviscosity, and cardiovascular risk factors.
-For patients at risk of thrombosis, administer this product at the minimum dose and infusion rate practicable.
-Ensure adequate hydration in patients before administration.
-Monitor for signs and symptoms of thrombosis and assess blood viscosity in at-risk patients.
-RENAL DYSFUNCTION, acute renal failure, osmotic nephrosis, and death may occur with immune globulin intravenous (IGIV) products in predisposed patients.
-Patients predisposed to renal dysfunction include those with any degree of preexisting renal insufficiency, diabetes mellitus, age greater than 65, volume depletion, sepsis, paraproteinemia, or patients on known nephrotoxic drugs.
-Renal dysfunction and acute renal failure occur more commonly in patients receiving IGIV products containing sucrose. The manufacturer product information should be consulted.
-For patients at risk of renal dysfunction or failure, administer at the minimum concentration available and the minimum infusion rate practicable.

Safety and efficacy of Bivigam(R) have not been established in PI patients younger than 6 years.
Safety and efficacy of Gammagard S/D(R) have not been established in pediatric ITP patients.
Safety and efficacy of Gammaplex(R) have not been established in PI patients younger than 2 years.
Safety and efficacy of Octagam(R) have not been established in pediatric ITP patients.
Safety and efficacy of Privigen(R) have not been established in ITP patients younger than 3 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Monitor vital signs throughout the infusion.
-Stop or slow the infusion for adverse reactions; if symptoms subside promptly, may resume infusion at a lower rate.
-Ensure patients are not volume depleted.
-Administer at the minimum dose and rate practicable in patients at risk of renal dysfunction or thrombosis.

Patient advice:
-Instruct patients to immediately report decreased urine output, sudden weight gain, fluid retention, and/or shortness of breath (which may suggest kidney damage).
-Instruct patients to report thrombosis symptoms, e.g. pain or swelling with warmth of a limb, limb discoloration, unexplained shortness of breath, chest pain or discomfort that worsens on deep breathing, unexplained rapid pulse, numbness or weakness on one side of the body.

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