immune globulin for I.M. use
immune globulin for I.M. use (IGIM)
immune globulin for I.V. use, human (IGIV)
immune globulin for I.V. and subcutaneous use, human
immune globulin for subcutaneous use, human
Pharmacologic class: Immune serum
Therapeutic class: Antibody-production stimulator
Pregnancy risk category C
FDA Box Warning
• IGIV (human) products have been linked to renal dysfunction, acute renal failure (ARF), osmotic nephrosis, and death. Patients predisposed to ARF include those with preexisting renal insufficiency, diabetes mellitus, age older than 65, volume depletion, sepsis, or paraproteinemia and those receiving known nephrotoxic drugs. In these patients, give drug at minimum rate of infusion feasible. IGIV products containing sucrose accounted for disproportionate share of renal dysfunction and acute renal failure reports.
Action
Improves immunity by binding to and neutralizing pathogens, thereby increasing antibodies against bacterial, viral, parasitic, and mycoplasmic antigens. Acts through antimicrobial and antitoxin neutralization.
Availability
Injection: 2- and 10-ml vials (IGIM)
Powder for injection: 1-, 2.5-, 3-, 5-, 6-, 10-, and 12-g vials (IGIV)
Solution (5%): 10-, 50-, 100-, 200-, and 250-ml vials (IGIV)
Solution (10%): 10-, 25-, 50-, 100-, and 200-ml vials (IGIV)
Indications and dosages
➣ To prevent hepatitis A
Adults traveling to areas where hepatitis A is common: 0.02 ml/kg I.M. if staying less than 3 months; 0.06 ml/kg repeated q 4 to 6 months if staying 3 months or longer
Adults with household or institutional contacts: 0.02 ml/kg I.M.
➣ To prevent or reduce severity of measles in susceptible persons
Adults and children: 0.2 ml/kg to 0.25 ml/kg I.M. within 6 days of exposure to measles
➣ Exposure to measles in immuno-compromised children
Children: 0.5 ml/kg I.M. as soon as possible after exposure
➣ Varicella in immunocompromised patients
Adults: 0.6 to 1.2 ml/kg I.M. as soon as possible if varicella-zoster immune globulin is unavailable
➣ To reduce risk of infection and fetal damage in females exposed to rubella during early pregnancy
Adults: 0.55 ml/kg I.M.
➣ Immunoglobulin deficiency
Adults: Initially, 1.3 ml/kg I.M., followed in 3 to 4 weeks by 0.66 ml/kg, up to 100 mg/kg q 3 to 4 weeks
➣ Immunodeficiency
Gamimune N-
Adults and children: 100 to 200 mg/kg I.V. or 2 to 4 ml/kg (10%) I.V. monthly
Gammagard S/D-
Adults and children: 200 to 400 mg/kg I.V., then monthly in doses based on response
Gammar-P IV-
Adults: 200 to 400 mg/kg I.V. q 3 to 4 weeks
Children and adolescents: 200 mg/kg I.V. q 3 to 4 weeks
Iveegam EN-
Adults and children: 200 mg/kg I.V. monthly; may increase up to 800 mg/kg/month based on response
Panglobulin-
Adults and children: 200 mg/kg I.V. monthly, increased to 300 mg/kg/month. In some patients, infusion frequency may be increased.
Panglobulin NF/Carimune NF-
Adults and children: 0.2 g/kg I.V. monthly. If response inadequate, dosage may be increased to 0.3 g/kg or infusion frequency may be increased.
Polygam S/D-
Adults and children: 100 to 400 mg/kg I.V. monthly
Sandoglobulin-
Adults and children: 100 to 400 mg/kg I.V. monthly. In patients with previously untreated agammaglobulinemia or hypogammaglobulinemia, first infusion may be increased to 300 mg/kg or infusion frequency may be increased.
Venoglobulin-
Adults and children: 200 mg/kg I.V. monthly, increased up to 400 mg/kg/month. In some patients, infusion frequency may be increased.
➣ Idiopathic thrombocytopenic purpura
Gamimune N-
Adults and children: 400 mg/kg I.V. for 5 consecutive days, or 1,000 mg/kg/day for 1 day or for 2 consecutive days
Gammagard S/D-
Adults and children: 1,000 mg/kg I.V. Up to three doses may be given on alternating days, dependent on platelet count.
Panglobulin-
Adults and children: Initially, 0.4 g/kg I.V. for 2 to 5 consecutive days
Polygam S/D-
Adults and children: 1 g/kg I.V. Depending on response, additional doses may be given.
Venoglobulin-S-
Adults and children: 2,000 mg/kg I.V. over 5 days or less for induction therapy; then 1,000 mg/kg p.r.n. to maintain platelet count of 30,000/mm3 in children or 20,000/mm3 in adults or to prevent bleeding episodes between infusions
➣ Kawasaki disease
Gammagard S/D-
Adults and adolescents: 1 g/kg I.V. as a single dose; alternatively, 400 mg/kg/day for 4 consecutive days with aspirin
Iveegam EN-
Adults and children: 400 mg/kg/day I.V. with aspirin
Polygam S/D-
Adults and children: 1 g/kg I.V. as a single dose, or 400 mg/kg I.V. for 4 consecutive days starting within 7 days of fever onset. Give with aspirin, as prescribed.
Sandoglobulin-
Adults and children: 400 mg/kg I.V. for 2 to 5 consecutive days. If platelet count falls below 30,000/mm3 or significant bleeding occurs, may give 0.4 g/kg as a single infusion, increased to 0.8 or 1 g/kg as a single infusion, depending on response.
Venoglobulin S-
Adults and children: 2 g/kg I.V. infused over 10 to 12 hours with aspirin
➣ To prevent bacterial infection in patients with hypogammaglobulinemia or recurrent bacterial infection associated with B-cell chronic lymphocytic leukemia
Adults and adolescents: 400 mg/kg I.V. (Gammagard S/D or Polygam S/D) q 3 to 4 weeks
➣ To reduce risk of graft-versus-host disease, interstitial pneumonia, septicemia, and other infections during first 100 days after bone marrow transplantation
Adults ages 20 and older: 500 mg/kg I.V. (Gamimune N) 7 days before and 2 days before transplantation, then weekly through 90th day after transplantation
➣ To prevent bacterial infection in children with human immunodeficiency virus
Children: 400 mg/kg I.V. (Gamimune N) q 28 days
Off-label uses
• Chronic inflammatory demyelinating polyneuropathy
• Guillain-Barré syndrome
Contraindications
• Hypersensitivity to drug or its components
• Selective immunoglobulin A deficiency
Precautions
Use cautiously in:
• bleeding disorders, renal impairment
• pregnant patients.
Administration
See Before giving, determine if patient has risk factors for acute renal failure (such as use of nephrotoxic drugs; history of diabetes mellitus, renal insufficiency, sepsis, volume depletion, or paraproteinemia; age 65 or older).
• For I.V. use, decrease infusion rate by 50% to 25% for patients at risk for renal dysfunction.
See Give IGIM by I.M. route only; give IGIV by I.V. route only.
• If sterile laminar airflow conditions aren't available for drug reconstitution, administer immediately; discard unused portion.
• Don't shake vigorously, because foaming may occur. Know that cold drug or diluent may take up to 20 minutes to dissolve.
Adverse reactions
CNS: headache, malaise
CV: chest pain, tachycardia, thromboembolism
GI: nausea, vomiting, abdominal pain
Musculoskeletal: joint pain, back pain, myalgia
Respiratory: dyspnea
Skin: pruritus
Other: chills, lymphadenopathy, pain at injection site, anaphylaxis
Interactions
Drug-drug. Live-virus vaccines: decreased antibody response to vaccine
Patient monitoring
See Watch for acute inflammatory reaction in patients receiving drug for first time (usually appears within 30 to 60 minutes after infusion begins), in those whose last treatment was more than 8 weeks earlier, and when initial infusion rate exceeds 1 ml/minute.
• Monitor vital signs continuously during I.V. infusion. Stay alert for hypotension.
• Assess fluid volume status and blood urea nitrogen and creatinine levels.
• After infusion ends, monitor patient closely for nausea, vomiting, drowsiness, and severe headache.
Patient teaching
• Instruct patient to report symptoms occurring during or after therapy.
• Advise patient to avoid live-virus vaccines for 3 months after therapy; drug may delay or inhibit body's response to vaccine.
• As appropriate, review all significant and life-threatening adverse reactions and interactions, especially those related to the drugs mentioned above.