Administration of IVIG

Product: Intragam P (3g/50ml)

Dilution:

• Can be infused undiluted
• Maybe diluted with up to 2 parts of 0.9% saline or 5% glucose

Administration:

• Allow product to warm to room temperature
• Use a separate IV line from other IV fluids or medications. If primary line is used, flush with saline prior to administration
• Initial, infuse slower at 1ml/min for 15minutes
• If no reactions, the infusion rate can be gradually increased to a maximum of 3-4ml/min

Consideration for infusion rate:

• Rate should be reduced in elderly and patients with pre-existing renal conditions
• Too rapid infusions can cause flushing and changes in heart rate and blood pressure
• Slow the rate of infusion or stop infusion (5-10minutes) in patients who develop fever, chills, nausea and vomiting until symptoms subside. Resume infusion at a rate which is tolerated by the patient

Contraindication

• True anaphylactic reaction to IVIG

Precautions

• Prolonged administration (>6hours)at higher doses (>0.4g/kg)  may result in thrombophlebitis at infusion site
• Aseptic Meningitis Syndrome has been reported. Usually begin within several hours to 2 days after initiation. Characterised by signs such as severe headache, nausea, drowsiness, fever, photophobia and painful eye movement.  
• High risk of acute renal failure: above 65 years, volume depletion, sepsis, DM, pre-existing renal insufficiency, concomitant nephrotoxic drugs

Monitoring

• Serum creatinine (to evaluate for changes in renal function)
• complete blood count with differential (to evaluate for neutropenia and anemia) are also suggested
• mild-moderate elevation in LFT has been seen
• monitor for any reactions, which may be acute or delayed.

 Reference:

1. www.uptodate.com

2. lexicomp

3. Intragam P, Product Information Leaflet