How is ivig dose

The study included patients with lung, kidney, heart, and liver transplants. Sarmiento et al. More recently, Carbone et al. Eighty five percent of severe infections occurred during the first 3 months and mean time to IVIG infusion was 2. IVIG therapy resulted in improved specific antibody titers in the group on replacement therapy and a significant reduction of bacterial infections, in the substituted group of patients compared with 55 untreated patients.

During autoimmune diseases. In a year European study of SLE patients 68 patients died 6. Similar results have been obtained in a multi-ethnic US cohort study: the 5-year mortality was Infections were also frequent causes of increased hospitalization Antibody failure due to medications other than immunosuppressants.

It has been known for a long time that anticonvulsant therapy with phenytoin or carbamazepine can cause low-serum IgG levels and recurrent infections 68 , Recently, valproic acid, a histone deacetylase HDAC inhibitor, has also been demonstrated to inhibit early B cell differentiation and activation 70 leading to hypogammaglobulinemia.

Few studies performed in small patient groups with SID due to immunosuppressive medication or chemotherapy also demonstrate beneficial effects of IVIG treatment. However, robust studies looking on clinical outcome are lacking, not least as prophylactic antibiotics are used as standard measure in many centers. Most studies in SID conditions such as CLL, MM, solid organ transplantation, and autoimmune diseases have been performed in chronic, stable disease with 0. Outcome in patients with antibody deficiency, with or without low-serum IgG levels as well as episodes of severe — potentially lethal — infection have to be included in the analysis 37 — Present research in translational medicine including PID aims at early diagnosis to identify patients before the first potentially life threatening infectious complications and this applies to SID as well.

Further clinical trials have been recommended in patients with SID. Patient selection in such studies will be critical and only test-immunized patients with proven antibody deficiency should be entered one T dependent vaccine — usually tetanus toxoid is used since the assay is reliable and available in immunology laboratories and one T-independent vaccine — either pneumovax or polysaccharide Salmonella vaccine — both with reliable assays as used in PIDs.

IVIG should be given early on during the course of an aggressive immunosuppressive therapy since lethal infections often occur at this stage. In a study by Blanchette et al. Although this protocol proved to be equally efficacious as the original of Imbach et al.

Treatment options in ITP vary with patient age childhood vs. These observations warrant a systematic evaluation of an up-scaling protocol starting with doses of 0.

In a study from Thailand a developing country , cost effectiveness of IVIG in childhood ITP has been proven, as compared to standard treatment of thrombocyte transfusions, corticosteroids plus immunosuppressants On the other hand, health economic studies from Canada and Ireland show for adult chronic ITP patients that romiplostim, a thrombopoietin receptor agonist, seems to compare favorably with standard treatment including IVIG 80 , Hopefully, new biomarkers may in future be able to identify early on IVIG responders from non-responders.

Thus, a recent study by Morimoto et al. Kawasaki disease KD is an acute self-limiting inflammatory disorder of children, associated with vasculitis, affecting predominantly medium-sized arteries, particularly the coronary arteries. In , Furusho et al. They observed a greater percentage of patients with coronary artery lesions in the ASA-alone group compared to the combined therapy 42 vs. In , Newburger et al. It was shown that the single large dose was more effective than the conventional regimen and equally safe.

Both dosing possibilities were taken into the coreSPC 0. The etiology of KD is still unknown. It is assumed that unidentified infectious agents trigger a strong, self-limiting inflammation in genetically susceptible hosts. Numerous studies have been undertaken to identify susceptibility genes for KD as well as for resistance to IVIG treatment.

Recently, Ogata et al. As the authors compare only 10 IVIG responders to 10 non-responders their findings have to be met with great caution and need a rigorous confirmation. Until relatively recently, corticosteroids were considered potentially detrimental in KD, as early studies showed an association with worse outcome However, it is likely that this at least in part reflected an inadvertent selection bias, as those with more severe KD received corticosteroids.

More recently, the potential role of corticosteroids as adjunct primary therapy in addition to IVIG has been addressed in randomized trials, either in unselected patients or in those considered at particularly high risk of coronary artery damage.

A multicenter, randomized, double-blind trial from the U. Addition of a single steroid dose to conventional therapy did not improve coronary artery outcomes A more recent prospective randomized, open-label, trial in Japan enrolled only those assessed by a locally derived risk score as being at particularly high risk of coronary damage Coronary artery outcomes during the 4-week study period were significantly better in the corticosteroid group.

However, the generalizability of these findings is uncertain; in particular, the scoring system on which selective recruitment was based does not perform well in non-Japanese patients , As approximately three-quarters of KD patients were excluded, as they did not meet enrollment criteria [including those with coronary artery dilatation at presentation ], it remains unclear whether this corticosteroid regimen would benefit KD patients more broadly.

Moreover, the prolonged intravenous course of corticosteroids would itself incur significant additional costs by prolonged admission and potential side effects The variation procedure showed that the data were mainly based on three published studies which each used different Ig products but revealed similarly efficacious outcomes with regard to decrease in disability grading when compared to plasma-exchange PE — the standard therapy at the time — The dosing taken into the coreSPC was 0.

The most common form, acute inflammatory demyelinating polyneuropathy AIDP , is characterized by segmental demyelination in peripheral nerves with acute flaccid paralysis. The Miller Fisher syndrome MFS variant is defined by the clinical triad of ophthalmoplegia, areflexia, and ataxia. Multiple logistic regression analysis showed that patients with persistent low-IgG galactosylation and sialylation despite IVIG treatment had the most severe forms of GBS and needed ventilator support more often.

The empirical dose of IVIG is 0. In a small, randomized trial including 39 GBS patients, treatment with 0. In patients receiving six treatments, there was a non-significant trend toward a better outcome.

This finding became significant in ventilated patients In another randomized, open trial with 51 children with GBS 1. Both treatments were equally effective; IVIG had less adverse events In five trials with participants for whom the outcome was available, the mean difference of change in a seven-grade disability scale after 4 weeks was not significantly different between the two treatments The authors concluded that IVIG when started within 2 weeks of disease onset hastens neurological recovery as much as PE.

Adverse events were not significantly different with either treatment but IVIG was significantly more likely to be completed than PE. However, none of these correlations is strong enough to guide therapeutic decisions The disease runs a progressive, relapsing-remitting, or monophasic course and can lead to significant disability due to walking difficulties and loss of arm dexterity. A diagnosis relies heavily on electrophysiological studies that typically show evidence of conduction block and demyelination.

The atypical forms of CIDP may exhibit a different natural course and treatment response The key mechanisms in the pathogenesis have not been identified although several studies have highlighted the role of T-cells in CIDP and an important role for auto-reactive T-cell responses against peripheral myelin antigens such as P0, P1, P2, and peripheral myelin protein PMP has been suggested — The most recent Cochrane systemic review analyzed 8 RCTs with a total of eligible patients.

The authors concluded that IVIG improves disability for at least 2—6 weeks compared with placebo, with a number needed to treat NNT of 3.

During this period, it has similar efficacy to PE, oral prednisolone, and intravenous methylprednisolone. In one large trial, the benefit of IVIG persisted for 24 and possibly 48 weeks. Further research is needed to compare the long-term benefits as well as side effects of IVIG with other treatments The change in IgG levels was associated with IVIG dosage, but not with treatment frequency, and both inter- and intra-patient variability was low.

This indicates that these patients have reached a steady state with a constant distribution rate and turnover of IgG without accumulation over time. In a retrospective cohort study, 15 CIDP patients underwent successful gradual dose reductions. There was high variability between patients in observed IgG levels : the lowest effective dose of IVIG per course ranged between 18 and g; it did not correlate to weight, frequency of administration, disease duration, or pre-therapeutic degree of disability.

These results suggest considerably lower, standardized, initiating, and maintenance doses might be effective and highlight the need for prospective dose comparative trials IgG level monitoring may be helpful in establishing optimum treatment regimens in individual cases The highly variable individual IgG doses and treatment intervals were also observed and analyzed by Broyeles et al.

However, whether these adjustments will optimize clinical outcome while limiting overall costs has still to be seen. A criticism of this study may be that it was too short to capture all long-term problems encountered with corticosteroids. On the other hand, IVIG may be a short-term cost minimizing therapy compared to PE and in long-term maintenance therapy SCIG has been proven to be feasible, safe, effective, and cost reducing , Nobile-Orazio et al.

IV methylprednisolone 0. The longer-term effects of these treatments on the course of CIDP need to be addressed in future studies, notably as in some patients improvement after corticosteroids seems to be more long-lasting than after IVIG In a review by Cocito et al.

In contrast, small open-label studies investigating mycophenolate mofetil and alemtuzumab showed promising results on the possibility to stop or reduce maintenance IVIG therapy.

Better understanding of the pathogenesis is needed to identify new treatment strategies and to develop biomarkers that correlate with disease activity and could help guiding maintenance treatment in these patients.

These showed that IVIG had a beneficial effect on strength and a non-significant trend toward improvement of disability. Patients with stable clinical course on IVIG conditions can be safely switched to SCIG at the same monthly dose without risking deterioration but with an improvement of quality of life , Multifocal motor neuropathy is a rare focal inflammatory neuropathy characterized by slowly progressive, asymmetric distal limb weakness without sensory loss.

The hallmark of electrophysiological examination is a conduction block in the absence of abnormalities in sensory nerves. Differentiation from amyotrophic lateral sclerosis ALS and CIDP with asymmetric onset is important as these diseases differ in prognosis and treatment , The underlying immuno-pathological mechanisms are unknown but IgM auto-antibodies against ganglioside GM1 and galactocerebroside GalC are thought to play a role Corticosteroids, immunosuppressants, or PE are not effective therapies for MMN, actually these treatments can even worsen the paresis , , Optimal dose and intervals in maintenance treatment have not been established.

An interesting dose-reduction protocol was described by Eftimov et al. All patients in the lower dose group deteriorated. In a small randomized trial, mycophenolate mofetil has been investigated as add-on therapy but did not show any additional effect over IVIG with placebo Cyclophosphamide especially in combination with autologous stem cell transplantation has been used in clinical practice and is recommended in some guidelines for treatment of refractory patients Myasthenia gravis is an autoimmune disease with auto-antibodies interfering with neuromuscular transmission.

Auto-antibodies are directed to signaling proteins at the neuromuscular junction, in particular, the nicotinic acetylcholine receptor AChR. At least three mechanisms have been proposed to explain how anti-AChR antibodies compromise neuromuscular transmission: i complement binding and activation at the neuromuscular junction; ii accelerated degradation of AChR molecules antigenic modulation ; and iii functional block of AChR-binding sites As in other autoimmune neuropathies IVIG has been tried as therapy besides corticosteroid, immunosuppressants, and PE.

The conclusion of this review is that there is no evidence from RCTs or from other trials to determine whether IVIG improves function or reduces the need for steroids. Fetomaternal or neonatal alloimmune thrombocytopenia is the most common cause of severe thrombocytopenia in an otherwise healthy fetus or neonate. Meanwhile, several observational studies have reported on further successful cases in such affected women — Based on the results of the available data, there is no doubt that IVIG starting between 12 and 20 weeks of gestation is currently the standard therapy , , , This indication is primarily based on the successful prevention of intracranial hemorrhage rather than on increasing the fetal platelet count.

The question whether corticosteroids may have an additional positive effect in women treated with IVIG remains open Currently, different recombinant monoclonal anti-HPA-1a antibodies, which would be applied in the management of FNAIT, are under development in murine and translational models — In addition, efforts are now being made to establish a screening program that would help in identifying pregnancies at risk, and justify the prevention of immunization by vaccination or neutralization of the antibodies , Immune antibodies to red blood cell RBC antigens can cause significant fetal anemia that may occur early in gestation, when fetal transfusion is difficult to perform.

Recommendations from the most recent European dermatology guideline for IVIG use list levels of evidence and grade of recommendations. These recommendations are briefly reiterated here. IVIGs were deemed to be efficacious in severe forms of dermatomyositis, polymyositis, and inclusion body myositis , but are usually recommended as second-line therapy.

The most convincing results have been reported in juvenile and adult myositis patients with acute, potentially life-threatening complications such as dysphagia, severe weakness, ulcerative skin leasions, and calcinosis cutis , The authors further recommended IVIG as a second-line treatment in autoimmune blistering diseases, which are relapsing or refractory to standard therapy In addition, for vasculitic syndromes with a particularly fulminant progressive disease form with multiple complications and severe side effects, IVIG therapy may be considered as a first-line treatment option.

Less clear evidence exists for the use of IVIG in systemic lupus erythematosus. The early administration of high-dose immunoglobulin should be considered in confirmed cases of TEN in the absence of any therapeutic alternative , For chronic dermatological diseases treatment, intervals should be every 4 weeks and after 6 months gradually increased to 6-week intervals.

Over the last 40 years, the demand of therapeutic Ig has been steadily increasing worldwide. This has several reasons i the number of indications kept extending from PID and SID into hematology, neurology, rheumatology, intensive care, and dermatology; by now international guidelines list 10—12 high-priority indications, 15—18 medium priority, and over 20 low-priority indications. It is the purpose of this survey to review critically and to update indications and dosing strategies of IVIG and SCIG therapies in view of increasing demand, pharmacoeconomic aspects, and emerging alternatives for the immunomodulatory indications.

Thus, monthly dosage, route of administration IV or SC , infusion intervals and serum Ig levels are secondary to this goal but have to be optimized for the individual patient in order to reach the best possible result There is reasonable evidence to calculate the loading dose on ideal body-weight 2 , 3 and to increase monthly dosages by 0.

It is now generally accepted that Ig replacement therapy does more than just replace the antibody repertoire in PAD patients The bottom line of the current knowledge on Ig replacement therapy is optimizing the results by individualizing the treatment regimens; recently, this principle has been beautifully illustrated by case studies from Bonagura Regarding the major immunomodulatory indications for IVIG, it is striking how little evidence and structure has so far been brought into the dosing issue.

There are only a few case reports dictated by economic constraints suggesting that lower doses 0. Especially no up-scaling dosage regimen has been pursued as in Ig replacement therapy for PAD patients Despite much effort that has been put into the analysis of mechanisms governing responsiveness and non-responsiveness to high-dose IVIG in ITP, KD, and the neuroimmunological indications no clear-cut picture has emerged so far Some biomarkers, however, may be helpful to identify responders from non-responders and thereby try early on alternative treatment options 94 — 96 , Driven by the need to be cost-effective the pursuit of alternative treatment options is another strong trend in many studies on immunomodulatory IVIG indications.

Thus, the renaissance of corticosteroids in the long-term treatment of KD 97 , — and CIDP , are examples. A recent overview of immunological treatment options in neuroimmunological emergencies by von Geldern et al. Clearly, more research is needed to clarify the mode of action of IVIG in immunomodulation and to optimize dosing and treatment intervals.

Abdulgabar Salama, none; Ivo N. Carrock Sewell, none; Taco W. Kuijpers, none. Robert P. Global plasma demand in In: Valverde JL, editor. Amsterdam: IOS Press Google Scholar.

Serum trough IgG level and annual intravenous immunoglobulin dose are not related to body size in patients on regular replacement therapy. Drug Metab Lett 5 2 —6. Impact of ideal body weight dosing for all inpatient i. Am J Health Syst Pharm 70 9 —2. Home-based subcutaneous immunoglobulin versus hospital-based intravenous immunoglobulin in treatment of primary antibody deficiencies: systematic review and meta analysis.

J Clin Immunol 32 6 — Shapiro RS. J Clin Immunol 33 Suppl 2 :S95—8. Higher doses of subcutaneous IgG reduce resource utilization in patients with primary immunodeficiency.

J Clin Immunol 32 2 —9. Fadeyi M, Tran T. Calculating the dose of subcutaneous immunoglobulin for primary immunodeficiency disease in patients switched from intravenous to subcutaneous immunoglobulin without the use of a dose-adjustment coefficient. P T 38 12 — European consensus proposal for immunoglobulin therapies.

Eur J Immunol 44 8 — Bruton O. Pediatrics 9 6 —8. Efficacy of intravenous immunoglobulin in primary humoral immunodeficiency disease. Ann Intern Med —9. Cunningham-Rundles C, Bodian C. Common variable immunodeficiency: clinical and immunological features of patients. Clin Immunol 92 — Intravenous immunoglobulins.

Current understanding and future directions. Clin Exp Immunol 1 — Chapel H, Cunningham-Rundles C. Update in understanding common variable immuno-deficiency disorders CVIDs and the management of patients with these conditions. Br J Haematol — Comparison of high-dose and low-dose intravenous immunoglobulin therapy in patients with primary immunodeficiency diseases. Am J Med 76 — Impact of trough IgG on pneumonia incidence in primary immunodeficiency: a meta-analysis of clinical studies.

Clin Immunol — Evaluation of correlation between dose and clinical outcomes in subcutaneous immunoglobulin replacement therapy.

Clin Exp Immunol — Infection outcomes in patients with common variable immunodeficiency disorders: relationship to immunoglobulin therapy over 22 years. J Allergy Clin Immunol — Clinical picture and treatment of patients with common variable immunodeficiency. J Allergy Clin Immunol 1 — Effectiveness of immunoglobulin replacement therapy on clinical outcome in patients with primary antibody deficiencies: results from a multicenter prospective cohort study.

J Clin Immunol 31 — Bonagura VR. Illustrative cases on individualizing immunoglobulin therapy in primary immunodeficiency disease. Pharmacokinetic modeling and simulation of biweekly subcutaneous immunoglobulin dosing in primary immunodeficiency. Postgrad Med 6 — Enhancing patient flexibility of subcutaneous immunoglobulin G dosing: pharmacokinetic outcomes of various maintenance and loading regimens in the treatment of primary immunodeficiency.

Biol Ther 4 — Intravenous and subcutaneous immunoglobulin replacement: a two-way road. Optimizing healthcare quality in patients with primary immunodeficiencies. J Clin Immunol 34 8 —7. J Clin Immunol 34 7 —9. Getting the methods right-the foundation of patient-centered outcomes research. N Engl J Med — Efficiency of immunoglobulin G replacement therapy in common variable immunodeficiency: correlations with clinical phenotype and polymorphism of the neonatal Fc receptor.

Clin Exp Immunol 2 — Review of intravenous immunoglobulin replacement therapy trials for primary humoral immunodeficiency patients. Infection 40 — Characterization of antibodies to capsular polysaccharide antigens of Haemophilus influenzae type b and Streptococcus pneumoniae in human immune globulin intravenous preparations. Clin Diagn Lab Immunol 11 — J Clin Immunol 30 — Intravenous immunoglobulins in immunodeficiencies: more than mere replacement therapy.

Clin Exp Immunol :2—5. Intravenous immunoglobulins — understanding properties and mechanisms. Clin Exp Immunol :2— Ballow M. The IgG molecule as a biological immune response modifier: mechanisms of action of intravenous immune serum globulin in autoimmune and inflammatory disorders. Eur J Pharmacol 37 3—4 —8. Subcutaneous immunoglobulin therapy given by subcutaneous rapid push vs infusion pump: a retrospective analysis. Ann Allergy Asthma Immunol 1 —5. Recombinant human hyaluronidase-facilitated subcutaneous infusion of human immunoglobulins for primary immunodeficiency.

J Allergy Clin Immunol 4 —7. Lingman-Framme J, Fasth A. Subcutaneous immunoglobulins for primary and secondary immunodeficiencies: an evidence-based review. Drugs 73 12 — Secondary antibody deficiency. Expert Rev Clin Immunol 10 5 — Management of secondary immune deficiencies: what is the role of immunoglobulins?

Evaluation of the adult with suspected immunodeficiency review. Am J Med 9 —8. Controlled Clinical Trial Cooperative Group.

Intravenous immunoglobulin for the prevention of infection in chronic lymphocytic leukemia. A randomized, controlled clinical trial. Cooperative group for the study of immunoglobulin in chronic lymphocytic leukemia. N Engl J Med 14 —7. Crossover study of immunoglobulin replacement therapy in patients with low-grade B-cell tumors.

Blood 73 2 —8. Randomized trial of intravenous immunoglobulin prophylaxis for patients with chronic lymphocytic leukaemia and secondary hypogamma-globulinaemia. Clin Lab Haematol 17 1 — Specific antibody deficiency in children with recurrent respiratory infections: a controlled study with follow-up. Antibody response to 7-valent conjugated pneumococcal vaccine in patients with chronic lymphocytic leukaemia.

Vaccine 26 1 —7. Smolej L. Efficacy of pneumococcal vaccination in chronic lymphocytic leukemia: should we rely on surrogate markers? Vaccine 26 11 Prophylaxis against infections with low-dose intravenous immunoglobulins IVIg in chronic lymphocytic leukemia. Results of a crossover study.

Haematologica 81 2 —6. Treatment of hypogammaglobulinaemia in chronic lymphocytic leukaemia by low-dose intravenous gammaglobulin. Eur J Haematol 53 2 —8. Randomised trial of intravenous immunoglobulin as prophylaxis against infection in plateau-phase multiple myeloma.

The UK group for immunoglobulin replacement therapy in multiple myeloma. Lancet — Clin Vaccine Immunol 18 6 — Immunoglobulin prophylaxis in chronic lymphocytic leukemia and multiple myeloma: systematic review and meta-analysis. Leuk Lymphoma 50 5 — Immunomodulatory and antimicrobial efficacy of intravenous immunoglobulin in bone marrow transplantation.

N Engl J Med 11 — Should immunoglobulin therapy be used in allogeneic stem-cell transplantation? A randomized, double-blind, dose effect, placebo-controlled, multicenter trial. Ann Intern Med 1 :8— Immunoglobulin prophylaxis in hematopoietic stem cell transplantation: systematic review and meta-analysis. J Clin Oncol 27 5 — Pediatr Transplant 16 8 — Intravenous immune globulin for the prevention of bacterial infections in children with symptomatic human immunodeficiency virus infection.

N Engl J Med 2 — A controlled trial of intravenous immune globulin for the prevention of serious bacterial infections in children receiving zidovudine for advanced human immunodeficiency virus infection. N Engl J Med 18 —7. Incidence of hypogammaglobulinemia in patients receiving rituximab and the use of intravenous immunoglobulin for recurrent infections. Clin Lymphoma Myeloma Leuk 13 2 — Impact of rituximab on immunoglobulin concentrations and B cell numbers after cyclophosphamide treatment in patients with ANCA-associated vasculitides.

PLoS One 7 5 :e B cell homeostasis is disturbed by immunosuppressive therapies in patients with ANCA-associated vasculitides. Autoimmunity 46 7 — What is the impact of hypogamma-globulinemia on the rate of infections and survival in solid organ transplantation? A meta-analysis. Am J Transplant 13 10 — Rubin RH. Infectious disease complications of renal transplantation review.

Kidney Int 44 1 — Immune monitoring of anti cytomegalovirus antibodies and risk of cytomegalovirus disease in heart transplantation. Int Immunopharmacol 9 6 — Restoration of humoral immunity after intravenous immunoglobulin replacement therapy in heart recipients with post-transplant antibody deficiency and severe infections. Clin Transplant 26 3 :E— Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses.

J Epidemiol Community Health 66 12 — Morbidity and mortality in systemic lupus erythematosus during a year period: a comparison of early and late manifestations in a cohort of 1, patients.

Medicine Baltimore 82 5 — Systemic lupus erythematosus in three ethnic groups. Arthritis Rheum 45 2 — Hospitalization of individuals with systemic lupus erythematosus: characteristics and predictors of outcome.

Lupus 12 9 —6. Depression of immune competence by phenytoin and carbamazepine. Studies in vivo and in vitro. Clin Exp Immunol 20 2 — Immunological study of IgA deficiency during anticonvulsant therapy in epileptic patients. Clin Exp Immunol 53 2 —8. Inhibition of human B-cell development into plasmablasts by histone deacetylase inhibitor valproic acid. J Allergy Clin Immunol 6 —9. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood.

Lancet 1 — Randomised trial of intravenous immunoglobulin G, intravenous anti-D, and oral prednisone in childhood acute immune thrombocytopenic purpura. Lancet —7. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group.

Blood 11 — The American society of hematology evidence-based practice guideline for immune thrombocytopenia. Blood 16 — Efficacy of combined intravenous immunoglobulins and steroids in children with primary immune thrombocytopenia and persistent bleeding symptoms. Blood Transfus 12 3 —5. Blood Coagul Fibrinolysis 24 5 —9. Clin Pediatr Hematol Oncol 13 —9. Dua V. Very low-dose intravenous immunoglobulin for treatment of immune thrombocytopenic purpura.

Indian Pediatr 50 Privigen dosing, administration, and monitoring. Chronic ITP. Recommended dosing and infusion rates for PI. Recommended dosing and infusion rates for chronic ITP. Recommended dosing and infusion rates for CIDP. Dosing calculator Patient Profile. Enter patient's weight lb kg.

Infusion Rate. Select Rate: 0. For patients at risk for renal dysfunction or thrombosis or patients switching from another Ig product, always start at the minimum dose and infusion rate. Calculated Infusion Rate. Calculate each daily dose by dividing the total loading dose above by the number of consecutive infusion days 2, 3, 4, or 5.

Assess corresponding infusion time by dividing by the number of consecutive infusion days. If you choose to administer the maintenance dose over 2 consecutive days, divide the total dose above by 2 and administer that amount each day.

Individualize duration of treatment beyond 6 months based on patient responses. View and download PDF. Starting new patients on Privigen When starting new patients on Privigen therapy: Start at a slow rate of infusion and gradually increase as tolerated Privigen should be administered at the minimum dose and infusion rate practicable in patients judged to be at risk of renal failure, renal dysfunction, or thrombotic events Patients at risk of thrombosis, renal dysfunction, or renal failure should not be volume depleted when initiating intravenous immunoglobulin IVIg therapy.

Ensure adequate hydration before administering Privigen The patient's vital signs should be monitored carefully throughout the infusion for adverse reactions If adverse reactions occur, the infusion should be stopped or slowed down until the symptoms subside, and may be resumed at a more comfortable, lower rate.

Transitioning patients from another Ig product to Privigen If you are transitioning patients from another Ig product to Privigen: Always start at the minimum rate of infusion The patient's vital signs should be monitored carefully throughout the infusion for adverse reactions If adverse reactions occur, the infusion should be stopped or slowed down until the symptoms subside, and may be resumed at a more comfortable, lower rate Titrate based on patient tolerability.

Monitoring patients for adverse reactions Patients receiving Privigen should be observed and monitored carefully throughout the infusion. Following are some other things to keep in mind: Thrombosis Warning Thrombosis may occur with immune globulin products, including Privigen.

Risk factors may include: advanced age, prolonged immobilization, hypercoagulable conditions, history of venous or arterial thrombosis, use of estrogens, indwelling vascular catheters, hyperviscosity, and cardiovascular risk factors Renal Failure Warning Renal dysfunction, acute renal failure, osmotic nephrosis, and death may be associated with the administration of Immune Globulin Intravenous Human IVIg products in predisposed patients.

Therapy Contraindications Privigen is contraindicated in patients with history of anaphylactic or severe systemic reaction to human immune globulin, in patients with hyperprolinemia, and in IgA-deficient patients with antibodies to IgA and history of hypersensitivity. Monitor patients with known risk factors for thrombotic events; consider baseline assessment of blood viscosity for those at risk for hyperviscosity.

AMS usually begins within several hours to 2 days following IVIg treatment Hemolysis can develop subsequent to Privigen treatments due to enhanced red blood cell sequestration.

These blood pressure elevations were resolved or significantly improved within hours with either observation alone or changes in oral anti-hypertensive therapy. Symptoms typically appear within 1 to 6 hours following treatment Carefully consider the relative risks and benefits before prescribing the high dose regimen for chronic ITP and CIDP in patients at increased risk of thrombosis, hemolysis, acute kidney injury, or volume overload Privigen is made from human blood and may contain infectious agents, e.

You are now leaving the current website.