Immune globulin IV (IGIV): Uses Action Administration Dosage Side Effects Nursing Considerations by Nurses Note

 Immune globulin IV (IGIV)

Uses of  Immune globulin IV (IGIV)

Treatment of pts with primary humoral immunodeficiency syndromes, acute/chronic immune idiopathic thrombocytopenic purpura (ITP), prevention of coronary artery aneurysms associated with Kawasaki disease, prevention of recurrent bacterial infections in pts with hypogammaglobulinemia associated with B-cell chronic lymphocytic leukaemia (CLL). Treatment of chronic inflammatory demyelinating polyneuropathies. Provide passive immunity in pts with hepatitis A, measles, rubella, varicella. 

OFF-LABEL: Guillain-Barré syndrome; myasthenia gravis; prevention of acute infections in immunosuppressed pts; prevention, treatment of infection in high-risk, preterm, low birth-weight neonates; treatment of multiple sclerosis, HIV-associated thrombocytopenia.

CLASSIFICATION

PHARMACOTHERAPEUTIC: Immune globulin, blood product.

CLINICAL: Immunizing agent.

BLACK BOX ALERT ■ Acute renal impairment characterized by increased serum creatinine, oliguria, acute renal failure, osmotic nephrosis,

particularly pts with any degree of renal insufficiency, diabetes mellitus, volume depletion, sepsis, and those older than age 65 yrs. Thrombosis may occur.

Precautions of Immune globulin IV (IGIV)

Contraindications: Hypersensitivity to immune globulin. Selective IgA deficiency, hyperprolinemia (Hizentra, Privigen), severe thrombocytopenia, and coagulation disorders where IM injections contraindicated. Hypersensitivity to corn (Octagam); infants/neonates for whom sucrose or fructose tolerance has not been established (Gammaplex).

Cautions: Cardiovascular disease, history of thrombosis, real interactions

Action of Immune globulin IV (IGIV)

Replacement therapy for primary/secondary immunodeficiencies and lgG antibodies against bacteria, viral antigens; interferes with receptors on cells of reticuloendothelial system for autoimmune cytopenias/idiopathic thrombocytopenia purpura (ITP); increases antibody titer and antigen-antibody reaction potential. 

Therapeutic Effect: Provides passive immunity replacement for immunodeficiencies, increases antibody titer.

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Pharmacokinetics

Evenly distributed between intravascular and extravascular space. Half-life: 21–23 days.

Lifespan considerations

Pregnancy/Lactation: Unknown if drug crosses placenta or is distributed in breast milk. Children/Elderly: No age-related precautions noted.

Interactions

DRUG: Live virus vaccines may increase vaccine side effects, potentiate virus replication, decrease pt’s antibody response to vaccine. 

HERBAL: None significant. 

FOOD: None known. 

LAB VALUES: None significant.

Availability (Rx)

Injection, Powder for Reconstitution (Carimune NF): 3 g, 6 g, 12 g. (Gammagard S/D): 5 g, 10 g. Injection, Solution (Bivigam 10%, Flebogamma DIF 5%, 10%, Gammagard Liquid 10%, Gammaplex 5%, Gamunex-C 10%, Octagam 5%, Privigen 10%).

Administration/handling

IV

Monitor vital signs, B/P diligently during and immediately after IV administration (precipitous fall in B/P may indicate anaphylactic reaction). Stop infusion immediately. EPINEPHrine should be readily available.

Reconstitution

• Reconstitute only with diluent provided by manufacturer.

• Discard partially used or turbid preparations.

Rate of Administration

• Give by infusion only.

• After reconstitution, administer via separate tubing.

• Rate of infusion varies with product used.

Storage

• Refer to individual IV preparations for storage requirements, stability after reconstitution.

IV incompatibilities

Do not mix with any other medications.

Indications/routes/dosage

Primary Immunodeficiency Syndrome

IV: ADULTS, ELDERLY, CHILDREN: (Privigen): 200–800 mg/kg q3–4wks. (Carimune NF): 400–800 mg/kg q3–4 wks. (Flebogamma DIF, Gammagard, Gamunex-C, Octagam): 300–600 mg/kg/q3–4wks. (Bivigam, Gammaplex): 300–800 mg/kg q3–4wks.

Idiopathic Thrombocytopenic Purpura (ITP)

IV: ADULTS, ELDERLY, CHILDREN: (Carimune NF): 400 mg/kg/day for 2–5 days. Maintenance: 400–1,000 mg/kg/dose to maintain platelet count or control bleeding. (Gammagard): 1,000 mg/kg: up to 3 additional doses may be given on alternate days.

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Kawasaki Disease

Note: Must be used with aspirin.

IV: ADULTS, ELDERLY, CHILDREN: (Gammagard): 1,000 mg/kg as single dose or 400 mg/kg/day for 4 consecutive days. Begin within 7 days of onset of fever. American Heart Association Guidelines:2,000 mg/kg as a single dose given over 10–12 hrs within 10 days of disease onset.

Chronic Lymphocytic Leukemia (CLL)

IV: ADULTS, ELDERLY, CHILDREN: (Gammagard): 400 mg/kg/dose q3– 4wks.

Chronic Inflammatory Demyelinating Polyneuropathy

IV: ADULTS, ELDERLY, CHILDREN: (Gamunex-C): Loading Dose: 2 g/kg divided over 2–4 days (consecutive). Maintenance: 1g/kg/day q3wks or 500 mg/kg for 2 consecutive days q3wks. Privigen: Loading Dose: 2 g/kg in divided doses over 2-5 consecutive days. Maintenance: 1 g/kg q3wks or 500 mg/kg for 2 consecutive days q3wks.

Dosage in Renal Impairment: Caution when giving IV.

Dosage in Hepatic Impairment: No dose adjustment.

Side effects

Frequent: Tachycardia, backache, headache, arthralgia, myalgia. Occasional: Fatigue, wheezing, injection site rash/pain, leg cramps, urticaria, bluish color of lips/nailbeds, light-headedness.

Adverse effects/toxic reactions

Anaphylactic reactions occur rarely, but incidence increases with repeated injections. EPINEPHrine should be readily available. Overdose may produce chest tightness, chills, diaphoresis, dizziness, facial flushing, nausea, vomiting, fever, hypotension. Hypersensitivity reaction (anxiety, arthralgia, dizziness, flushing, myalgia, palpitations, pruritus) considerations

Nursing considerations

Baseline assessment

Inquire about exposure history to disease for pt/family as appropriate. Have EPINEPHrine readily available. Pt should be well hydrated prior to administration .

Nursing Intervention/evaluation

Control rate of IV infusion carefully; too-rapid infusion increases risk of precipitous fall in B/P, signs of anaphylaxis (facial flushing, chest tightness, chills, fever, nausea, vomiting, diaphoresis). Assess pt closely during infusion, esp. first hr; monitor vital signs continuously. Stop infusion if aforementioned signs noted. For treatment of idiopathic thrombocytopenic purpura (ITP), monitor platelet count.