Immune Globulin

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Contents 1 More Specific Terms 2 Indications 3 Contraindications 4 Dosage 5 Pharmacokinetics 6 Drug-interactions 7 Mechanism-of-action 8 More General Terms 9 Additional Terms 10 References

More Specific Terms

• cytomegalovirus immune globulin (Cytogam)
• galsulfase (Naglazyme)
• hepatitis B immune globulin (H-BIG, Hep-B-Gammagee, HyperHep)
• human botulism immune globulin (BIG-IV, BabyBIG)
• intravenous immunoglobulin
• rabies immune globulin (RIG, Hyperab Imogam)
• respiratory syncytial virus immune globulin
• Rho(D) immune globulin (Gamulin Rh, HypRho-D MICRhoGAM, MiniGamulin Rh, Rhesonativ, RhoGAM, WinRho)
• tetanus immune globulin (Hyper-Tet, TIG, tetanus antitoxin)
• vaccinia immune globulin (DynPort)
• varicella-zoster immune globulin (VZIG)

Indications

• treatment of immunodeficient diseases
• treatment of some autoimmune diseases

• immune thrombocytopenic purpura ( ITP)

• to provide passive immunity in certain infectious disease (see more specific types of immune globulin)

Contraindications

• thrombocytopenia (except ITP)
  

• Caution:

• do NOT perform skin test: local reaction may occur & be misinterpreted
• screen for IgA deficiency in hypogammaglobulinemic patients
  

• pregnancy-category C
• safety in lactation ?

Dosage

• intramuscular ( IM)

• hepatitis A:

• post-exposure prophylaxis 0.02 mL/kg
• pre-exposure prophylaxis

• < 3 months: 0.02 mL/kg
• > 3 months: 0.06 mL/kg; repeat q4-6 months

• IgG: 1.2-1.3 mL/kg, followed by 0.6-0.66 mL/kg q2-4 weeks
• measles (within 6 days of exposure)

• 0.25 mL/kg
• immunosuppressed patient: 0.5 mL/kg (max: 15 mL)

• rubella: 0.55 mL/kg
• varicella 0.6-1.2 mL/kg

• intravenous (IV)

• primary immunodeficiency: 200-400 mg/kg/month
• idiopathic thrombocytopenic purpura ( ITP):

• 400 mg/kg/day for 5 days

• chronic lymphocytic leukemia

• 400 mg/kg every 3 weeks

• Kawasaki disease: single dose of 2000 mg/kg over 10 hours
• IgG subclass deficiencies: 200-300 mg/kg every 3-4 weeks
• pediatric HIV: 200-400 mg/kg every 2-4 weeks
• Guillain-Barre syndrome: 400 mg/kg for 5 days

• Injection: IM 165 +/- 15 mg (protein)/ mL (10 mL) IV: 2.5 g, 3 g, 5 g, 6 g, 10 g.

Pharmacokinetics

• appears in plasma immediately following IV administration
• elimination: liver
• 1/2life is 21-29 days
• duration of action: 3-4 weeks Adverse reactions:
• common (> 10%)

• pain & tenderness site of IM injection)

• less common (1-10%)

• nausea, flushing, chills

• uncommon (< 1%)

• lethargy, fever, urticaria, angioedema, vomiting, erythema, myalgia, hypersensitivity reactions

• other

• most adverse reactions related to rate of infusion
• mild chest, hip & joint pain
• leg cramps
• fatigue

Drug-interactions

• live virus vaccines ( mumps, measles, rubella)

Mechanism-of-action

• passive immunity by increasing antibody titers
• increased potential for antibody- antigen reactions

More General Terms

• transfusion component

Additional Terms

• immunoglobulin
• toxoid
• vaccine

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 613-614
2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
3. Kaiser Permanente Northern California Regional Drug Formulary, 1998

immune globulin (Gamastan, Gamimune N, Gammagard, Gammar, Sandoglobulin, Venoglobulin-I, Venoglobulin-S, ISG, Vivaglobulin)