immune globulin (Gamastan, Gamimune N, Gammagard, Gammar, Sandoglobulin, Venoglobulin-I, Venoglobulin-S, ISG, Vivaglobulin, Gamunex, Privigen, Gammaplex, Flebogamma, Gammaked, Bivigam, Carimune, Hizentra)
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Indications
- treatment of immunodeficiency (hypogammaglobulinemia)
- bone marrow transplantation
- X-linked agammaglobuliniemia
- chronic lymphocytic leukemia
- treatment of some autoimmune diseases
- alloimmune disorders
- allergic reactions
- to provide passive immunity in certain infectious disease (see more specific types of immune globulin)
- inclusion body myositis
- empiric treatment for fever of unknown origin
- Maroteaux-Lamy syndrome[5]
Contraindications
- thrombocytopenia (except ITP)
Caution:
- do NOT perform skin test: local reaction may occur & be misinterpreted
- screen for IgA deficiency in hypogammaglobulinemic patients
Dosage
- intramuscular (IM)
- hepatitis A:
- post-exposure prophylaxis 0.02 mL/kg
- pre-exposure prophylaxis
- 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
- hepatitis A:
- 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 effects
- common (> 10%)
- pain & tenderness site of IM injection)
- less common (1-10%)
- 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
- boxed warning for thrombosis[4]
Drug interactions
Mechanism of action
- passive immunity by increasing antibody titers
- increased potential for antibody-antigen reactions
More general terms
More specific terms
- antithymocyte globulin
- cytomegalovirus immune globulin (Cytogam)
- galsulfase (Naglazyme)
- hepatitis A immune globulin
- hepatitis B immune globulin (H-BIG, Hep-B-Gammagee, HyperHep)
- human botulism immune globulin (BIG-IV, BabyBIG)
- intravenous immunoglobulin (Baygam, Octagam)
- 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 (HyperTet, TIG, tetanus antitoxin)
- vaccinia immune globulin (DynPort)
- varicella-zoster immune globulin (VZIG)
Additional terms
Component of
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 613-614
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 4.0 4.1 FDA Safety Communication: June 10, 2013 New boxed warning for thrombosis related to human immune globulin products. http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ucm355986.htm
- ↑ 5.0 5.1 5.2 5.3 Deprecated Reference
- ↑ Patwa HS, Chaudhry V, Katzberg H, Rae-Grant AD, So YT Evidence-based guideline: intravenous immunoglobulin in the treatment of neuromuscular disorders: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2012 Mar 27;78(13):1009-15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22454268
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015