|IMMUNE GLOBULIN INTRAMUSCULAR [IGIM, GAMMA GLOBULIN, IMMUNE SERUM GLOBULIN (ISG)]
IMMUNE GLOBULIN INTRAVENOUS (IGIV)
Flebogamma, Gammagard, Gammar-P IV, Gamunex, IGIV, Iveegam, Octagam, Sandoglobulin
Classifications: biologic response modifier; immunoglobulin; Therapeutic: immunoglobulin
Pregnancy Category: C
IGIM: 2 mL, 10 mL vials
IGIV: 5%, 10% solution; 50 mg/mL powder for injection
Sterile concentrated solution containing globulin (primarily IgG) prepared from large pools of normal human plasma of either
venous or placental origin and processed by a special fractionating technique.
Like hepatitis B immune globulin (H-BIG), contains antibodies specific to hepatitis B surface antigen but in lower concentrations.
Therefore, not considered treatment of first choice for postexposure prophylaxis against hepatitis B but usually an acceptable
alternative when H-BIG is not available.
IGIM: In susceptible persons to provide passive immunity or to modify severity of certain infectious diseases [e.g., rubeola
(measles), rubella (German measles), varicella-zoster (chickenpox), type A (infectious) hepatitis], and as replacement therapy
in congenital agammaglobulinemia or IgG deficiency diseases. May be used as an alternative to H-BIG to provide passive immunity
in hepatitis B infection. Also for postexposure prophylaxis of hepatitis non-A, non-B, and nonspecific hepatitis. IGIV: Principally as maintenance therapy in patients unable to manufacture sufficient quantities of IgG antibodies, in patients
requiring an immediate increase in immunoglobulin levels, and when IM injections are contraindicated as in patients with
bleeding disorders or who have small muscle mass. Also in chronic autoimmune thrombocytopenia and idiopathic thrombocytopenic
purpura (ITP). Treatment of primary immunodeficiency disorders associated with defects in humoral immunity.
Kawasaki syndrome, chronic lymphocytic leukemia, AIDS, premature and low-birth-weight neonates, autoimmune neutropenia,
or hemolytic anemia.
History of anaphylaxis or severe reaction to human immune serum globulin (IG) or to any ingredient in the formulation such
as thimerosal (mercury derivative) preservative in IM formulations and maltose (stabilizing agent) in IV formulations; persons
with clinical hepatitis A; IGIV for patients with class-specific anti-IgA deficiencies; IGIM in severe thrombocytopenia or
other bleeding disorders; intramuscular injection, pregnancy (category C).
Dehydration, diabetes mellitus, children, older adults, hypovolemia, IgA deficiency, infection; renal disease, renal failure,
renal impairment; sepsis; sucrose hypersensitivity; vaccination, viral infection; lactation.
Route & Dosage
|Hepatitis A Exposure
Adult/Child: IM 0.02 mL/kg as soon as possible after exposure; if period of exposure will be ≥3
mo, give 0.050.06 mL/kg once q46mo
Hepatitis B Exposure
Adult/Child: IM 0.020.06 mL/kg as soon as possible after exposure if H-BIG is unavailable
Adult: IM 20 mL as single dose in susceptible pregnant women
Adult/Child: IM 0.25 mL/kg within 6 d of exposure
Adult/Child: IM 0.61.2 mL/kg promptly
*Dosages may vary between brandsAdult/Child: IV 200400 mg/kg monthly IM 1.2 mL/kg followed by 0.6 mL/kg q24wk
Idiopathic Thrombocytopenia Purpura
Adult/Child: IV 400 mg/kg/d for 5 consecutive days or 1 g/kg x 12 d
Dose based on IBW or adjusted IBW.
- Give adults and older children injections into deltoid or anterolateral aspect of thigh; neonates and small children, into
anterolateral aspect of thigh.
- Avoid gluteal injections; however, when large volumes of immune globulin are prescribed or when large doses must be divided
into several injections, the upper outer quadrant of the gluteus has been used in adults.
PREPARE: IV Infusion: Refer to manufacturer's directions for information on reconstitution and dilution of the specific product.
ADMINISTER: IV Infusion: Flow rates vary with product being infused. Refer to manufacturer's directions for the specific product.
INCOMPATIBILITIES Manufacturer recommends not mixing other drugs with immunoglobulin.
- Store as directed by manufacturer for specific product. Avoid freezing. Do not use if turbidity has occurred or if product
has been frozen.
- Do not mix with other drugs.
- Discard partially used vial.
Adverse Effects (≥1%)Body as a Whole: Pain, tenderness, muscle stiffness at IM site;
local inflammatory reaction, erythema
, urticaria, angioedema, headache, malaise
, fever, arthralgia
, nephrotic syndrome
hypersensitivity (fever, chills, anaphylactic shock
), infusion reactions (nausea, flushing, chills,
headache, chest tightness, wheezing, skeletal pain, back pain, abdominal cramps, anaphylaxis), renal
May interfere with antibody response to live virus vaccines
(measles/mumps/rubella); give vaccines
14 d before or 3 mo after immune globulins
2 d. Distribution:
Rapidly and evenly distributed to intravascular and extravascular fluid compartments. Half-Life:
Assessment & Drug Effects
- Make sure emergency drugs and appropriate emergency facilities are immediately available for treatment of anaphylaxis or
- Note: Hypersensitivity reactions (see Appendix F) are most likely in patients receiving large IM doses, repeated injections, or
rapid IV infusion.
- Monitor vital signs and infusion rate closely when patient is receiving IGIV.
- Note: IGIV has a mild diuretic effect in some patients due to presence of maltose.
Patient & Family Education
- Report immediately S&S of hypersensitivity (see Appendix F).
- Report immediately infusion symptoms of nausea, chills, headache, and chest tightness; these are indications to slow rate
- Note: Passive immunity to measles (rubeola) lasts about 34 wk after immune globulin. In general, children ≤15
mo need active immunization with measles virus vaccine 3 mo after IGIM.