Guidelines Standardised infusion rates for intravenous ...

[Pages:2]Guidelines ? Standardised infusion rates for intravenous immunoglobulin replacement therapy

Immunoglobulin replacement therapy (IRT) is the standard treatment for most children and adults with primary immune deficiencies and some other medical conditions. The aim is to replace immunoglobulin to maintain normal IgG levels. The dose used is individualised for each patient. IRT may be given as intravenous immunoglobulin (IVIg) or subcutaneous immunoglobulin (SCIg).

There are several intravenous immunoglobulin (IVIg) immunoglobulin products available. In both Australia and New Zealand the IVIg products imported for clinical use may change from time to time. Products that are currently available include:

Intragam? 10 is a 10% w/v solution of IgG produced by the CSL Behring from voluntary donors to the Australian Red Cross Blood Service. Intragam? 10 is available in 2.5 g in 25 mL, 10 g in 100 mL and 20 g in 200 mL.

Privigen? is a 10% solution of IgG produced from imported plasma by CSL Behring, Australia. Privigen? is available in 5 g in 50 mL, 10 g in 100 mL, 20 g in 200 mL and 40 g in 400 ml.

Flebogamma? is in both 5% and 10% solutions of IgG produced by Instituto Grifols, Spain. Flebogamma? 5% is available in 0.5 g in 10 ml, 2.5 g in 50 mL, 5 g in 100 ml, 10 g in 200 mL and 20 g in 400 mL. Flebogamma? 10% is available in 5 g in 50 mL, 10 g in 100 ml and 20 g in 200 mL.

Infusion Rates

Individual products recommend different weight based rates of infusion. To avoid confusion, ASCIA has developed standardised infusion rates for both 5% and 10% solutions, regardless of product. These rates are generally well tolerated.

These recommended infusion rates are for patients with immune deficiency on replacement IVIg therapy. Patients using IVIg for other conditions such as Kawasaki disease or immunomodulation should follow local protocols.

Adverse reactions

Adverse reactions tend to be related to the rate of infusion and often resolve with stopping or slowing the infusion rate. Severe reactions are uncommon and are most likely to occur during the first infusion, but may occur subsequently. Symptoms or signs of reactions may include: dyspnoea, wheezing, chest tightness, coughing, changes in blood pressure, tachycardia, flushing, fever, rigors, skin rash/urticaria, headache, vomiting, nausea and abdominal and back pain.

First Infusion

10% IVIG products: For the first infusion, Intragam? 10, Privigen?, Flebogamma? 10%, Kiovig? Octagam? 10% should be infused at a rate of 0.5 mL/kg/hour for the first 30 minutes. If there are no adverse reactions the rate can be increased every 30 mins according to the table to a maximum rate of 3mg/kg/hour (not to exceed 150 mL/hour).

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ASCIA INFORMATION FOR HEALTH PROFESSIONALS

5% IVIG products: For the first infusion, Flebogamma? 5% should be infused at a rate of 1 mL/kg/hour for the first 30 minutes. If there are no adverse reactions the rate can be increased every 30 mins according to the table to a maximum rate of 6mg/kg/hour (not to exceed 300 mL/hour).

Step 1st 2nd 3rd 4th

Time 30mins 30mins 30mins To complete infusion

First Infusion 10% IVIG products Intragam? 10, Privigen?, Flebogamma? 10% Kiovig?, Octagam? 10% Rate (ml/kg/hr) 0.5 1 2 31

5% IVIG products Flebogamma 5%

Rate (ml/kg/hr) 1 2 4 62

1 Rate not to exceed 150ml/hr; 2 Rate not to exceed 300mls

Subsequent Infusions

10% IVIG products: If no reaction to first infusion, Intragam? 10, Privigen?, Flebogamma? 10%, Kiovig? Octagam? 10% should be infused at a rate of 0.5 mL/kg/hour for the first 15 minutes. If there are no adverse reactions the rate can be increased every 15 mins according to the table to a maximum infusion rate of 3mg/kg/hour (not to exceed 300 mL/hour). Patients considered at risk with co-morbidities such as cardiac disease, renal failure etc. should have a maximum infusion rate of 200mls/hr

5% IVIG products: If no reaction to first infusion, Flebogamma? 5% should be infused at a rate of 1 mL/kg/hour for the first 15 minutes. . If there are no adverse reactions the rate can be increased every 15 mins according to the table to a maximum infusion rate of 3mg/kg/hour (not to exceed 500 mL/hour). Patients considered at risk with co-morbidities such as cardiac disease, renal failure etc. should have a maximum infusion rate of 300mls/hr

Step 1st 2nd 3rd 4th

Time 15mins 15mins 15mins To complete infusion

Subsequent Infusion 10% IVIG products Intragam? 10, Privigen?, Flebogamma? 10% Kiovig?, Octagam? 10% Rate (ml/kg/hr) 0.5 1 2 31

5% IVIG products Flebogamma 5%

Rate (ml/kg/hr) 1 2 4 62

1 Rate not to exceed 300ml/hr; 2 Rate not to exceed 500ml/hr

? ASCIA 2017

ASCIA is the peak professional body of clinical immunology and allergy specialists in Australia and New Zealand

Disclaimer This document has been peer reviewed by ASCIA members and is based on expert opinion and the available published literature at the time of review. Information contained in this document is not intended to replace medical advice and any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner.

This document has been developed independently by ASCIA, with an unrestricted grant from CSL Behring. CSL Behring has not determined the content, and responsibility for this document remains for ASCIA. Development of this document is not influenced by CSL Behring or any other commercial organisations.

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