Reply To: IVIG reaction

April 1, 2015 at 9:33 pm

It seems to me that a ‘standard’ recommended loading dose of IVIG for CIDP was 2g/kg over 2 to 5 days. So, let’s say you are 75kg (165 lbs). Hence 2*75 = 150g.

However, the headache part, in my experience, had more to do with the infusion rate and hydration levels than with the levels of Benadryl or Tylenol. Drink water and more water the day before and every day during infusion. At least, that helped me.

Equally important, is reigning in the nurse(s) desire to get in you quickly and get you out the door quickly. Your doctor should have specified an infusion rate in the initial order. Ask the nurse to see the order. If necessary, call your doctor.

The Octagam product information sheet lists one suggested infusion rate as: “Administration OCTAGAM 10% [100 mg/mL] should be infused intravenously at an initial rate of 0.6 to 1.2 mL/kg/hour for 30 minutes. If well tolerated, the rate of administration may gradually be increased to a maximum of 7.2 mL/kg/hour.”

Therefore, the initial rate, for a 75 kg person would be in the range of 0.6*75 to 1.2*75 or 45ml to 90 ml per hour.

Personally, I was never able to go that high. Flushing was the first warning sign for me.

Ultimately, the infusion tubing size determines the drip rate and it might behoove you to find out what tubing and what drip rate, that is the number of drops you see falling from the bottle into the tube each minute compared to the doctor’s order.

Edited to add: It is common now to use electronic infusion pumps. These pumps offer much better control than the old style compression tubing squeeze fitting.

Of course, every situation and person is unique. If, by a rate of 150, you mean 150 ml per hour there is no chance I would have tolerated that. It sounds as if you don’t tolerate it either.

However, the headache could have entirely other causes. Please check with your doctor.