Reply To: IVIG Dose

Of course the dose is best determined by your doctor.

The Cleveland Clinic as a Pharmacy publication on line, https://www.clevelandclinicmeded.com/medicalpubs/pharmacy/pdf/Pharmacotherapy_XI-1.pdf, and it includes this discussion:

“Dose:
There are three key points when dosing IVIG based on the Formulary restrictions. First, the
dose of IVIG is calculated based on ideal body weight (IBW), not actual body weight (ABW). If the
person is 30-40% above IBW, then an adjusted BW will be used. Therefore, it is important to have
the current weight of the patient. Second, the total dose of IVIG should be no more than 2 grams/kg
(e.g., 0.4 gram/kg/day for 3 to 5 days or 1 gram/kg/day for 2 days). All doses greater than 1 gram/kg
must be approved by the Drug Information Center. Third, IVIG should not be dosed any more fre-
quently than every 4 to 6 weeks.”

Note that the dose is to be based on ‘ideal’ body weight, not actual body weight.

Further, according to Medscape, “Maintenance therapy should be tailored to the individual according to the duration of the improvement after each infusion. The most common regimen involves 1 g/kg or 2 g/kg every 4-8 weeks, as needed.”

http://www.medscape.org/viewarticle/747804_5

So, one might conclude, without knowing the doctor’s reasoning, that 40g every 4 weeks might be low.

A second reference source is: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487533/

“The recently published IVIg in CIDP Efficacy (ICE) trial was the largest and longest randomized, double-blind placebo-controlled trial demonstrating sustained efficacy of IVIg in CIDP utilizing a loading dose of 2 g/kg administered over 2–5 days, followed by repeated infusions of 1 g/kg administered every 3 weeks for 6 months [Hughes et al. 2008].”

Note that in this discussion the mention of loading dose is “administered over 2-5 days”. Therefore, a two day loading dose may not be too unusual.

Generally, speaking, for headaches drink more water the day before and the day of infusion. As, lots of water.