May 19, 2017 at 2:02 pm
I have a question regarding dose… I have had loading dose of IVIG that my neuro gave me over just a two day period. It was the standard dose that is usually given over five days.. he felt I was strong enough to do it in two. Other than 4 days of headache I tolerated it well. I did feel some improvement after a couple of weeks.. but nothing dramatic.
I am now doing 40 gram every four weeks.. so monthly. I weigh 214 lbs.. so I feel like he is giving me a low dose.. I believe I am around 96kg.. so if the standard dose is 1 gram per kg, shouldn’t I be getting at least 90 gr or so. I had my first 40 gr Friday.. no headache.. felt weak for 4 days.. a little better now.. but no significant or dramatic improvement.
Any thoughts on his approach?
May 19, 2017 at 8:45 pm
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:
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.”
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.
May 19, 2017 at 10:10 pm
I get 125 grams per month (25 grams per day over 5 days). My doctor said that because I have a severe case of CIDP, with a lot of ongoing nerve damage, he wanted to “hit it hard” and try to stop the disease’s progress. Ask your doctor to explain your dose.
May 20, 2017 at 8:41 pm
Thanks for the thoughtful replies… I am giving the doc the benefit of the doubt right now. Will ask more next month as to why the dose, I am taking notes on how I am responding.
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