[PAGID] Maximum rate for IVIG

[Kirkpatrick, Charles]

It is my understanding that the renal injury was most likely due to the sugar content of the IgG.  I have seen renal injury in only one patient; she was given a sugar containing IgG without permission because the pharmacy was out of Gamunex..  Personally, I never use sugar containing IgG either IV or SQ.

With respect to infusion rates, most of my patients are adults... We start with 15 cc of 10% IgG (usually Gamunex) for 15 minutes.  If everything is stable we increase to 30 cc/hour for 15 minutes.  If everything is OK (vital signs, clinical symptoms, etc.),. we increase to 60 cc/hr.  We follow the same schedule of dose increments until we get to 240 cc/hr.  If the patient has a history of migraine, I stop at 240 cc per hour.  Migraine patients are more likely to have post-infusion aseptic meningitis and headaches.  Other wise we give up to 360 cc /hour.

We do not pre-mediate all patients; just those with symptoms.

Chuck Kirkpatrick, M.D. .

-----Original Message-----
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Chris Seroogy
Sent: Wednesday, May 06, 2009 3:23 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] Maximum rate for IVIG

Dear Colleagues,

A question was recently posed to me by our pharmacy staff regarding maximum infusion rate for IVIG.  They noted some practioners maxed at 110 cc/hr of 10% solution and felt faster infusion rates may lead to renal toxicity regardless of the product formulation.  This is not something that I typically monitor and was wondering if anyone has sound data on the safety for maximum infusion rates of IVIG?  Thank you for any insights, Chris


--
Christine M. Seroogy MD, FAAP, FAAAAI
Assistant Professor
University of Wisconsin
Department of Pediatrics
Division of Allergy, Immunology & Rheumatology
H4/474 CSC
600 Highland Avenue
Madison, WI  53792-4108
phone: 608-263-2652
fax: 608-265-0164

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