Intravenous Immunoglobulin
A DRUG Information Sheet
What is intravenous immunoglobulin (IV Ig)?
Immunoglobulins are proteins produced by the immune system (the body's own defence system): they help to fight infection. Intravenous immunoglobulin, or IV Ig (immunoglobulin given by injection into a vein), can dampen down some inflammatory diseases involving the immune system. IV Ig, which is also called 'human normal immunoglobulin', is a blood product which combines immunoglobulins from many human blood donors. The donors have been screened to make sure that they have no serious diseases which can be passed on to you – all are negative for hepatitis B, hepatitis C and human immunodeficiency virus (HIV).
Why am I being prescribed IV Ig?
Rheumatologists may use IV Ig in the treatment of several different conditions. IV Ig can reduce inflammation in people with polymyositis and dermatomyositis. It is also sometimes used in people with lupus (systemic lupus erythematosus, or SLE) – for example to raise their platelet count if it is low – and in people with adult-onset Still's disease, vasculitis and antiphospholipid syndrome.
When and how do I take IV Ig?
IV Ig is given into a vein through a cannula (a small plastic tube) using an infusion pump. You will therefore need to go to the hospital each time you receive the treatment. The infusion will take several hours as the drug has to be given slowly. The rate of the infusion will be increased during the first hour provided you have no problems. You will be observed closely and have your blood pressure, pulse and temperature checked regularly. After the infusion has finished you will need to be observed for a further hour to check for any side-effects.
The dose of IV Ig varies according to the condition that is being treated. The dose is calculated according to your weight. Sometimes you will need to attend on just one day, sometimes on 2 consecutive days and sometimes on 5 consecutive days. Some people may require repeat courses every 4 weeks.
Do I need to rest after the infusions?
Not unless you feel the need to. Having an infusion for a number of hours can make some people feel tired.
How long will IV Ig take to work?
It may take 2–12 weeks to become effective.
What are the possible risks or side-effects?
People receiving IV Ig may occasionally experience (during or after the infusion) a chill, headache, abdominal pain, fever, nausea, vomiting and joint pain – particularly low back pain. These symptoms are known as an 'infusion reaction' and will usually settle quickly. If they occur during the infusion, then the infusion may be stopped or slowed down. Occasionally people may experience an allergic reaction when their blood pressure may drop (sometimes causing them to feel faint or light-headed) and they may develop itchy skin, swelling of the face and throat, and have difficulty breathing. Very occasionally IV Ig can cause a rise in blood pressure. A nurse will monitor you during the infusion but please report any new symptoms during or after the infusion. These reactions occur only in a minority of patients.
Rarely, people receiving IV Ig may experience a rash or abnormalities in liver function (detected by blood tests), but these usually settle quickly. Other rare side-effects can also occur. These include acute kidney failure, inflammation of the brain (aseptic meningitis), and a type of anaemia called haemolytic anaemia which will recover with time. All these infrequent side-effects can be treated.
The administration of IV Ig can very rarely be associated with conditions caused by increased clotting of the blood – heart attack, stroke, and blood clots in the lung (pulmonary embolism) or legs (deep venous thrombosis, or DVT).
As stated above, all blood donors from whom IV Ig is made are carefully screened. However, it is impossible to eliminate completely the risk of passing on infection, for example with an unknown virus.
If possible, you will be given the same brand of IV Ig, e.g. Flebogamma, Octagam. This is to reduce the likelihood of an infusion reaction. However, occasionally difficulties with supply of IV Ig mean that another brand has to be used.
What other treatments could be used instead of IV Ig?
A number of other drugs are used in the treatment of arthritis and related conditions (see arc leaflet 'Drugs and Arthritis'). Your rheumatologist will discuss these other options with you.
Do I need any special checks while on IV Ig?
Before starting the treatment your immunoglobulin levels will be checked and your condition will be fully assessed.
May I take other medicines along with IV Ig?
IV Ig does not usually interfere with other medications. However, you must tell your consultant which medicines you are currently taking, including over-the-counter medicines and herbal remedies.
Can I have immunisations while on IV Ig?
IV Ig may interfere with the immune response following any vaccine and thus make the vaccine less effective. Therefore it is best to avoid vaccines for at least 6 weeks (sometimes longer, depending on the exact vaccine) after receiving IV Ig.
May I drink alcohol while taking IV Ig?
There is no reason to avoid alcohol before or after IV Ig.
Does IV Ig affect pregnancy?
Although experience has suggested that there are no definite harmful effects to the mother or baby if IV Ig is given during pregnancy, IV Ig should usually be avoided during pregnancy because its safety is not well established.
What about breastfeeding?
The immunoglobulins from the IV Ig will pass into breast milk. Therefore you should not breastfeed if receiving IV Ig.
Where can I obtain further information?
If you would like any further information about IV Ig, or if you have any concerns about your treatment, you should discuss this with your doctor, rheumatology nurse or pharmacist.
Remember to keep all medicines out of reach of children.
PLEASE NOTE: We have made every effort to ensure that the content of this information sheet is correct at time of going to press, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.
