Section 07 · Monograph
Immune globulin IV (IVIG)
Reviewed Nov 2026FDA label
Gamunex-C / Privigen / othersImmunomodulator
- Forms
- IV: 10% liquid (100mg/mL)
- Dose
- MG exacerbation (off-label): 2g/kg over 2-5 days | CIDP: 2g/kg load, then 1g/kg every 3 weeks
- MOA
- FcRn saturation, anti-idiotypic and complement/cytokine modulation
Black Box Warning
- Thrombosis may occur with immune globulin products — risk factors include advanced age, prolonged immobilization, hypercoagulable states, estrogen use, indwelling catheters and hyperviscosity
- Renal dysfunction, acute renal failure, osmotic nephrosis and death may occur, particularly with sucrose-containing products — ensure adequate hydration and use the minimum infusion rate practicable in patients at risk
Indications
- Primary humoral immunodeficiency and immune thrombocytopenic purpura (product-dependent)FDA-labeled
- Chronic inflammatory demyelinating polyneuropathy (Gamunex-C, Privigen, Panzyga); multifocal motor neuropathy (Gammagard Liquid); dermatomyositis (Octagam 10%)FDA-labeled
Off-Label Uses
- Myasthenia gravis exacerbation or crisisOff-label
- Guillain-Barre syndromeOff-label
- Stiff-person syndrome and autoimmune encephalitisOff-label
Mechanism of Action
- Pooled polyclonal IgG with multiple immunomodulatory effects: FcRn saturation (reducing pathogenic IgG half-life), anti-idiotypic neutralization, and complement/cytokine and Fc-receptor modulation
Full Dosing
Adult / usual
- MG exacerbation: 2g/kg divided over 2-5 days
- Guillain-Barre syndrome: 0.4g/kg/day for 5 days
- CIDP: 2g/kg loading dose divided over 2-5 days, then 1g/kg every 3 weeks (product-specific)
- Start at a slow infusion rate and titrate as tolerated; hydrate before infusion
Contraindications
- Prior anaphylactic or severe systemic reaction to human immune globulin
- IgA deficiency with antibodies to IgA and a history of hypersensitivity
- Hyperprolinemia (Privigen)
Drug Interactions
- May impair response to live virus vaccines (measles, mumps, rubella, varicella) — delay vaccination for several months
- Concomitant nephrotoxic drugs increase renal injury risk
Adverse Effects
- Headache, fever, chills, infusion reactions
- Thrombosis
- Acute kidney injury
- Aseptic meningitis
- Hemolysis and transfusion-related acute lung injury (TRALI)
- Hypersensitivity and anaphylaxis
Monitoring Parameters
- Renal function (BUN, creatinine) before and after infusion
- Vital signs during infusion
- Signs of thrombosis, hemolysis and volume overload
- Hydration; consider sucrose-free products and slower rates in high-risk patients
Pregnancy & Lactation
- IgG crosses the placenta; generally used when clinically needed
- Present in milk; considered compatible with breastfeeding