Intravenous
Immunoglobulin (IVIg)
prescribing guidance
Kejal Mehta (Pharmacist)
[December 2016]
Review Date: December 2017
Author: Kejal Mehta (Pharmacist) Dec. 2016
Contents
Introduction: ........................................................................................................................................... 2
Prior to Intravenous immunoglobulin (IVIg) prescribing: ....................................................................... 2
1. Approval ...................................................................................................................................... 2
2. Dosing ......................................................................................................................................... 2
3. Prescription ................................................................................................................................. 3
4. Supply .......................................................................................................................................... 3
Appendix A: Demand Management Poster ........................................................................................ 4
Appendix B: Clinician Request form .................................................................................................... 5
Appendix C: Prescription chart ........................................................................................................... 7
Appendix D: IVIg Infusion form ........................................................................................................... 8
Author: Kejal Mehta (Pharmacist) Dec. 2016
Intravenous immunoglobulin (IVIg) prescribing guidance
Introduction
In 2006, the Department of Health initiated “National Demand Management Programme for
Immunoglobulin” to secure the supply of immunoglobulin for patients in the UK in whom it is life-
saving. The supply of IVIg is limited and demand continues to exceed supply therefore a guideline
was developed for a more evidence-based approach to IVIg use. The indications are colour coded to
reflect prioritisation and approval for IVIg treatment.
Prior to Intravenous immunoglobulin (IVIg) prescribing
1. Approval
• Use the Demand Management Poster (Appendix A) to determine which colour the indication
fits in. Indication priority can vary depending on the duration of treatment. These can be
either short term (< 3months) or long term (>3 months) treatments.
Indication Priority Immunoglobulin Assessment Panel (IAP)/ CCG
approval prior to treatment
Red High Automatic approval.
Blue Medium Contact ward/ oncall pharmacist to obtain
Immunoglobulin Assessment Panel approval.
Grey/Black Low (little or no evidence) Contact ward/ oncall pharmacist to obtain
Immunoglobulin Assessment Panel + CCG
approval.
Immunoglobulin Assessment Panel consists of:
Pharmacists: David Heller, Joanne Rhodes, Jane Allen,
Consultants (excluding their own patients): Dr Barry Jackson and Dr Jeff Kimber
• Complete the mandatory Clinician Request form (Appendix B). This must be completed for
all indications. A registrar or above should sign the form. Please return this to pharmacy
ASAP for reimbursement.
2. Dosing
• Use the clinical guideline for dosing regimen for the indication.
http://www.igd.nhs.uk/clinical-info/ (link to guideline)
• Calculate the dose using the actual body weight (kg). (Use dose determining weight (DDW)
if BMI >30kg/m2)
DDW = IBW + 0.4 (actual body weight (kg) – IBW)
IBW for males = 50 + (2.3 x (height in inches – 60))
IBW for females = 45.4 + (2.3 x (height in inches – 60))
• Round each dose to the nearest 5g (dose per day may vary as necessary). Confirm the dose
with the ward/ on call pharmacist.
Author: Kejal Mehta (Pharmacist) Dec. 2016
3. Prescription
• Complete the Prescription Chart (Appendix C) and attach it to the drug chart. Ensure all
relevant boxes are completed.
• Calculate the actual rate (mL/hr) of infusion. Confirm the calculated rates (mL/hr) with a
pharmacist.
Actual rate (mL/hr) = rate required (mL/kg/hr) x patient weight (kg)
• Infusion Form (Appendix D) must be completed by the nurses with batch numbers of every
dose administered and returned to pharmacy.
• Prescribe chlorphenamine 4mg TDS as supportive treatment on PRN side of drug chart and
keep anaphylaxis box available.
4. Supply
• Privigen (100mg/ml) is the ONLY brand kept at SASH. Do NOT dilute
• Working hours: contact the ward pharmacist for screening and supply
• Out of hours: contact the on call pharmacist to confirm all the above before obtaining
supply from the emergency drug cupboard.
Author: Kejal Mehta (Pharmacist) Dec. 2016 4
Appendix A: Demand Management Poster
Author: Kejal Mehta (Pharmacist) Dec. 2016
5
Appendix B: Clinician Request form
Author: Kejal Mehta (Pharmacist) Dec. 2016
6
Author: Kejal Mehta (Pharmacist) Dec. 2016 7
Kg
Kg
mL/kg/hr Actual rate
(mL/hr)
0.3
0.6
1.2
2.4
4.8
0.3
0.6
1.2
2.4
4.8
0.3
0.6
1.2
2.4
4.8
0.3
0.6
1.2
2.4
4.8
0.3
0.6
1.2
2.4
4.8
Author: Kejal Mehta Created 12/2016
Atta
ch p
rescrip
tion to
pa
tien
t dru
g ch
art
(IBW (males)= 50+ (2.3x height in inches - 60))
(IBW (females)= 45.5+ (2.3x height in inches - 60))
Appendix C. Prescription and administration chart for Intravenous Immunoglobulin infusion (Privigen 100mg/ml Solution)
Patient name
(Use DDW If BMI>30kg/m2, Otherwise use Actual weight)
Monitor temperature, blood pressure, respiratory rate, heart rate and signs of anaphylaxis throughout. (Anaphylaxis box must be available)
Day Date Time Dose (g) Volume
(mL)
(Do not
dilute)
Calculated infusion rates
(increase rate every 30 mins
if tolerated)
Prescriber
Signature
and reg. no.
Allergies
Date
of
admin
Start
time
Given by/
checked
by
Batch number/expiry date Pharm
.
2
1
3
4
5
DOB
Hospital no.
Actual body weight (ABW)
Dose-determining weight (DDW)
Calculate DDW= IBW+ 0.4 (ABW - IBW)
Each dose to be rounded to the nearest 5g
Dosing Regime
as per
guideline
Indication
Appendix C:
Prescription char
Author: Kejal Mehta (Pharmacist) Dec. 2016 8
Appendix D: IVIg Infusion form
(Nurses to stick batch numbers and must be returned to pharmacy once complete)
Trust ID NHS / CHI no
Infusion
Date Product Batch No.
Grams
per Vial
Vial
Count
Total
Grams
-
-
-
-
-
-
-
-
(Patient details)