FormWeb • immune globulin intravenous

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Brand name products with an equivalent generic may not be available to order at Henry Ford Health. For questions, contact inpatient pharmacy.

Henry Ford Health

Approved Hospital Formulary

FormWeb QuickStart Questions or Suggestions? Pharmacy Intranet

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immune globulin intravenous

immune globulin intravenous

Drug Name	Form	Strength	Clinic Use Only	Inpatient Restrictions	Outpatient Restrictions	Non-Formulary
Gammagard S/D	POWDER FOR INJECTION, INTRAVENOUS	5 g; 10 g
Privigen	SOLUTION, INTRAVENOUS	10%

VIEW MORE immune globulins, immunologic agents
CLASS

HFHS approved uses for Intravenous Immune Globulin (IVIG)

Disease	Recommendation
CIDP where plasmapheresis, corticosteroids, or other immune-modulating agents are not clinically appropriate	0.4 g/kg/day x 5 days, or 1 g/kg x 2 days
Guillain-Barre’ Syndrome where plasmapharesis is not clinically appropriate	0.4 g/kg/day x 5 days
HCT recipients, patient with multiple myeloma or CLL with recurrent (>/=3 /year) bacterial, sino-pulmonary infections with documented IgG<400mg/dL.	0.4 g/kg Q 3-4 weeks Give monthly IVIG to keep IgG > 400-500 mg/dL.
Idiopathic Thrombocytopenic Purpura with Active Bleeding	0.4 g/kg/day x 5 days, or 1 g/kg x 1-2 days
Myasthenia gravis Crisis where plasmapheresis is not clinically appropriate	0.4 g/kg/day for 5 days, or 1 g/kg x 2 days
Multifocal Motor Neuropathy (MMN)	0.4 g/kg x 5 days, or 1 g/kg x 2 days
PANDAS [or post-infectious encephalitis or disseminated encephalomyelitis] in current & established HFHS pediatric patients	Initial dose: 2 g/kg over 5 days, then 1-2 g/kg every month x 3-6 months, and then once every 3-6 months thereafter. Dosing and frequency after initial dose is lower and individualized
Primary Immunodeficiency Diseases with documented IgG<400mg/dL and documented severe lung disease(s)	0.4-0.6 g/kg Q 21-28 days [titrated to response]
Solid Organ Transplant: Antibody mediated rejection – All organs, biopsy positive and diagnosed early in the rejection process	0.1 – 0.5 g/kg for all organs

Last updated: Apr. 6, 2020

Black Box Warning Renal dysfunction, acute renal failure

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