The reasons a patient may be switched from one IVIG product to another include clinical factors, fiscal issues, and/or product availability. Regardless of the underlying reason for the change, there are several factors involved with IVIG treatment, which should be considered such as the rate of infusion, the concentration, the product itself, as well as the patientís health status at the time of infusion. All these factors can influence how you will tolerate the infusion of a new IVIG product.
Each IVIG product is different and every manufacturer has specific recommendations regarding the rate of infusion. Those rates can vary greatly, and usually reflect what was done in the clinical trials to get the products approved by the FDA. It has been proven that slower infusion rates reduce rate-related symptoms. This includes headache during and after infusion, nausea, shivering, muscle or joint aches, rapid pulse, and blood pressure changes.
Your physician should be involved when the brand of IVIG is changed. Your vital signs should be monitored frequently during the transitional infusions. To reduce the potential for adverse events, you should be well hydrated before treatment except if you have other co-existing diseases that warrant restrictions on fluids. A physician may order medications before, during, or after your infusions to help lessen the symptoms.
All IVIG infusions should begin with a slow rate of infusion and then be increased according to patient tolerability and other considerations, such as patientís co-morbidities and age. Increasing the rate of infusion should occur for every infusion in a stepwise fashion, slowly ramping up the rate every 15-30 minutes at each infusion. An infusion rate that may be tolerable with one product is not necessarily the same rate that you may be able to tolerate other products, especially the first 2 or 3 times you receive it.
An IDF survey reported that 34% of reactions occurred when an IVIG product is infused for the first time. However, after several immunoglobulin treatments with the same product, infusion reactions decrease, and the rate of infusion can carefully and slowly be increased. Recent IVIG licensing studies have observed a lower rate of adverse events after the first several infusions of a new brand of IVIG in the enrolled subjects.
To learn more, check out:
Orange J, Hossny E, et al. Use of intravenous immunoglobulin in human disease: A review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology J ALLERGY CLIN IMMUNOL. 2006:117 S525-S553.
IDF Guide for Nurses, 2nd edition