Intravenous immunoglobulin (IVIg)

What is IVIg?

Immunoglobulins are the antibodies produced naturally by the body’s immune system, which help fight infection and disease. Intravenous immunoglobulin, or IVIg, is a treatment that combines immunoglobulins donated by different people and is given by a drip to treat various conditions.

Uses

IVIg is used to reduce the effects of some inflammatory conditions that involve the immune system, also known as autoimmune diseases. It’s also used to increase levels of immunoglobulins if these are low, or have been lowered by treatment with other drugs, such as rituximab.

It can be used in the treatment of several different conditions, including:

Are there any reasons why I won’t be prescribed IVIg?

Before you start IVIg, your doctor will check the levels of immunoglobulin in your blood. If one type, known as IgA, is very low, then you may not be given IVIg. You might not be given IVIg if you've had a previous reaction to immunoglobulin, and you may not be able to have some types of IVIg if you have an intolerance to fruit sugar.

There’s currently a shortage in the supply of IVIg, so for some conditions you’ll only be given it if you’ve tried certain other treatments first, and if those treatments haven’t worked for you.

How is it taken?

IVIg is usually given by a drip into a vein, known as an intravenous infusion. It’s sometimes given as an injection if you’re only taking it to increase your immunoglobulin levels following other treatments.

You’ll need to go to hospital each time you have the treatment. The infusion will take several hours as the drug has to be given slowly. You’ll need to have your blood pressure, pulse and temperature checked regularly while you’re having the drip.

If you don’t have any problems during the first hour of the infusion, the rate will be increased by the doctor or nurse looking after you. After it’s finished you’ll need to be observed at the hospital for an hour to check for any side effects.

How often you have IVIg infusions will depend on the condition you have and how you respond to the treatment. The dose will be calculated based on your weight.

How long does it take to work?

IVIg should start to work within a few weeks, but this will vary depending on which condition you have and how you respond to the treatment. If IVIg works for you, the effects should last for a few months.

Side effects and risks

People having IVIg occasionally have a reaction during or after the infusion. The symptoms of this include:

  • a chill or a fever
  • headache
  • stomach pain
  • feeling sick or vomiting
  • joint pain
  • low back pain
  • tiredness.

If these symptoms happen during the infusion, it will be slowed down or stopped. The symptoms usually settle quickly.

You’ll be monitored while you’re having the treatment, but you should report any new symptoms during or after the infusion to a healthcare professional.

If possible, you’ll be given the same brand of IVIg, such as Flebogamma or Octagam, every time you have an infusion to reduce the likelihood of a reaction. However, sometimes problems with the supply of IVIg will mean that another brand has to be used.

All blood donors for IVIg are carefully tested for any diseases that could be passed on to you, such as hepatitis B, and they’re only able to donate if their blood is safe. However, it's impossible to completely rule out the risk of passing on some infections.

Sometimes people having IVIg may experience the following side effects, but all of these can be treated:

  • a rash
  • liver problems
  • kidney failure
  • inflammation of the brain, known as aseptic meningitis
  • haemolytic anaemia, a condition with different causes, that destroys red blood cells.

Very rarely, people may experience a severe allergic reaction to IVIg. If you experience any of the following symptoms, you should seek urgent medical attention:

  • chest tightness
  • breathing difficulties
  • a rash
  • swelling of the face or tongue
  • a drop in blood pressure.

IVIg can sometimes cause a rise in blood pressure, which can lead to an increase in the risk of heart attack or stroke. It can also increase the risk of blood clots.

If you have any concerns about your treatment or its side effects, you should discuss these with your doctor, rheumatology nurse or pharmacist.

Effects on other treatments

You should be fine to take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and painkillers along with IVIg. Always check with your doctor before starting any new medications, and remember to mention you're on IVIg if you're treated by anyone other than your usual rheumatology team.

IVIg doesn’t usually affect other drugs, but you should tell your doctor which medicines you’re currently taking, including over-the-counter drugs and herbal remedies.

Vaccinations

IVIg may affect how your immune system reacts following any vaccination, and this can make the vaccine less effective, so it's best to avoid vaccinations for at least six weeks after having IVIg.

Speak to your doctor for advice before having any vaccinations.

Having an operation

Talk this over with your surgeon or doctor. It's likely you'll be able to continue, but your doctor might need to make changes to your dose or the timing of your IVIg.

Alcohol

There's no particular reason to avoid alcohol before or after IVIg treatment.

If you do drink alcohol, it’s recommended that you stay within the limit of 14 units a week for both men and women. You should try and spread these out across the week and not have all your units in one go.

Fertility, pregnancy and breastfeeding

Current guidelines say that IVIg can be given during pregnancy and breastfeeding because it’s not been shown to have harmful effects on the mother or baby.

We’re not sure yet how it might affect men trying to father a child. Because it’s not harmful in pregnant women, it’s unlikely to be harmful to men hoping to father a child.