What’s the Typical IVIG Dose?
After a discussion with my doctor today as to why others are being treated with higher levels of IVIG than I am, he told me all the literature he could find supports his dosing. Of course I had to find out for myself. And it turns out he’s right.
I looked up every pub med study I could (in 4-5 hours) in order to find the typical dosage of IVIG.
The typical “loading dose” is 400mg/kg body weight per day for 5 days. So that ends up being a TOTAL of 2g/kg.
I only found one study that deviated by administering 1000mg/kg, but it didn’t tell over how many days, so it was useless to determine a typical dose.
The maintenance dose is also 400mg/kg/day for 1 day. However I found this varied in frequency. Some never got a maintenance dose, some every 4 weeks, some every 6 weeks… I think every 4 weeks is more typical.
So there’s the typical dosing, based on pub med studies. Below is the data.
- 2004 Review of case report from 1987 woman with HE
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1739535/pdf/v076p00455.pdf
400mg/kg daily as initial 5 day dose - 2005 Review of case report of 2 year old boy with acute encephalopathy
http://www.ajnr.org/cgi/content/full/26/9/2311
Prolongation of the infectious encephalopathy condition was suspected, and high-dose (1000 mg/kg) intravenous immunoglobulin therapy was administered in the hope of improving the neurologic symptoms. The patient showed no clinical symptoms during and after infusion, but disturbed consciousness and weakness of limbs appeared later that evening.
Low-dose (100–200 mg/kg) intravenous immunoglobulin is used as a replacement therapy for antibody deficiencies and high-dose (400–1000 mg/kg) intravenous immunoglobulin is used as an immunomodulatory agent in many immune and inflammatory disorders. - Review of 10 case reports on limbic encephalitis
http://brain.oxfordjournals.org/cgi/reprint/127/3/701
case 1: IvIg; 2g/kg divided into five daily doses
Case 4: IvIg; 2g/kg divided into five daily doses (improvement within 1 week, normal within 3 months)
Case 8: IvIg; 2g/kg divided into five daily doses (worsened, then plasma exchange, no change then improved with steroids) - 2001 Review of 10 cases with OMS
http://brain.oxfordjournals.org/cgi/reprint/124/2/437
3 cases: 0.4g/kg over 5 days (all recovered in <3 months) - Review of 55 year old woman with Guillain-Barre
IVIG 0.4g/kg per day was started - 10 year review of MS patients receiving IVIG
http://informahealthcare.com/doi/abs/10.1080/08916930600825867
initial loading dose of 0.4g/kg body weight/day for 5 days
booster maintenance dose of 0.4 g/kg every 6 weeks.
