Dosing in different disorders — Dosing varies depending upon whether the IVIG is administered for the purpose of preventing infections in immunodeficient patients or for suppression of an inflammatory or autoimmune process.
Immune deficiencies — IVIG doses in the range of 400 to 800 mg/kg/month are usually used for replacement therapy in patients with immune deficiencies. Bolus doses may be given every three to four weeks. Typical starting doses are in the range of 400 to 600 mg/kg. Lower weekly doses are used for subcutaneous immunoglobulin replacement therapy (eg, 100 to 150 mg/kg weekly) [33,66]. The use of subcutaneous immune globulin (SCIG), including hyaluronidase- and nonhyaluronidase-containing preparations, is reviewed in detail separately. (See "Subcutaneous and intramuscular immune globulin therapy", section on 'Administration and dosing of SCIG'.)
Dosing of IVIG can be adjusted depending on the patient's progress (eg, frequency of infections). Some patients may need higher or more frequent doses to remain free from acute infections; to control chronic infections, particularly of the sinopulmonary tract; and/or to maintain target serum immunoglobulin G (IgG) levels. As such, dosing is quite variable among patients in that each patient may have their own dosing requirements [63,67]. Compared with subcutaneous dosing given more frequently, bolus IV dosing yields lower serum levels of IgG at the end of each dosing interval as the time for the next dose nears. Some patients will become more susceptible to infections during this period or feel otherwise unwell; this is commonly called "wear-off." (See "Immune globulin therapy in primary immunodeficiency".)
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