Implement Strategies to Tackle the IVIG Shortage

Dwindling supplies will lead to questions about how to handle the intravenous immune globulin (IVIG) shortage.

The shortage seems to be due to demand that is outpacing plasma donations...plus long manufacturing times.

Expect your hospital to reserve IVIG for severe acute cases, such as Guillain-Barre, Kawasaki disease, or myasthenia gravis crisis. You may also see IVIG alternatives when possible...such as plasmapheresis.

When alternatives can't be used, think of these strategies to help maintain your supply.

Use ideal body weight for IVIG doses. Some hospitals use adjusted for obese patients...but consider switching to ideal. There's no proof using adjusted body weight in obesity leads to better outcomes.

Round doses down to the nearest vial size, if able.

Don't assume a total of 2 g/kg is always needed. For example, give 1 g/kg if treating immune thrombocytopenia (ITP). Save the second 1 g/kg dose for patients whose platelets don't start rising by the next day.

Consider sending multiple bottles for nurses to hang in succession...rather than the whole dose in 1 bag. This way, if a patient has a reaction, the remaining bottles aren't wasted.

But ensure measures are in place to avoid errors. For example, educate nurses...and label bottles "Bottle 1 of 3," etc.

Generally feel comfortable switching between products. But consider safety strategies. For example, monitor patients more closely, since reactions can occur when starting a new IVIG product.

Be aware that acute kidney injury with IVIG may be less of a concern now that the last sucrose-based product, Carimune NF, is off the market.

For infusion center patients on chronic IVIG for primary immune deficiency, check a serum IgG level. During shortages, consider if a dose can be delayed when levels are maintained above 500 mg/dL.

Also be aware that infusion center patients may need a new prior auth for each product switch.

Get our chart, Comparison of Immune Globulin Products, to see how agents stack up, including new products Asceniv and Xembify.

Key References

  • www.ashp.org/Drug-Shortages/Current-Shortages/Drug-Shortage-Detail.aspx?id=527 (08-22-19)
  • Ann Pharmacother 2017;51(2):135-9
  • Clin Exp Immunol 2017;188(3):353-62
  • Am J Health Syst Pharm 1998;55(20):2090, 2093
Hospital Pharmacist's Letter. September 2019, No. 350922



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