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Intragam P

Generic Name: Immunoglobulin, normal (human)
Product Name: Intragam P

Indication

Intragram P is used as replacement IgG therapy in:
- primary immunodeficiency
- myeloma and chronic lymphatic leukaemia with severe secondary hypogammaglobulinaemia and recurrent infections
- congenital acquired immune deficiency syndrome with recurrent infections
It is used as immunomodulatory therapy in:
- idiopathic thrombocytopaenic purpura (ITP), to correct platelet count when there is high risk of bleeding or prior to surgery
- allogeneic bone marrow transplantation
- Kawasaki disease
- Guillain-Barre syndrome

Action

Intragram P consists of normal human immunoglobulin, which is usually found in the body. Immunoglobulins are proteins produced by plasma cells (white blood cells) to aid in fighting infection. They take part in various immune responses to bacteria or foreign material, including modulation of the inflammatory response and regulation of specific immune responses. Because of these and a large range of other effects, normal immunoglobulin is used for a variety of indications, including treatment of infection in immunodeficiency states and immunomodulatory therapy.

Dose advice

Intragram P may be infused undiluted, or may be diluted with up to two parts of normal saline 0.9% or glucose 5%. Infusion should begin at a rate of 1ml/min, gradually increasing after 15 minutes to a rate of 3-4ml/min over a further 15 minutes. Rate should be reduced in the elderly and patients with renal insufficiency.
Replacement therapy
- optimal dose and frequency must be determined for each individual patient
- a serum IgG level above 5g/L usually protects from bacterial infection
- most patients receive 0.2-0.6g/kg every month, in a single dose or two equal doses fortnightly
- higher doses may be required following initial diagnosis (0.4-0.6g/kg for several months)
Immunomodulatory therapy
Optimal dose for each patient should be determined individually.
ITP
- maximum total cumulative dose is 2g/kg over 2-5 days
- adjustment of dose and dose interval should be made based on clinical state
Kawasaki disease
- 1.6-2g/kg in divided doses over 2-5 days; or
- 2g/kg as a single dose
- concomitant treatment with aspirin is recommended
Allogeneic bone marrow transplantation
- Intragram P can be used as part of the conditioning regime and after the transplant
- starting dose of 0.5g/kg/week is recommended
Guillain-Barre syndrome
- 0.4g/kg/day for 5 days
Administration
- Intragram P contains no antibacterial agents so must be used on opening
- any unused portion should be discarded
- the preparation should be allowed to warm to room temperature before administration

Schedule

S4

Common side effects

Side effects are more common in patients who have never received normal human immunoglobulin before. They include:
- headache
- migraine
- excessive destruction of red blood cells leading to transient anaemia
- nausea
- fever/rigors
- abdominal pain
- facial flushing
- shortness of breath
- skin rash
If any of these reactions occur during treatment, the infusion will be temporarily stopped and recommenced at a slower rate once the patient has stabilised.

Uncommon side effects

Some less common reactions include:
- vertigo
- fatigue
- depletion of white blood cells
- depletion of platelets
- muscle ache
- oversleeping
- vomiting
- increased blood pressure
- inflammation of the site of injection
Allergic reactions are uncommon, but the symptoms are important and should be immediately reported to your doctor:
- hives
- angioedema (widespread red swelling)
- wheezing and trouble breathing
- severely lowered blood pressure
If these symptoms occur the treatment will be immediately stopped and reversing agents given.

 

For further information talk to your doctor.

Dates

Posted On: 22 July, 2003
Modified On: 22 July, 2003


Created by: myVMC