Select a medication above to begin.
Gamunex-C
immune globulin (human)
Black Box Warnings .
Thrombosis
may occur w/ immune globulin products; risk factors incl. advanced age, prolonged immobilization, hypercoagulable conditions, venous or arterial thrombosis hx, estrogen use, indwelling central vascular catheter, hyperviscosity, and cardiovascular dz risk; thrombosis may occur in pts w/o risk factors; ensure adequate hydration before admin; give minimum dose at lowest infusion rate practicable in pts at risk; monitor for s/sx thrombosis and assess blood viscosity in pts w/ hyperviscosity risk
Renal Dysfxn/Acute Renal Failure
renal dysfxn, acute renal failure, osmotic nephrosis, and death reported w/ intravenous immune globulin (IVIG) use; pts predisposed to acute renal failure incl. those w/ pre-existing renal impairment, diabetes mellitus, volume depletion, sepsis, paraproteinemia, >65 yo, or receiving nephrotoxic drugs; ensure adequate hydration before admin; admin. IVIG at minimum dose and lowest infusion rate practicable in pts at risk; IVIG products containing sucrose as stabilizer accounted for disproportionate share of renal dysfxn/failure cases; this product does not contain sucrose
Adult Dosing .
Dosage forms: INJ
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing
primary immunodeficiency
- [IV route]
- Dose: 300-600 mg/kg/dose IV q3-4wk; Info: adjust dose based on trough IgG levels and clinical response; give 400 mg/kg/dose IV x1 ASAP if measles exposure; if maint. dose <400 mg/kg/dose IV q3-4wk and measles exposure risk, give 400 mg/kg/dose IV x1 just prior to exposure
- [SC route]
- Dose: weekly SCIG dose = [last IVIG dose (mg) x1.37] divided by last IVIG dosing interval (wk); Start: 1wk after receiving last IVIG dose; Info: adjust dose based on trough IgG levels and clinical response; consider additional dose if measles exposure; consider incr. maint. dose if measles exposure risk
idiopathic thrombocytopenic purpura
- [1000 mg/kg/dose IV x1 on day 1, may give additional dose x1 on subsequent day]
- Alt: 400 mg/kg/dose IV qd x5 days; Info: may repeat q3-4wk prn
chronic inflammatory demyelinating polyneuropathy
- [1000 mg/kg/dose IV q3wk]
- Start: 2000 mg/kg/total dose IV divided over 2-4 days, infused daily; Alt: 500 mg/kg/dose IV qd x2 days, given q3wk
secondary immunodeficiency, B-CLL assoc. (off-label)
- [400 mg/kg/dose IV q3-4wk]
myasthenia gravis (off-label)
- [400 mg/kg/dose IV qd x5 days]
- Max: 1000 mg/kg/day; Alt: 1000 mg/kg/dose IV qd x2 days
renal dosing
- [see below]
- renal impairment: not defined, caution advised; Info: use minimum dose and infusion rate practicable
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing
primary immunodeficiency
- [IV route]
- Dose: 300-600 mg/kg/dose IV q3-4wk; Info: adjust dose based on trough IgG levels and clinical response; give 400 mg/kg/dose IV x1 ASAP if measles exposure; if maint. dose <400 mg/kg/dose IV q3-4wk and measles exposure risk, give 400 mg/kg/dose IV x1 just prior to exposure
- [SC route, 2 yo and older]
- Dose: weekly SCIG dose = [last IVIG dose (mg) x1.37] divided by last IVIG dosing interval (wk); Start: 1wk after receiving last IVIG dose; Info: adjust dose based on trough IgG levels and clinical response; consider additional dose if measles exposure; consider incr. maint. dose if measles exposure risk
idiopathic thrombocytopenic purpura
- [800-1000 mg/kg/dose IV x1]
- Alt: 1000 mg/kg/dose IV qd x1-2 days or 400 mg/kg/dose IV qd x5 days; Info: may repeat q3-4wk prn
secondary immunodeficiency, B-CLL assoc. (off-label)
- [400 mg/kg/dose IV q3-4wk]
Kawasaki dz (off-label)
- [2000 mg/kg/dose IV x1]
- Start: w/in 7-10 days of dz onset; Info: give w/ aspirin; may consider repeat dose x1 if s/sx persist
renal dosing
- [see below]
- renal impairment: not defined, caution advised; Info: use minimum dose and infusion rate practicable
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- caution: IgA deficiency
- caution: nephrotoxic agent use, concurrent
- caution: pts >65 yo
- caution: renal impairment
- caution: renal impairment risk
- caution: paraproteinemia
- caution: migraine hx
- caution: thrombosis risk
- caution: hyperviscosity
- caution: A blood group
- caution: AB blood group
- caution: B blood group
- caution: inflammatory disorder
- caution: high-dose use
- caution: volume overload (ITP use)
Drug Interactions .
Overview
immune globulin
immunoglobulin
- immunomodulatory effects (immune globulin)
- nephrotoxicity
- thrombogenic effects
- monitor renal fxn; nephrotoxicity risk may be higher w/ sucrose-containing immune globulins, may vary depending on route of admin.
Contraindicated
- cidofovir
Avoid/Use Alternative
- aldesleukin
- amikacin
- amikacin inhaled
- bumetanide
- clofarabine
- efgartigimod alfa
- ethacrynic acid
- foscarnet
- furosemide
- ganciclovir
- gentamicin
- immune globulin
- mannitol
- methotrexate
- oxaliplatin
- pentamidine
- polymyxin B
- pozelimab
- rozanolixizumab
- streptomycin
- streptozocin
- tenofovir disoproxil
- tobramycin
- tobramycin inhaled
- torsemide
- tranexamic acid
- vaccinia immune globulin
- valganciclovir
Monitor/Modify Tx
- abemaciclib
- abrocitinib
- acyclovir
- adefovir dipivoxil
- adenovirus vaccine, live
- aflibercept
- alectinib
- aliskiren
- amiloride
- aminocaproic acid
- amphotericin
- angiotensin II
- anthrax immune globulin
- anti-inhibitor coagulant complex
- antihemophilic factor (factor VIII)/von Willebrand factor complex
- asciminib
- asparaginase
- aspirin
- atidarsagene autotemcel
- auranofin
- avatrombopag
- axitinib
- azilsartan medoxomil
- balsalazide
- baricitinib
- bazedoxifene
- benazepril
- bevacizumab
- binimetinib
- bleomycin
- botulism immune globulin
- brolucizumab
- C1 esterase inhibitor
- cabozantinib
- calaspargase
- candesartan cilexetil
- capecitabine
- captopril
- carboplatin
- carfilzomib
- celecoxib
- chlorothiazide
- chlorthalidone
- chorionic gonadotropin
- cisplatin
- clindamycin
- clozapine
- coagulation factor IX
- coagulation factor VIIa
- coagulation factor XIII A-subunit
- colistimethate
- concizumab
- creatine
- cyclophosphamide
- cyclosporine
- cytomegalovirus immune globulin
- danazol
- darbepoetin alfa
- deferasirox
- deferoxamine
- deflazacort
- dengue vaccine, live
- desogestrel (contraceptive)
- deuruxolitinib
- dexamethasone
- diclofenac
- diclofenac topical
- dienogest (contraceptive)
- diflunisal
- drospirenone (contraceptive)
- drospirenone (hormone replacement)
- eltrombopag
- enalapril
- enalaprilat
- epirubicin
- epoetin alfa
- estetrol (contraceptive)
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- ethynodiol (contraceptive)
- etodolac
- etonogestrel (contraceptive)
- everolimus
- exenatide
- factor XIII concentrate
- faricimab
- fedratinib
- fenofibrate
- fenofibric acid
- fenoprofen
- fitusiran
- flucytosine
- flurbiprofen
- follitropin
- fosinopril
- fruquintinib
- hepatitis B immune globulin
- hydrochlorothiazide
- ibuprofen
- ibuprofen lysine
- ifosfamide
- indapamide
- indomethacin
- iohexol
- iomeprol
- iopamidol
- irbesartan
- ketoprofen
- ketorolac
- lazertinib
- lenalidomide
- lenvatinib
- levonorgestrel (contraceptive)
- levonorgestrel (hormone replacement)
- lifileucel
- liraglutide
- lisinopril
- lithium
- losartan
- luspatercept
- lusutrombopag
- lutetium Lu 177 vipivotide tetraxetan
- magnesium citrate
- magnesium salicylate
- measles/mumps/rubella vaccine, live
- meclofenamate
- medroxyprogesterone (contraceptive)
- medroxyprogesterone (hormone replacement)
- mefenamic acid
- megestrol
- meloxicam
- menotropins
- mesalamine
- mesalamine rectal
- methoxy polyethylene glycol-epoetin beta
- methyltestosterone
- metolazone
- mitomycin
- moexipril
- momelotinib
- nabumetone
- naproxen
- necitumumab
- neomycin
- nintedanib
- norelgestromin (contraceptive)
- norethindrone (contraceptive)
- norethindrone acetate (hormone replacement)
- norgestimate (contraceptive)
- norgestimate (hormone replacement)
- norgestrel (contraceptive)
- nusinersen
- olaparib
- olmesartan medoxomil
- olsalazine
- ospemifene
- oxaprozin
- pacritinib
- pamidronate
- paromomycin
- pazopanib
- pegaspargase
- pemetrexed
- penicillamine
- pentostatin
- perindopril
- piroxicam
- plazomicin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pomalidomide
- ponatinib
- porfimer
- progesterone (hormone replacement)
- progesterone vaginal (hormone replacement)
- prothrombin complex concentrate (human)
- quinapril
- raloxifene
- ramipril
- ramucirumab
- ranibizumab
- ravulizumab
- Rho(D) immune globulin
- ritlecitinib
- rituximab
- romiplostim
- ropeginterferon alfa-2b
- ruxolitinib
- ruxolitinib topical
- salsalate
- segesterone (contraceptive)
- sipuleucel-T
- sirolimus
- sitagliptin
- sodium tetradecyl sulfate
- sotatercept
- sparsentan
- spironolactone
- sulfate bowel prep
- sulindac
- sunitinib
- tacrolimus
- tamoxifen
- telavancin
- telmisartan
- temsirolimus
- tenofovir alafenamide
- testosterone
- thalidomide
- tiopronin
- tivozanib
- tofacitinib
- tolmetin
- toremifene
- trametinib
- trandolapril
- tretinoin
- triamterene
- upadacitinib
- vadadustat
- valacyclovir
- valoctocogene roxaparvovec
- valsartan
- vamorolone
- vancomycin
- varicella vaccine, live
- varicella zoster immune globulin
- voclosporin
- von Willebrand factor
- vorinostat
- ziv-aflibercept
- zoledronic acid
- zonisamide
Caution Advised
- eculizumab
Adverse Reactions .
Serious Reactions
- hypersensitivity rxn, severe
- anaphylaxis
- Stevens-Johnson syndrome
- erythema multiforme
- nephrotoxicity
- hyperproteinemia
- hyponatremia
- pseudohyponatremia
- hyperviscosity
- thromboembolism
- aseptic meningitis
- hemolytic anemia
- transfusion-related acute lung injury
- viral transmission risk
Common Reactions
- headache
- cough
- injection site rxn (SC use)
- infusion rxn (IV use)
- nausea
- vomiting
- rash
- urticaria
- fever
- rigors
- flushing
- back pain
- fatigue
- asthenia
- chest tightness
- muscle cramps
- blood pressure lability
- URI
- BUN or Cr elevated
Safety/Monitoring .
Monitoring Parameters
BUN/Cr at baseline, then periodically; urine output if acute renal failure risk; vital signs during infusion; blood viscosity at baseline, s/sx thrombosis if hyperviscosity risk; consider Hgb or Hct at baseline, then w/in 36h, then 7-10 days post-infusion if hemolysis risk
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; no known risk of fetal harm based on human data
Lactation
Clinical Summary
may use while breastfeeding; no known risk of infant harm based on human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: other; CYP450: unknown
Excretion: other; Half-life: 20-72 days; Info: half-life varies among pts
Subclass: Immunoglobulins ; Myasthenia Gravis ; Neuropathy/Neuralgia
Mechanism of Action
exact mechanism of action unknown; reestablishes normal immunoregulatory pathways
Formulary .
No Formulary Selected
Join Now to View Patient Handouts!
Create a FREE epocrates Online account to access patient medication instructions. Your patients and caregivers will appreciate you printing these friendly handouts, available in English and Spanish. Each handout addresses common concerns such as how to take the medication, and possible side effects.
Current Members: Sign In.
Pill Pictures
Join Now to View Pill Pictures!
Create a FREE epocrates Online account to access full-color images of medications within the drug monograph.
Current Members: Sign In.