intravenous immunoglobulin (ivig) prescribing guidance · intravenous immunoglobulin (ivig)...

Intravenous

Immunoglobulin (IVIg)

prescribing guidance

Kejal Mehta (Pharmacist)

[December 2016]

Review Date: December 2017

Author: Kejal Mehta (Pharmacist) Dec. 2016

Contents

Introduction: ........................................................................................................................................... 2

Prior to Intravenous immunoglobulin (IVIg) prescribing: ....................................................................... 2

1. Approval ...................................................................................................................................... 2

2. Dosing ......................................................................................................................................... 2

3. Prescription ................................................................................................................................. 3

4. Supply .......................................................................................................................................... 3

Appendix A: Demand Management Poster ........................................................................................ 4

Appendix B: Clinician Request form .................................................................................................... 5

Appendix C: Prescription chart ........................................................................................................... 7

Appendix D: IVIg Infusion form ........................................................................................................... 8


Intravenous immunoglobulin (IVIg) prescribing guidance

Introduction

In 2006, the Department of Health initiated “National Demand Management Programme for

Immunoglobulin” to secure the supply of immunoglobulin for patients in the UK in whom it is life-

saving. The supply of IVIg is limited and demand continues to exceed supply therefore a guideline

was developed for a more evidence-based approach to IVIg use. The indications are colour coded to

reflect prioritisation and approval for IVIg treatment.

Prior to Intravenous immunoglobulin (IVIg) prescribing

1. Approval

• Use the Demand Management Poster (Appendix A) to determine which colour the indication

fits in. Indication priority can vary depending on the duration of treatment. These can be

either short term (< 3months) or long term (>3 months) treatments.

Indication Priority Immunoglobulin Assessment Panel (IAP)/ CCG

approval prior to treatment

Red High Automatic approval.

Blue Medium Contact ward/ oncall pharmacist to obtain

Immunoglobulin Assessment Panel approval.

Grey/Black Low (little or no evidence) Contact ward/ oncall pharmacist to obtain

Immunoglobulin Assessment Panel + CCG

approval.

Immunoglobulin Assessment Panel consists of:

Pharmacists: David Heller, Joanne Rhodes, Jane Allen,

Consultants (excluding their own patients): Dr Barry Jackson and Dr Jeff Kimber

• Complete the mandatory Clinician Request form (Appendix B). This must be completed for

all indications. A registrar or above should sign the form. Please return this to pharmacy

ASAP for reimbursement.

2. Dosing

• Use the clinical guideline for dosing regimen for the indication.

http://www.igd.nhs.uk/clinical-info/ (link to guideline)

• Calculate the dose using the actual body weight (kg). (Use dose determining weight (DDW)

if BMI >30kg/m2)

DDW = IBW + 0.4 (actual body weight (kg) – IBW)

IBW for males = 50 + (2.3 x (height in inches – 60))

IBW for females = 45.4 + (2.3 x (height in inches – 60))

• Round each dose to the nearest 5g (dose per day may vary as necessary). Confirm the dose

with the ward/ on call pharmacist.


3. Prescription

• Complete the Prescription Chart (Appendix C) and attach it to the drug chart. Ensure all

relevant boxes are completed.

• Calculate the actual rate (mL/hr) of infusion. Confirm the calculated rates (mL/hr) with a

pharmacist.

Actual rate (mL/hr) = rate required (mL/kg/hr) x patient weight (kg)

• Infusion Form (Appendix D) must be completed by the nurses with batch numbers of every

dose administered and returned to pharmacy.

• Prescribe chlorphenamine 4mg TDS as supportive treatment on PRN side of drug chart and

keep anaphylaxis box available.

4. Supply

• Privigen (100mg/ml) is the ONLY brand kept at SASH. Do NOT dilute

• Working hours: contact the ward pharmacist for screening and supply

• Out of hours: contact the on call pharmacist to confirm all the above before obtaining

supply from the emergency drug cupboard.

Author: Kejal Mehta (Pharmacist) Dec. 2016 4

Appendix A: Demand Management Poster


5

Appendix B: Clinician Request form


6


Kg

Kg

mL/kg/hr Actual rate

(mL/hr)

0.3

0.6

1.2

2.4

4.8

0.3

0.6

1.2

2.4

4.8

0.3

0.6

1.2

2.4

4.8

0.3

0.6

1.2

2.4

4.8

0.3

0.6

1.2

2.4

4.8

Author: Kejal Mehta Created 12/2016

Atta

ch p

rescrip

tion to

pa

tien

t dru

g ch

art

(IBW (males)= 50+ (2.3x height in inches - 60))

(IBW (females)= 45.5+ (2.3x height in inches - 60))

Appendix C. Prescription and administration chart for Intravenous Immunoglobulin infusion (Privigen 100mg/ml Solution)

Patient name

(Use DDW If BMI>30kg/m2, Otherwise use Actual weight)

Monitor temperature, blood pressure, respiratory rate, heart rate and signs of anaphylaxis throughout. (Anaphylaxis box must be available)

Day Date Time Dose (g) Volume

(mL)

(Do not

dilute)

Calculated infusion rates

(increase rate every 30 mins

if tolerated)

Prescriber

Signature

and reg. no.

Allergies

Date

of

admin

Start

time

Given by/

checked

by

Batch number/expiry date Pharm

.

2

1

3

4

5

DOB

Hospital no.

Actual body weight (ABW)

Dose-determining weight (DDW)

Calculate DDW= IBW+ 0.4 (ABW - IBW)

Each dose to be rounded to the nearest 5g

Dosing Regime

as per

guideline

Indication

Appendix C:

Prescription char


Appendix D: IVIg Infusion form

(Nurses to stick batch numbers and must be returned to pharmacy once complete)

Trust ID NHS / CHI no

Infusion

Date Product Batch No.

Grams

per Vial

Vial

Count

Total

Grams

-

-

-

-

-

-

-

-

(Patient details)

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