NORMAL IMMUNOGLOBULIN MAY BE USED TO CONTROL OUTBREAKS OF HEPATITIS A, THE RECOMMENDED INTRAMUSCULAR DOSE FOR CLOSE CONTACTS BEING 250 MG IN THOSE UNDER 10 YEARS OF AGE AND 500 MG IN OLDER CHILDREN AND ADULTS. IT MAY ALSO BE USED FOR PROPHYLAXIS AGAINST HEPATITIS A IN IMMUNOCOMPROMISED PATIENTS IF THEIR RESPONSE TO HEPATITIS A VACCINE IS UNLIKELY TO BE ADEQUATE.
NORMAL IMMUNOGLOBULIN MAY BE USED TO PREVENT OR POSSIBLY MODIFY AN ATTACK OF MEASLES IN CHILDREN AND ADULTS AT SPECIAL RISK (SUCH AS THOSE WHO ARE IMMUNOCOMPROMISED) BUT SHOULD BE GIVEN AS SOON AS POSSIBLE AFTER CONTACT WITH MEASLES. IN THE UK RECOMMENDED DOSES, GIVEN INTRAMUSCULARLY, FOR THE PREVENTION OF AN ATTACK ARE 250 MG FOR THOSE UNDER 1 YEAR OF AGE, 500 MG FOR THOSE AGED 1 TO 2 YEARS, AND 750 MG FOR THOSE AGED 3 YEARS AND OVER; TO MODIFY AN ATTACK, RECOMMENDED DOSES ARE 100 MG FOR THOSE UNDER 1 YEAR OF AGE AND 250 MG FOR OLDER CHILDREN.
NORMAL IMMUNOGLOBULIN DOES NOT PREVENT RUBELLA INFECTION AND IS NOT RECOMMENDED FOR THE PROTECTION OF PREGNANT WOMEN EXPOSED TO RUBELLA; IT SHOULD ONLY BE CONSIDERED WHERE TERMINATION OF PREGNANCY IS UNACCEPTABLE. THE DOSE IS 750 MG BY INTRAMUSCULAR INJECTION.
NORMAL IMMUNOGLOBULIN MAY BE USED IN THE MANAGEMENT OF PATIENTS WITH PRIMARY ANTIBODY DEFICIENCIES SUCH AS CONGENITAL AGAMMAGLOBULINAEMIA, HYPOGAMMAGLOBULINAEMIA, OR IMMUNOCOMPROMISED PATIENTS INCLUDING THOSE WITH IMMUNODEFICIENCY SYNDROMES; THE IMMUNOGLOBULIN IS GIVEN TO PROVIDE PROTECTION AGAINST INFECTIOUS DISEASES THAT SUCH PATIENTS MAY SUFFER. THE INTRAMUSCULAR PREPARATION HAS BEEN USED BUT THE INTRAVENOUS ROUTE IS USUALLY PREFERRED SINCE ADMINISTRATION IS LESS PAINFUL FOR THE DOSES REQUIRED. ALTERNATIVELY, THE SUBCUTANEOUS ROUTE MAY BE USED. FOR INTRAVENOUS INFUSION THE DOSE, EXPRESSED IN TERMS OF WEIGHT (PROTEIN OR IMMUNOGLOBULIN G CONTENT), IS USUALLY 400 TO 800 MG/KG INITIALLY, THEN 200 MG/KG EVERY 3 WEEKS ADJUSTED AS NECESSARY ACCORDING TO TROUGH-IMMUNOGLOBULIN CONCENTRATIONS; THE MAINTENANCE DOSE IS USUALLY 200 TO 800 MG/KG PER MONTH. IN PATIENTS WITH SECONDARY IMMUNODEFICIENCY SYNDROMES, DOSES OF 200 TO 400 MG/KG EVERY 3 TO 4 WEEKS HAVE BEEN RECOMMENDED. OTHER DOSAGE REGIMENS HAVE BEEN USED. SUBCUTANEOUS DOSES ARE 200 TO 500 MG/KG AS AN INITIAL LOADING DOSE (DIVIDED OVER SEVERAL DAYS), FOLLOWED BY MAINTENANCE DOSES AT REPEATED INTERVALS TO ACHIEVE A CUMULATIVE MONTHLY DOSE OF 400 TO 800 MG/KG. WHEN INFUSED INTRAVENOUSLY, NORMAL IMMUNOGLOBULIN SHOULD ALWAYS BE GIVEN VERY CAREFULLY AND SLOWLY WITH GRADUAL INCREASES IN THE RATE OF ADMINISTRATION.
FOR PROPHYLAXIS OF INFECTION AFTER BONE MARROW TRANSPLANTATION, NORMAL IMMUNOGLOBULIN IS GIVEN INTRAVENOUSLY IN A DOSE OF 500 MG/KG WEEKLY, ADJUSTED ACCORDING TO RESPONSE.
INTRAVENOUS INFUSION OF NORMAL IMMUNOGLOBULIN IS ALSO USED TO RAISE THE PLATELET COUNT IN PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA. DOSES OF 400 MG/KG ARE GIVEN DAILY FOR 2 TO 5 CONSECUTIVE DAYS. ALTERNATIVELY, A DOSE OF 800 TO 1000 MG/KG MAY BE GIVEN ON DAY 1 AND REPEATED ON DAY 3 IF NECESSARY. FURTHER DOSES MAY BE GIVEN AS NECESSARY.
FOR KAWASAKI DISEASE, NORMAL IMMUNOGLOBULIN (USED WITH ASPIRIN) IS GIVEN INTRAVENOUSLY IN A DOSE OF 1.6 TO 2 G/KG IN DIVIDED DOSES OVER 2 TO 5 DAYS, OR 2 G/KG GIVEN AS A SINGLE DOSE. SIMILAR DOSES OF INTRAVENOUS NORMAL IMMUNOGLOBULIN HAVE BEEN TRIED IN A RANGE OF DISORDERS BELIEVED TO HAVE AN AUTO-IMMUNE ORIGIN. THE PRECISE MODE OF ACTION OF NORMAL IMMUNOGLOBULIN IN SUCH DISORDERS IS UNKNOWN.
FOR THE TREATMENT OF GUILLAIN-BARRΓ SYNDROME, NORMAL IMMUNOGLOBULIN IS GIVEN INTRAVENOUSLY IN A DOSE OF 400 MG/KG FOR 5 CONSECUTIVE DAYS, REPEATED EVERY 4 WEEKS IF REQUIRED.