Immunorel Dosage/Direction for Use

Treatment dosage varies according to the indication and preparation used. IVIG for a patient should be adjusted according to clinical response. The following are dosage schedule guidelines: See table.
Note: Doses and frequency must be based primarily on clinical course and response.

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IVIG should be used with caution in patients with pre-existing renal insufficiency and in patients judged to be at increased risk of developing renal insufficiency (including, but not limited to those with diabetes mellitus, age greater than 65 years, volume depletion, para-proteinemia, sepsis, and patients receiving known nephro-toxic drugs).
In these cases especially it is important to assure that patients are not volume depleted prior to immunoglobulin infusion.
The first infusion of immunoglobulin preparation should start at the initial rate of 0.6 to 1.2 mL/kg of body weight/hour for the first thirty minutes and can be increased up to 2.4 mL/kg of body weight/hour. Subsequent infusion to the same patient may be increased to 4.8 mL/kg of body weight/hour.
The first infusion of immunoglobulin in previously untreated agammaglobulinemic and hypogammaglobulinemic patients may lead to systemic side effects. The nature of these effects has not been fully elucidated. Some of them may be due to the release of pro-inflammatory cytokines by activated macrophages in immunodeficient recipients. Subsequent administration of immunoglobulin to immunodeficient patients as well as to normal individuals usually does not cause further untoward side effects.
Patients should be observed for at least 20 minutes after administration. In case of shock, treatment should follow the guidelines for shock therapy.
Alternative routes of administration: Several intravenous immunoglobulin preparations have been given to patients by alternative routes like intraperitoneal, intrathecal, intraventricular, oral etc. very successfully. Physicians desirous of knowing more on these alternative routes of administration are recommended to refer to relevant literature.
IVIG, in general, has been known to be administered for prophylaxis and treatment of peritoneal infections after major abdominal surgery through intraperitoneal route and through intraventricular route for meningoencephalitis and enterovirus encephalitis.
IVIG has also been administered in patients with primary immunodeficiency syndromes to reduce the risk of repeated infection introduced by repeated connections to permanent indwelling catheters through subcutaneous route.