RHESUGAM IM

Indications

• Primary immunodeficiency disorders
• Secondary immunodeficiency disorders
• Autoimmune diseases such as Guillain-Barré syndrome and systemic lupus erythematosus
• Certain infections including hepatitis A and measles
• Prevention of hemolytic disease of the newborn

Dosage

Children: Refer to the BNF for Children for appropriate dosing information tailored to the specific needs and conditions of pediatric patients.

Adults: Refer to the BNF for specific dosing guidelines based on the condition being treated.

Mechanism of action

Immunoglobulins function by recognizing specific antigens on pathogens and forming immune complexes. This leads to neutralization of the pathogen, opsonization for enhanced phagocytosis, and activation of the complement system. Immunoglobulin G (IgG) is the most abundant and provides the majority of antibody-based immunity against invading pathogens.

Pharmacodynamics

The pharmacodynamic effects of immunoglobulin include the enhancement of opsonization and phagocytosis, neutralization of toxins and viruses, and modulation of immune responses. They can also have anti-inflammatory effects and may reduce the severity of autoimmune responses in certain conditions.

Pharmacokinetics

Immunoglobulins are administered intravenously or subcutaneously, leading to a rapid increase in serum immunoglobulin levels. The half-life of immunoglobulin varies, typically ranging from 21 to 30 days. They are distributed widely in body fluids and tissues, and are eventually metabolized by the liver and eliminated through the kidneys.

Contra-indications

• Hypersensitivity to immunoglobulin products
• Severe hyperprolinemia (for specific formulations)
• IgA deficiency with antibodies against IgA (for specific formulations)

Adverse effects

• Headache
• Fever
• Nausea
• Rash
• Myalgia
• Chills
• Anaphylactic reactions
• Thromboembolic events
• Hemolytic anemia

Interactions

• Live attenuated vaccines may be less effective when given concurrently. It is advisable to delay vaccination for at least 3 months after administration of immunoglobulin.
• Caution should be exercised when used with anticoagulants due to potential increased risk of bleeding.

Precautions

• Monitor for signs of allergic reactions, especially in patients with a history of anaphylaxis.
• Use with caution in patients with renal impairment or a history of thromboembolic events.
• Injection site reactions may occur; proper administration techniques should be employed.

Pregnancy

Immunoglobulin can be used during pregnancy when clinically indicated, as it is generally considered safe.

Breast-feeding

Immunoglobulin is excreted in human breast milk but is not known to cause any adverse effects in nursing infants.

Storage

Store between 2°C and 8°C. Do not freeze. Protect from light. Once opened, use promptly as instructed.

Formulations

• Intravenous immunoglobulin (IVIG)
• Subcutaneous immunoglobulin (SCIG)
• Intramuscular immunoglobulin (IMIG)