BNF advice on Immunoglobulins

Normal immunoglobulin

• 250mg vial, 750mg vial

Notes

1. Human normal immunoglobulin preparations for hepatitis A, measles, polio and rubella and specific immunoglobulin preparations for hepatitis B, rabies and varicella-zoster for intramuscular use are issued by the Communicable Disease Surveillance Centre (CDSC) and by certain regional HPA and NHS laboratories.

Antithymocyte Immunoglobulin (Rabbit) (Sanofi)

• Powder and solvent for solution for infusion vials 25mg

Notes

1. NICE TA481: Rabbit anti-human thymocyte immunoglobulin (Thymoglobuline) is not recommended as an initial option to prevent organ rejection in adults having a kidney transplant. (October 2017)
2. NICE TA482: Rabbit anti-human thymocyte immunoglobulin is not recommended as an initial option to prevent organ rejection in children and young people having a kidney transplant. (October 2017)

Antithymocyte Immunoglobulin (Rabbit) (Fresenius)

• Concentrate for solution for infusion vials 100mg in 5ml (unlicensed preparation)

Antithymocyte Immunoglobulin (Equine) (Pfizer)

• Concentrate for solution for infusion vials 50mg in 1ml (unlicensed preparation)

Disease-specific immunoglobulins

Hepatitis B immunoglobulin

• Advice on the usage and availability can be obtained from on call Microbiologist via Trust switchboard.

Rabies immunoglobulin

• Advice on the usage and availability can be obtained from the Consultant in Communicable Disease Control (CCDC) via on call Microbiologist.

Tetanus immunoglobulin

• Available in A&E department.
• Advice on the usage and availability can be obtained from on call Microbiologist.

Varicella-Zoster immunoglobulin (VZIG)

• Advice on the usage and availability can be obtained from on call Microbiologist.

Notes

1. Varicella–zoster immunoglobulin is recommended for individuals who are at increased risk of severe varicella and who have no antibodies to varicella–zoster virus and who have significant exposure to chickenpox or herpes zoster. Those at increased risk include:
   1. Neonates whose mothers develop chickenpox in the period 7 days before to 7 days after delivery;
   2. Susceptible neonates exposed in the first 7 days of life;
   3. Susceptible neonates or infants exposed whilst requiring intensive or prolonged special care nursing;
   4. Susceptible women exposed at any stage of pregnancy (but when supplies of VZIG are short, may only be issued to those exposed in the first 20 weeks' gestation or to those near term) providing VZIG is given within 10 days of contact;
   5. Immunocompromised individuals including those who have received corticosteroids in the previous 3 months at the following dose equivalents of prednisolone; children 2 mg/kg daily for at least 1 week or 1mg/kg daily for 1 month; adults about 40 mg daily for more than 1 week.
2. Please refer to Varicella (The Green Book; Chapter 34) for further information, including dosing and treatment regimens
3. Western Locality: If VZIG is required the prescriber should send the prescription to Derriford Hospital pharmacy.
   1. In an emergency Derriford Hospital pharmacy will dispense this from an emailed prescription. plh-tr.pharmacydispensary@nhs.net
   2. Prior to emailing this must be discussed and agreed with the pharmacy department, if out of hours the on-call pharmacist must be contacted via switchboard.
   3. The original prescription must then be received by them.
   4. Derriford Hospital pharmacy will have it dispensed and sent to the practice via courier the following day
   5. Alternatively, it may be collected from them by a nominated person on behalf of the patient.
   6. It is dispensed from the hospital Pharmacy NOT the Lloyds Pharmacy on site
4. Please write indication on the prescription and confirm it is in line with the recommendations above/Green Book or as agreed with consultant microbiologist
5. If the consultant microbiologist is contacted, they will need to know:
   1. The underlying condition of the patient
   2. Gestation if pregnant
   3. Date and circumstances of contact
   4. Any previous history of chickenpox or shingles
   5. A contact number for results if susceptibility testing is performed

Anti-D immunoglobulin

Human Anti-D immunoglobulin

• Refer to Trust Guidelines for the use of Anti-D immunoglobulin in pregnancy

Notes

1. NICE TA156: Routine antenatal anti-D prophylaxis (RAADP) is recommended as a treatment option for all pregnant women who are rhesus D (RhD) negative and who are not known to be sensitised to the RhD antigen. (August 2008)

Normal immunoglobulins for subcutaneous use

Cuvitru 20%

• 1g (5ml), 2g (10ml), 4g (20ml), 8g (40ml)

Gammanorm 16.5%

• 1.65g (10ml), 3.3g (20ml)

Notes

1. For use in University Hospitals Plymouth NHS Trust

Hizentra 20%

• 1g (5mL), 2g (10mL), 4g (20mL)

Notes

1. For use in University Hospitals Plymouth NHS Trust

HyQvia 10%

• 2.5g (25ml), 5g (50ml), 10g (100ml), 20g (200ml), 30g (300ml)

Subcuvia 16%

• 800mg (5ml), 1.6g (10ml)

Notes

1. For use in University Hospitals Plymouth NHS Trust

Subgam 14% - 18%

• 250mg, 750mg, 1.5g vial (University Hospitals Plymouth NHS Trust)
• 1.5g vial (Torbay and South Devon NHS Foundation Trust)

Normal immunoglobulins for intravenous use

Flebogamma DIF 5%

• 2.5g (50ml), 5g (100ml), 10g (200ml)

Gammaplex 5%

• 5g (100ml), 10g (200ml)

Notes

1. For use in University Hospitals Plymouth NHS Trust

Gamunex 10%

• 5g (50ml), 10g (100ml), 20g (200ml)

Notes

1. For use in University Hospitals Plymouth NHS Trust

Intratect 10%

• 5g (100ml), 10g (200ml)

Notes

1. For use in University Hospitals Plymouth NHS Trust

Iqymune 10%

• 2g (20ml), 5g (50ml), 10g (100ml), 20g (200ml)

Kiovig 10%

• 1g (10ml), 2.5g (25ml), 5g (50ml), 10g (100ml), 20g (200ml), 30g (300ml)

Notes

1. For use in University Hospitals Plymouth NHS Trust

Octagam 10%

• 5g (50ml), 10g (100ml), 20g (200ml)

Notes

1. For use in University Hospitals Plymouth NHS Trust

Privigen 10%

• 5g (50ml), 10g (100ml), 20g (200ml)