This information sheet answers some of the common questions patients ask about IVIg. Further information can be found from your consultant neurologist, specialist nurse or pharmacist.

What is intravenous immunoglobulin (IVIg)

Immunoglobulin treatment is often helpful for autoimmune conditions like myasthenia gravis, where the body's immune system attacks the body.

Immunoglobulins are proteins produced naturally by the body's immune system to fight off infections. IVIg is a blood product which combines immunoglobulins from many human blood donors. It is not clear exactly how IVIg works, but it is known to prevent the immune system from attacking the body's own tissues. By dampening down the autoimmune process, the aim is to stop myasthenia getting worse and improve your symptoms.

Why am I being prescribed IVIg?

IVIg is used in the treatment of myasthenia gravis when there is a need for a fast response, often while waiting for other medications for myasthenia to take effect. It can also be used as a "rescue" treatment in the event of an acute relapse of symptoms.

When and how do I take IVIg?

IVIg is given intravenously into a vein via an infusion pump. The treatment will be administered in hospital. The infusion will take several hours as the drug has to be given slowly. The rate of the infusion can be gradually increased, to a maintenance level, provided there are no problems.

You should be observed closely and regularly have your blood pressure, pulse and temperature checked. After the infusion has finished you should be observed for any side effects.

The dose of IVIg is calculated according to your weight. Some people will need to attend every day for 5 days and others every 3 days. In rare circumstances some people require the treatment to be repeated on a regular basis.

How long with IVIg take to work?

Each person's response to IVIg varies. If IVIg is to have an effect on your myasthenia, it may take up to 4 weeks for you to notice any improvement in your symptoms. Some people, however, do not respond to this treatment. If this is the case, you and your doctor will discuss alternatives.

What are the possible risks or side effects?

People receiving IVIg may occasionally experience (during or after the infusion) a chill, headache, abdominal pain, fever, nausea, vomiting and joint pain - particularly lower back pain. If they occur during the infusion, the infusion may be slowed down or stopped. Occasionally people may experience an allergic reaction or their blood pressure drops (sometimes causing them to feel faint or light-headed). They may develop itchy skin, swelling of the face and throat, and have difficulty breathing. Very occasionally IVIg can cause a rise in blood pressure.

A nurse should monitor you during the infusion but please report any new symptoms during or after the infusion.

These reactions occur only in a minority of patients.

Rarely, people receiving IVIg may experience a rash or abnormalities in liver function (detected by blood tests), but these usually settle quickly. Other rare side effects can also occur. These include acute kidney failure, inflammation of the brain (aseptic meningitis), and a type of anaemia called haemolytic anaemia which will recover with time. All these rare side effects are treatable.

The administration of IVIg can very rarely be associated with conditions cause by increased clotting of the blood - heart attack, stroke, and blood clots in the lung (pulmonary embolism) or legs (deep venous thrombosis, or DVT).

All blood donors have been screened to make sure that they have no serious conditions which can be passed on to you - all are negative for hepatitis B, hepatitis C and human immunodeficiency virus (HIV).

However, it is impossible to eliminate completely the risk of passing on infections, for example with an unknown virus.

May I take other medicines along with IVIg?

IVIg does not usually interfere with other medications. However, you must tell your doctor which medicines you are currently taking, including over-the-counter preparations and herbal remedies.

Can I have immunisations while on IVIg?

IVIg may alter the effect of a vaccine. Therefore it is best to avoid vaccines for at least 6 weeks after receiving IVIg.

Does IVIg affect pregnancy?

There is no evidence to suggest that IVIg is harmful to the mother or baby if IVIg is given during pregnancy. However, it is advised to avoid IVIg during pregnancy.

May I drink alcohol while taking IVIg?

There is no reason to avoid alcohol before or after IVIg. However, only take alcohol in moderation.