Intravenous Immunoglobulin (IVIg) prescribing guidance Kejal Mehta (Specialist Pharmacist) [December 2016] Review Date: December 2017
Contents Introduction:... 2 Prior to Intravenous immunoglobulin (IVIg) prescribing:... 2 1. Approval... 2 2. Dosing... 2 3. Prescription... 3 4. Supply... 3 Appendix A: Demand Management Poster... 4 Appendix B: Clinician Request form... 5 Appendix C: Prescription chart... 7 Appendix D: IVIg Infusion form... 8 Author: Kejal Mehta (Specialist Pharmacist) Dec. 2016 1
Introduction Intravenous immunoglobulin (IVIg) prescribing guidance In 2006, the Department of Health initiated National Demand Management Programme for Immunoglobulin to secure the supply of immunoglobulin for patients in the UK in whom it is lifesaving. The supply of IVIg is limited and demand continues to exceed supply therefore a guideline was developed for a more evidencebased approach to IVIg use. The indications are colour coded to reflect prioritisation and approval for IVIg treatment. Prior to Intravenous immunoglobulin (IVIg) prescribing 1. Approval Use the Demand Management Poster (Appendix A) to determine which colour the indication fits in. Indication priority can vary depending on the duration of treatment. These can be either short term (< 3months) or long term (>3 months) treatments. Indication Priority Immunoglobulin Assessment Panel (IAP)/ CCG approval prior to treatment Red High Automatic approval. Blue Medium Contact ward/ oncall pharmacist to obtain Immunoglobulin Assessment Panel approval. Grey/Black Low (little or no evidence) Contact ward/ oncall pharmacist to obtain Immunoglobulin Assessment Panel + CCG approval. Immunoglobulin Assessment Panel consists of: Pharmacists: David Heller, Joanne Rhodes, Jane Allen, Consultants (excluding their own patients): Dr Barry Jackson and Dr Jeff Kimber Complete the mandatory Clinician Request form (Appendix B). This must be completed for all indications. A registrar or above should sign the form. Please return this to pharmacy ASAP for reimbursement. 2. Dosing Use the clinical guideline for dosing regimen for the indication. http://www.igd.nhs.uk/clinicalinfo/ (link to guideline) Calculate the dose using the actual body weight (kg). (Use dose determining weight (DDW) if BMI >30kg/m 2 ) DDW = IBW + 0.4 (actual body weight (kg) IBW) IBW for males = 50 + (2.3 x (height in inches 60)) IBW for females = 45.4 + (2.3 x (height in inches 60)) Round each dose to the nearest 5g (dose per day may vary as necessary). Confirm the dose with the ward/ on call pharmacist. Author: Kejal Mehta (Specialist Pharmacist) Dec. 2016 2
3. Prescription Complete the Prescription Chart (Appendix C) and attach it to the drug chart. Ensure all relevant boxes are completed. Calculate the actual rate (ml/hr) of infusion. Confirm the calculated rates (ml/hr) with a pharmacist. Actual rate (ml/hr) = rate required (ml/kg/hr) x patient weight (kg) Infusion Form (Appendix D) must be completed by the nurses with batch numbers of every dose administered and returned to pharmacy. Prescribe chlorphenamine 4mg TDS as supportive treatment on PRN side of drug chart and keep anaphylaxis box available. 4. Supply Privigen (100mg/ml) is the ONLY brand kept at SASH. Do NOT dilute Working hours: contact the ward pharmacist for screening and supply Out of hours: contact the on call pharmacist to confirm all the above before obtaining supply from the emergency drug cupboard. Author: Kejal Mehta (Specialist Pharmacist) Dec. 2016 3
Appendix A: Demand Management Poster Author: Kejal Mehta (Specialist Pharmacist) Dec. 2016 4
Appendix B: Clinician Request form Author: Kejal Mehta (Specialist Pharmacist) Dec. 2016 5
Author: Kejal Mehta (Specialist Pharmacist) Dec. 2016 6
Appendix C. Prescription and administration chart for Intravenous Immunoglobulin infusion (Privigen 100mg/ml Solution) Patient name DOB Hospital no. Appendix C: Allergies Actual body weight (ABW) Dosedetermining weight (DDW) (Use DDW If BMI>30kg/m2, Otherwise use Actual weight) Calculate DDW= IBW+ 0.4 (ABW IBW) (IBW (males)= 50+ (2.3x height in inches 60)) (IBW (females)= 45.5+ (2.3x height in inches 60)) Monitor temperature, blood pressure, respiratory rate, heart rate and signs of anaphylaxis throughout. (Anaphylaxis box must be available) Day Date Time Dose (g) Volume Calculated infusion rates Prescriber Date Start Given by/ Batch number/expiry date (ml) (increase rate every 30 mins Signature of time checked (Do not if tolerated) and reg. no. admin by dilute) ml/kg/hr Actual rate (ml/hr) 1 4.8 2 4.8 3 4.8 4 4.8 5 Author: Kejal Mehta (Specialist Pharmacist) Dec. 4.82016 7 Kg Kg Indication Dosing Regime as per guideline Each dose to be rounded to the nearest 5g Prescription char Pharm. Author: Kejal Mehta Created 12/2016 Attach prescription to patient drug chart
(Patient details) Appendix D: IVIg Infusion form (Nurses to stick batch numbers and must be returned to pharmacy once complete) Trust ID NHS / CHI no Infusion Date Product Batch No. Grams per Vial Vial Count Total Grams Author: Kejal Mehta (Specialist Pharmacist) Dec. 2016 8