By Cindy Berry, RN, BSN.

This week's IGL Blog is sponsored by NuFACTOR Speciality Pharmacy.

Immune Globulin (IG) therapy is used to treat many different diseases. Because the drug itself can have many side effects when administered, it is important for patients to understand what to do when facing side effects from therapy to ensure a treatment is well tolerated.

IG therapy can be given in a number of different ways.  Depending on the disease being treated, patients may have a range of therapy from one day a month, to five days a month.  Patients receiving larger doses may experience more side effects.

IG is known to have certain "expected" side effects, which patients can experience during and after their infusions.  Expected effects are those that are the most common, and are considered mild side effects.  They generally do not require medical intervention and can be easily managed.  Although we "expect" some side effects, there are many ways to help decrease the severity and length of side effects by prevention and proper management.

Many physicians prescribe premedications to help decrease side effects.  Usually, Tylenol (500 mg) and Benadryl (25-50 mg) are prescribed to take 30-60 minutes prior to the start of IG therapy.  Taking both of these medications can help decrease infusion related side effects, as well as post-infusion related side effects.  Tylenol helps to prevent low-grade fevers, flu-like symptoms, headaches and muscle spasms, while Benadryl helps decrease the body’s response to the IG antibodies being introduced into a person’s system.  Usually, repeating premedications every 6 hours for 24 hours after the infusion can significantly help reduce most immune globulin side effects.

Being well hydrated plays an important role when receiving IG therapy.  Patients are encouraged to maintain good hydration status before, during and after their treatment.  Drinking 1-2 liters of fluid a day, starting 24 hours prior to infusion and continuing throughout the infusion, as well as 24 hours post-infusion, is advised for most patients.  Being well hydrated can help decrease headaches, which is one of the most common side effects reported from IG therapy.  Good hydration will also help maintain good urine output, which is important for healthy kidney function.

Patients who have a history of migraines should inform their physician before initiating therapy.  It may be important to take migraine medication prior to treatment to help prevent an onset of migraines.

During an infusion, some patients may experience infusion-related side effects that can be associated with the rate at which the drug is infused.  Usually, if a patient experiences side effects during the infusion, it can be easily managed by the nurse.  Many times, shutting off the drug for a period of time and then slowing the infusion can help prevent further side effects.  Most patients report mild symptoms during the infusion such as chills/rigors, headache, nausea, back pain and/or low grade fever.  If a patient is being infused and experiences any of these side effects, it is important to report this to the nurse at the onset of symptoms.

Following IG therapy, it is important to notify the physician if any serious side effects occur.  These side effects include migraine headaches or severe headaches, tightness in chest, difficulty breathing, development of hives/rash, decreased urine output and/or dark colored urine.

Immune Globulin Therapy Side Effects
When receiving IG therapy – either by IV administration or subcutaneous administration, it is important to understand the difference between side effects that are expected and side effects that are not expected.  Since side effects may have an onset after drug administration, it is important for the patient and/or caregiver to identify when to seek medical attention.