Learn about mild, moderate, and severe IVIG and SCIG therapy side effects, and when to call the pharmacist, the MD, and/or 911.
Marianna Herrera, RN, BSN, IgCN, Clinical Nurse Educator II - July 31, 2025
Timely recognition and communication of side effects during IVIg or SCIG therapy is essential to patient safety and treatment adherence. Reactions vary by patient and can range from mild to severe. As the nurse, you are often the only clinician physically present during infusions—your assessments and communication are critical in managing the patient’s care. If side effects are not managed appropriately and tolerability becomes an issue, the patient may want to stop therapy, which could impact the management of their condition. The following is a guide to help you determine who to call and when.
Rule of thumb: If the Prescriber is called, call the Pharmacist as well.
As the nurse infusing the patient, you are one of the few medical professionals that have hands-on interaction with the patient while they are on therapy, making you the eyes and ears for the pharmacist and the prescriber. They rely on you for communication on how the patient tolerates therapy. Pharmacists clinically manage Ig therapy and need full visibility into patient response.
- Remember that side effects are anticipated and you should be prepared to manage them. This includes understanding the severity of the reactions. Mild reactions may not require phone calls.
- When in doubt, call the pharmacist first for guidance, you could never call a pharmacist too much.
- For more severe reactions, the prescriber should be notified first, then the pharmacist.
- For life-threatening or most severe reactions, call 911 first, and then contact the prescriber and pharmacist.
Keep in mind you should err on the side of caution in communicating reactions, but not to the point of overwhelming the prescriber’s office with calls.
Common side effect: Headache.
One of the most common side effects is headache. This is an anticipated reaction that can be offset by recommending optimized hydration and taking pre-medications as prescribed. The prescriber and/or pharmacist will decide on the maximum rate per hour, never to exceed what is on the package insert for the brand. You should never increase the rate of infusion beyond the ordered titration schedule without conversing with the pharmacist. In some cases, the pharmacist may need to obtain orders from the prescriber. While actively infusing the patient, it’s important to assess if they are experiencing a headache and if so, rate its intensity using a standard pain scale of 0-10.
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If 0-4, slow the infusion and then reassess. Does not require a phone call.
- Decrease infusion rate by half, i.e. current rate 100mL/hr, decrease to 50mL/hr, infuse for about 15-30 mins, reassess. If improvement is voiced/noted increase to 75ml/hr, infuse for 15-30 mins, reassess. Continue this process until max rate is reached and if patient experiences a headache again, return to the last tolerated rate and complete infusion at that rate.
- If 5-7, stop infusion or slow the infusion (as described above) and call the pharmacist for further direction. The pharmacist will inform the prescriber.
- If 8-10 and/or accompanied with other symptoms such as neck soreness or stiffness, nausea, vomiting and/or visual disturbances, it could be indicative of one of the more severe reactions such as aseptic meningitis. STOP the infusion. Notify the prescriber immediately. The patient may need to go to the ER. If the prescriber is not readily available, you should recommend the patient go to the ER.
Monitor all vital signs at regular intervals.
All vital signs need to be monitored at regular intervals during the infusion, especially prior to a rate increase.
Follow Nufactor’s provided parameters:
- For IVIg, record vital signs at baseline, 15 minutes into infusion, every rate change, hourly once maximum rate reached achieved and end of infusion. If vital signs fluctuate, monitor every 15 minutes until stable.
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For SCIG, record vital signs at baseline, at the end of the infusion, and when clinical signs warrant.
- Ensure patients with hypertension are compliant with blood pressure medications.
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Contact Nufactor:
- Before starting IVIg if baseline SBP ≥ 140 mm Hg (age <60 yr).
- SBP ≥ 150 mm Hg (age > 60 yr) or DBP ≥ 90 mm Hg.
- During IVIg if increase or decrease in SBP ≥ 20 mm Hg or DBP ≥ 10 mm Hg from baseline.
Other symptoms
MILD side effects are not unusual, should not interfere with daily activities, can be managed at home, and should subside within 72 hours after receiving Ig therapy.
- IVIg: Mild nausea, general fatigue, flu-like symptoms, diarrhea, low-grade temperatures less than 101° F, rash/itchy skin, mild back or leg pain/achiness.
- SCIG, mild local needle site reaction.
MODERATE side effects are unexpected. These symptoms affect daily activities and need to be reported to the pharmacist. The pharmacist will work with the prescriber to manage side effects.
- Nausea/vomiting, diarrhea lasting 24 hours or more.
- Hives, rash lasting more than 72 hours.
- Fatigue affecting daily activities.
- Temperature between 101–104°F.
SEVERE side effects are not expected. If any of these symptoms are present, a patient must seek immediate medical attention. Depending on symptom severity, call 911 or have a family member/caregiver drive patient to the ER.
- Fever over 104°F.
- Uncontrollable vomiting/diarrhea.
- Decreased or dark urine.
- Sudden weight gain.
- New swelling in feet.
- Chest pain; shortness of breath.
- Lower leg swelling or pain.
- Mental status changes such as confusion, slurred speech, drooling, or unresponsiveness.
- Rigors (uncontrollable shaking).
Remember: Mild reactions are expected and manageable. Severe or unresolving symptoms must be escalated. Education and communication help prevent therapy discontinuation and supports safe, effective treatment.
