Calculate intravenous immunoglobulin (IVIG) dose by weight and indication including ITP, Kawasaki, Guillain-Barré, CIDP, and immunodeficiency with infusion rate planning.
Intravenous immunoglobulin (IVIG) is a pooled human IgG product used to treat a wide spectrum of autoimmune, inflammatory, and immunodeficiency conditions. Dosing varies dramatically by indication — from 0.4 g/kg/month for primary immunodeficiency replacement to 2 g/kg as a single immunomodulatory course for Kawasaki disease — making accurate weight-based calculation essential for ordering, pharmacy preparation, and infusion planning.
This IVIG dose calculator provides indication-specific dosing for eight major conditions, computes the total course dose, converts grams to volume based on product concentration (5% or 10%), estimates the number of bottles needed, and generates an infusion rate plan from initiation through maximum tolerated rate. IVIG infusions require careful rate titration to minimize adverse reactions including headache, fever, and rare but serious events like thrombosis, renal injury, and aseptic meningitis.
The cost of IVIG therapy ranges from $5,000 to $30,000+ per course, making precise dosing and minimal waste critical. Each indication has specific evidence-based dosing regimens supported by guidelines from the American Academy of Allergy, Asthma & Immunology (AAAAI), the American Academy of Neurology (AAN), and the American Heart Association (AHA for Kawasaki disease). This calculator incorporates these standard protocols while allowing custom dose-per-kilogram overrides for physician-directed regimens.
IVIG dosing varies dramatically by indication, and calculating volumes, infusion times, and bottle counts manually is error-prone and time-consuming. This calculator provides instant indication-specific dosing with volume conversion, infusion rate planning, and bottle estimation — reducing pharmacy preparation errors and optimizing expensive immunoglobulin use. Keep these notes focused on your operational context. Tie the context to the calculator’s intended domain.
Total daily dose (g) = weight (kg) × dose (g/kg/day). Total course dose = daily dose × number of days. Volume (mL) = total dose (g) ÷ concentration (g/mL). Infusion time ≈ volume (mL) ÷ (max rate mL/kg/hr × weight kg). Concentration: 5% = 0.05 g/mL = 50 mg/mL; 10% = 0.10 g/mL = 100 mg/mL.
Result: 28 g/day × 5 days = 140 g total course (2,800 mL at 5%). Min infusion time ~10 hrs/day.
A 70 kg GBS patient: 0.4 g/kg/day × 70 kg = 28 g/day. Over 5 days: 140 g total. At 5% (50 mg/mL): 28 g ÷ 0.05 = 560 mL/day. At max rate 4 mL/kg/hr = 280 mL/hr: minimum 2 hours/day at max rate, but ~10 hours accounting for slow titration start.
Intravenous immunoglobulin is a pooled preparation of IgG antibodies from thousands of blood donors, providing passive immunity and immunomodulatory effects. At replacement doses (0.4–0.6 g/kg), it increases circulating IgG to protect immunodeficient patients from infection. At immunomodulatory doses (1–2 g/kg), IVIG acts through multiple mechanisms: Fc receptor blockade on macrophages (particularly relevant in ITP), anti-idiotypic antibody networks, complement pathway modulation, cytokine regulation, and suppression of autoreactive B cells. The exact predominant mechanism varies by disease.
For ITP, the landmark Imbach study (1981) demonstrated rapid platelet recovery with 0.4 g/kg × 5 days, later simplified to 1 g/kg × 1–2 days. Kawasaki disease requires 2 g/kg as a single infusion (AHA guideline), reducing coronary artery aneurysm risk from 25% to 4%. GBS treatment was established in the Dutch GBS Trial (1992) showing equivalence to plasma exchange. For CIDP, the ICE trial (2008) proved IVIG efficacy with sustained improvement over 24 weeks.
Multiple IVIG brands are available, including Gamunex-C, Privigen, Octagam, Gammaplex, and Panzyga, each with different stabilizers, osmolality, IgA content, and approved indications. Product selection depends on patient factors (renal function, IgA status, fluid tolerance), indication-specific FDA approvals, and institutional formulary. Sucrose-free products are preferred for renal safety. 10% solutions reduce infusion volume and time. Some products allow room temperature storage while others require refrigeration. Subcutaneous immunoglobulin (SCIG) products like Hizentra and HyQvia offer alternative dosing routes for chronic conditions.
IVIG infusions are initiated at 0.5–1.0 mL/kg/hr and gradually increased because rate-related adverse reactions (headache, flushing, tachycardia, chest tightness) are common with faster initial rates. The rate is escalated every 15–30 minutes if tolerated, up to the maximum rate. Pre-medication with acetaminophen and diphenhydramine helps reduce reactions.
5% IVIG contains 50 mg/mL (requires larger volume) while 10% IVIG contains 100 mg/mL (half the volume). 10% products reduce infusion time but may have higher osmolality. For patients at risk of volume overload (heart failure, renal impairment), 10% formulations are preferred to minimize fluid volume.
Sucrose-stabilized IVIG products carry a higher risk of osmotic nephrosis and acute kidney injury (AKI). Products stabilized with glycine, L-proline, or maltose are preferred for patients with renal impairment. The infusion rate should also be limited to ≤3.3 mL/kg/hr for renal protection.
IgA-deficient patients may develop anti-IgA antibodies and are at risk for anaphylaxis with standard IVIG. IgA-depleted IVIG products (e.g., Gammagard S/D) should be used. A serum IgA level should be checked before the first IVIG infusion when possible.
For primary immunodeficiency, IVIG is given as replacement therapy every 3–4 weeks at 0.4–0.6 g/kg/dose. The goal is to maintain trough IgG levels above 500–800 mg/dL. Subcutaneous immunoglobulin (SCIG) given weekly is an alternative route.
Pre-infusion labs typically include serum creatinine (renal function), CBC, IgA level (first infusion), hepatitis screening, and type & screen for blood bank. IgG trough levels guide dosing for immunodeficiency replacement. Post-infusion monitoring includes renal function at 24–72 hours.