Appendix 5 - Normal Immunoglobulins

Normal immunoglobulins are plasma products that remain the only treatment option for patients with primary immunodeficiencies which, in certain cases, are life-threatening. These medicines are in worldwide shortage and it is imperative to minimise the impact of these shortages by limiting their use to patients who have a clear indication for treatment. In addition, normal immunoglobulins represent a significant cost pressure for NHSGGC.

Considering the above, the use of normal immunoglobulins is restricted to specific indications and treatment must be initiated and reviewed by a Consultant.

Colour coded indications

Indications for normal immunoglobulin use are grouped into colour coded categories.

Red indications: High priority

Treatment may be life-saving. Supply will be reserved for these indications in times of shortage.

Blue indications: Medium priority

Evidence base is reasonable but other treatment options are available. Treatment should be modified in times of shortage.

Grey indications: Low priority (non-Formulary)

Evidence base is weak, in many cases because the disease is rare. Treatment must be considered on a case by case basis, prioritised against other competing demands.

Black indications: Use is not appropriate (non-Formulary)

The prescription of normal immunoglobulins is not permitted for these conditions.

A comprehensive list of colour-coded indications can be found page on the National Plasma Products Expert Advisory Group Guidelines and Forms page and search for:

  • “NHS Scotland guidelines, V3 March 2021-Immunology/Haematology/Neurology” 
  • “NHS Scotland guidelines, V2 March 2012-Dermatology/Haematology”

Treatment with normal immunoglobulins for grey or black indications is considered non-Formulary within NHSGGC. Any indication not listed in the National Guidelines is also non-Formulary. For grey indications, an Individual Patient Request Form should be completed and approved prior to immunoglobulin supply. The form, titled "Individual Patient Request Form - Grey Indications", can be found on GGC Clinical Info Immunoglobulins SharePoint page here (link active if connected to GGC network).

Prescribing normal immunoglobulins

Normal immunoglobins should be prescribed generically with the exception of patients with primary immunodeficiency and those on home therapy. Any contraindications / allergies to specific brands must be documented on the request form and on the drug kardex.

Brand specific normal immunoglobulins

Brand specific IV infusion schedules for normal immunoglobulins are available on GGC Clinical Info Immunoglobulins SharePoint page here (link active if connected to GGC network). These include information on administration and monitoring parameters.

Prescribing in overweight patients

Information on dosing calculation in overweight patients can also be found on GGC Clinical Info Immunoglobulins SharePoint page here (link active if connected to GGC network). 

Ordering normal immunoglobulins

Normal immunoglobulins must be ordered from pharmacy using a specific request form, which can be found on GGC Clinical Info Immunoglobulins SharePoint page here (link active if connected to GGC network) or the form can be found on the National Plasma Products Expert Advisory Group Guidelines and Forms page. Contact your local Pharmacy department (see Appendix 6 for contact details) if you require further information on this.

 

Guideline reviewed: July 2021

Page updated: March 2022