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 prone to temporary shortages 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.
Indications for normal immunoglobulin use are grouped into colour coded categories.
Treatment may be life-saving. Supply will be reserved for these indications in times of shortage.
Evidence base is reasonable but other treatment options are available. Treatment should be modified in times of shortage.
Evidence base is weak, in many cases because the disease is rare. Treatment should be considered on a case by case basis, prioritised against other competing demands.
The prescription of normal immunoglobulins is not recommended for these conditions.
A comprehensive list of colour-coded indications can be found in the National Services Division website (NSD), search for "Clinical Guidelines for Immunoglobulin Use, NHS Scotland" (second edition, March 2012).
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. Requests for these indications should follow non-Formulary standard procedures.
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 IV infusion schedules for normal immunoglobulins are available on NHSGGC StaffNet / Clinical Info section / IV Immunoglobulin / Normal Immunoglobulin IV infusion schedules. These include information on administration and monitoring parameters.
Information on dosing calculation in overweight patients can also be found on NHSGGC StaffNet, Clinical Guideline Electronic Resource Directory and search in the 'Haematology' section for 'Maximum dosing weight for adult patients prescribed normal immunoglobulin'.
Normal immunoglobulins must be ordered from pharmacy using a specific form, which can also be found on NHSGGC StaffNet / Clinical Info / under 'Other links' select IV immunoglobulins or the form can be found via the NSD website. Contact your local Pharmacy department (see Appendix 6 for contact details) if you require further information on this.