Immune Globulin (Human), Intravenous (IVIG)
Fractionated human immunoglobulins (primarily intact IgG)
Also known as: hIVIG · IGIV · Felbogamma · Octagam · Gammaplex · Gamunex · Gammagard · Privigen · Carimune NF · immunglobuline · immunoglobulinas · Immune Serum
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Immune-mediated diseases (IMHA, ITP) - General | 0.3-1.5 grams/kg | IV | varies | varies | 🌎 NA |
| IMHA (refractory to conventional treatment) | 0.5-1.5 grams/kg | IV | once | over 12 hours | 🌎 NA |
| Primary immune-mediated thrombocytopenia (pIMT) | 0.5 grams/kg | IV | single infusion | — | 🌎 NA |
| Refractory erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis, and other cutaneous adverse drug reactions | 0.5-1 gram/kg | IV | 1-2 times, 24 hours apart | over a 4-6 hour period; may need to be repeated for 3-4 days in a row | 🌎 NA |
- Immune-mediated diseases (IMHA, ITP) - General: Cost-benefit must be weighed carefully due to extreme expense.
- Refractory erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis, and other cutaneous adverse drug reactions: Uses a 5-6% solution.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Immune Globulin (Human), Intravenous (IVIG) is a highly concentrated biological product consisting of fractionated immunoglobulins (primarily IgG) pooled from thousands of human plasma donors.
In veterinary medicine, it is primarily utilized as an expensive, off-label salvage therapy for severe, refractory immune-mediated diseases when conventional immunosuppressive therapies (like glucocorticoids or cyclosporine) have failed.
Key Clinical Applications:
- Primary Immune-Mediated Thrombocytopenia (pIMT): Shows the most promise in veterinary studies for rapid platelet recovery.
- Immune-Mediated Hemolytic Anemia (IMHA): Used in refractory cases, though prospective studies show mixed results regarding survival benefits compared to standard therapy.
- Immune-Mediated Dermatopathies: E.g., Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis.
Clinical Pearl: Because IVIG is a human blood product, its use in veterinary medicine is controversial due to ethical considerations regarding human supply shortages, the extremely high cost of the drug, and the risk of hypersensitivity reactions to foreign proteins.
Mechanism of action
IVIG exerts complex immunomodulatory effects through multiple concurrent pathways rather than a single mechanism:
- Fc Receptor Blockade: The massive influx of human IgG binds to and saturates Fc receptors on the patient's mononuclear phagocyte system (macrophages) → prevents the phagocytosis and destruction of the patient's own autoantibody-coated red blood cells or platelets.
- Anti-idiotypic Antibodies: Contains antibodies that directly bind to and neutralize pathogenic autoantibodies.
- Cytokine Modulation: Binds to and downregulates pathogenic cytokines including Interleukin (IL)-1a, IL-6, and Tumor Necrosis Factor-alpha (TNF-α).
- Receptor Interference: Binds to CD5 receptors and T-cell receptors, suppressing pathogenic T-cell and B-cell activation.
- Negative Feedback: High circulating IgG levels provide negative feedback → downregulation of endogenous antibody production by B lymphocytes.
Safety & warnings
Contraindications
- Prior hypersensitivity reactions to human albumin or human blood products
Adverse effects
- Increased blood pressure
- Local injection site reactions (pain, tenderness)
- Anaphylaxis / Hypersensitivity reactions
- Volume overload (due to colloid-like properties)
- Thrombotic events
- Fever, chills, facial flushing, nausea (human data)
- Renal dysfunction / Acute renal failure (human data)
Precautions
BLACK BOX WARNING (Human Label): IVIG has been associated with renal dysfunction, acute renal failure, osmotic nephrosis, and death in humans.
- Hypersensitivity: IVIG contains trace amounts of human albumin, which can trigger severe hypersensitivity or anaphylaxis in dogs, especially upon repeated exposure.
- Infusion Rates: Adverse reactions are strongly associated with rapid infusion. Must be infused slowly (typically over a 6-12 hour period in dogs).
- Volume Overload: IVIG has colloid-like properties; use with caution in patients with compromised cardiac or renal function.
- Laboratory Interference:
- Blood Glucose: Can cause falsely elevated readings on glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ) based monitors. Use glucose oxidase or other unaffected methods.
- Coombs Test: Passively transferred antibodies may cause false-positive serological test results.
Drug interactions
IVIG may interfere with the immune response and efficacy of the vaccine due to passively transferred antibodies.
Monitoring
- Vital signs (blood pressure, temperature, heart rate)
- Lung auscultation (to assess for pulmonary edema/volume overload)
- Renal function tests (BUN, Creatinine) and urine output
- Clinical efficacy (e.g., serial platelet counts, hematocrit, dermatological lesion resolution)
Pharmacokinetics
Half-life
Absorption
Rapid onset of action following intravenous administration.
Distribution
Widely distributed in plasma.
Metabolism
Eliminated primarily by catabolism. Fever or active infection may increase catabolism and consumption, thereby decreasing the half-life.
Elimination
Catabolism
Overdose
Overdosage primarily increases the risk of fluid volume overload due to the colloid-like osmotic pull of the concentrated proteins. Other reactions could include severe pain and tenderness at the injection site, and potentially an increased risk of thrombotic events or renal impairment.
Available products
Formulations
- Injection solution (5%, 10%)
- Lyophilized powder for solution
Human-labeled
- Immune Globulin (Human) Injection 5% (50 mg/mL) preservative-free (Felbogamma, Octagam, Gammaplex)
- Immune Globulin (Human) Injection 10% (100 mg/mL) preservative-free (Gamunex, Gammagard, Privigen)
- Immune Globulin (Human) Lyophilized Powder for Solution (Carimune NF, Gammagard S/D)
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Usually stored at room temperature, but specific storage requirements vary by manufacturer and product formulation (refer to the specific package insert). Do not freeze. Do not mix with other medications (though some products like Privigen may be diluted with D5W if necessary).
Client information
Important Information for Pet Owners:
- What it is: IVIG is a highly specialized human blood product made of concentrated antibodies. It is used as a "last resort" treatment for severe autoimmune diseases where the pet's immune system is attacking its own body.
- Cost: This medication is extremely expensive (often thousands of dollars for a single treatment) because it is derived from human plasma donors.
- Risks: Because it is a human protein, there is a risk of allergic reactions (including severe anaphylaxis) in dogs. It can also cause fluid overload or, rarely, kidney issues or blood clots.
- Expectations: It is given as a very slow intravenous (IV) drip in the hospital, usually over 6 to 12 hours. While it can be life-saving, results are not guaranteed, and it is usually reserved for pets that have failed all other standard therapies.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.