BNF for Children 2011-2012

624 14.5.2 Disease-specific immunoglobulins BNFC 2011–201214 Immunological products and vaccinesSubgam c (BPL) ANormal immunoglobulin (protein 14–18%) injection,net price 250-mg vial = £11.20, 750-mg vial = £28.50,1.5-g vial = £57.00DoseAntibody deficiency syndromes. By subcutaneous infusionConsult product literatureHepatitis A prophylaxis (see also notes above). By intramuscular injectionChild under 10 years 500 mgChild 10–18 years 750 mgRubella prophylaxis in pregnancy (see also notes above). By intramuscular injection750 mgNote Subgam c is not licensed for prophylactic use, but due todifficulty in obtaining suitable immunoglobulin products, theHealth Protection Agency recommends intramuscular use forprophylaxis against Hepatitis A, or rubellaVivaglobin c (CSL Behring) ANormal immunoglobulin (protein 16%) injection, netprice 3-mL vial £17.76, 10-mL vial = £59.20, 20-mLvial = £118.40Cautions risk factors for arterial or venous thromboembolicevents; ensure adequate hydrationSide-effects rarely thromboembolic eventsDoseAntibody deficiency syndromes. By subcutaneous infusionConsult product literatureFor intravenous useNote Dose recommendation for Kawasaki Sydrome, seesection 14.5.1; other indications—consult product literaturefor dosage regimensFlebogamma c DIF (Grifols) TAIntravenous infusion, human normal immunoglobulin(protein 5%), net price 0.5 g (10 mL) = £30.00, 2.5 g(50 mL) = £150.00; 5 g (100 mL) = £300.00, 10 g(200 mL) = £600.00, 20 g (400 mL) = £1200.00Note Contains sorbitol 50 mg/mL; contra-indicated inpatients with hereditary fructose intoleranceGammagard S/D c (Baxter) AIntravenous infusion, powder for reconstitution,human normal immunoglobulin (providing protein 5%or 10%), net price 0.5 g (with diluent) = £20.05, 2.5 g(with diluent) = £100.25, 5 g (with diluent) = £200.50,10 g (with diluent) = £401.00Gammaplex c (BPL) TAIntravenous infusion, human normal immunoglobulin(protein 5%), net price 2.5 g (50 mL) = £85.00, 5 g(100 mL) = £170.00, 10 g (200 mL) = £340.00Note Contains sorbitol 50 mg/mL; contra-indicated inpatients with hereditary fructose intoleranceIntratect c (Biotest UK) AIntravenous infusion, human normal immunoglobulin(protein 5%), net price 1 g (20 mL) = £45.00, 2.5 g(50 mL) = £112.50, 5 g (100 mL) = £225.00, 10 g(200 mL) = £450.00Kiovig c (Baxter) AIntravenous infusion, human normal immunoglobulin(protein 10%), net price 1 g (10 mL) = £49.00, 2.5 g(25 mL) = £122.50, 5 g (50 mL) = £245.00, 10 g(100 mL) = £490.00, 20 g (200 mL) = £980.00Note Use Glucose 5% intravenous infusion, if dilution priorto administration is requiredPrivigen c (CSL Behring) TAIntravenous infusion, human normal immunoglobulin(protein 10%), net price 2.5 g (25 mL) = £135.00,5 g (50 mL) = £270.00, 10 g (100 mL) = £540.00, 20 g(200 mL) = £1080.00Note Contains L-proline; contra-indicated in patients withhyperprolinaemiaVigam c (BPL) TAIntravenous infusion, human normal immunoglobulin(protein 5%), net price 2.5 g (50 mL) = £95.00, 5 g(100 mL) = £190.00, 10 g (200 mL) = £380.00Note Contains sucrose (see Renal Impairment above)14.5.2 Disease-specificimmunoglobulinsSpecific immunoglobulins are prepared by pooling theplasma of selected human donors with high levels of thespecific antibody required. For further information, seeImmunoglobulin Handbook (www.hpa.org.uk).There are no specific immunoglobulins for hepatitis A,measles, or rubella—normal immunoglobulin, section14.5.1 is used in certain circumstances. There is nospecific immunoglobulin for mumps; neither normalimmunoglobulin nor MMR vaccine is effective as postexposureprophylaxis.Hepatitis BDisease-specific hepatitis B immunoglobulin (‘HBIG’)is available for use in association with hepatitis Bvaccine for the prevention of infection in infants bornto mothers who have become infected with this virus inpregnancy or who are high-risk carriers (see Hepatitis BVaccine, p. 608). Hepatitis B immunoglobulin will notinhibit the antibody response when given at the sametime as hepatitis B vaccine, but should be given atdifferent sites.An intravenous preparation of hepatitis B-specificimmunoglobulin is licensed for the prevention of hepatitisB recurrence in HBV-DNA negative patients whohave undergone liver transplantation for liver failurecaused by the virus.HEPATITIS B IMMUNOGLOBULINCautions IgA deficiency; interference with live virusvaccines—see under Normal Immunoglobulin, p. 622Side-effects injection site swelling and pain, arthralgia;rarely anaphylaxis chest tightness, dyspnoea;also reported tremor, dizziness, facial oedema, glossitis,and buccal ulceration; for side-effects associatedwith intravenous immunoglobulins, see section 14.5.1Indication and doseSee under preparations and see also notes aboveHepatitis B Immunoglobulin AInjection, hepatitis B-specific immunoglobulin,100 units/mL. Vials containing 200 units or 500 units,available from selected Health Protection Agency and