premedication-for-dental-treatment

List of Premeds Often Used Before IVIG Treatment

Premeds are an important part of IVIG infusion in treating diseases like CIDP neuropathy, make sure to talk to your doctor and see what works best for you.

The following is a list of premeds people used before IVIG treatment. IVIG treats and sometimes cures CIDP neuropathy.

According to NuFactor.com:

Category Drugs Names (Brand)
[Route of Administration] 
Comments*
Analgesic Acetaminophen (Tylenol) [oral]
  • Take 30 – 60 minutes before IVIG.
  • Risk of hepatic toxicity. Adult maximum 3000 mg/day from all sources. Pediatric maximum: consult with pharmacist.
Analgesic Aspirin [oral]
  • Take 15 – 30 minutes before IVIG.
  • May cause GI upset; take with food.
  • Bleed risk; caution with concomitant anti-coagulation therapy.
Analgesic – NSAID Ibuprofen (Motrin, Advil) [oral]
Ketoprofen (Orudis) [oral]
Naproxen (Naprosyn) [oral]
  • Take 30 – 60 minutes before IVIG.
  • May cause GI upset; take with food.
  • Caution with renal impairment.
Anti-histamine – low or non-sedating Cetrizine (Zyrtec) [oral]
Fexofenadine (Allegra) [oral]
Desloratadine (Clarinex) [oral]
Loratadine (Claritin) [oral]
  • Take 30 – 60 minutes before IVIG.
  • Some require dose adjustment with hepatic and/or renal dysfunction
Anti-histamine – sedating Chlorpheniramine (Chlor-Trimeton) [oral]
Diphenhydramine (Benadryl) [oral, IM, IV]
  • Take 30 – 60 minutes before IVIG.
  • May cause sedation. Caution with alcohol and while driving or operating machinery.
  • Diphenhydramine has anti-emetic properties.
Steroids Dexamethasone (Decadron) [oral, IM, IV]
Hydrocortisone (SoluCortef) [IM, IV]
Methylprednisolone (SoluMedrol)
Prednisone [oral] 
  • Generally used for severe headache management.
  • Typical issues with constant, daily use generally not a concern as IVIG pre-medication (e.g., fluid imbalance, electrolyte imbalance, glucose metabolism).
  • Oral steroids: Take with food
  • IV steroids: IVP over 3 – 15 minutes; IVPB over 15 – 60 minutes, depending on dose
Anti-migraine Eletriptan (Relpax) [oral]
Rizatriptan (Maxalt) [oral]
Sumatriptan (Imitrex) [oral, nasal, SubQ]
Zolmitriptan (Zomig) [oral, nasal]
  • Specific maximum dose/day or other time period recommended. Many payers limit the number of doses/month.
  • Eletriptan/sumatriptan: Caution with hepatic impairment
  • Rizatriptan: Take orally disintegrating tablet version SL
  • Zolmitriptan: Caution with renal/hepatic impairment; take orally disintegrating tablet version SL
Anti-emetics Metoclopramide (Reglan) [oral, IM, IV]
Ondansetron (Zofran) [oral, IM, IV]
Prochlorperazine (Compazine) [oral, IM, IV]
  • Metoclopramide has boxed warning for tardive dyskinesia; IVP over 1 – 2 minutes; IVPB over >15 minutes
  • Ondansetron: IVP over 2 – 5 minutes; IVPB over >15 minutes
  • Prochlorperazine: IM – administer deep IM; IVP over at least 5mg/minute
Anti-coagulants Aspirin [oral]
Enoxaparin (Lovenox) [SC]
Heparin [SC]
  • May be ordered on days of IVIG to prevent thromboembolism
IV fluids
  • Generally used for severe headache management

*IVP = Intravenous Push; IVPB = IV Piggy Back; SL = Sublingual 
IV medications can generally be administered 15 minutes before IVIG.

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