Situation: Hospitals and Health Systems across the country are being forced to manage a nation-wide shortage of intravenous immune globulin (IVIG) with unpredictable product availability for the next 6-12 months.MLH Pharmacy Department is committed to managing available supply, making it available to as many patients as possible, and guiding prescribers to help manage their patients.
Background: Drug shortages are caused by multiple factors. Rising demand for immunoglobulin and insufficient human donors is the main factor in the current IVIG shortage. Also, IVIG is being used for more and more conditions: some with FDA approval and an abundance of evidence; some off-label and with little to no evidence. Lastly, two manufacturing sites have had recent quality issues and there are two new immunoglobulin products that have recently received FDA approval, which will divert supply away from the available market while they ramp up production. Each MLH pharmacy department has been placed on a monthly allocation of IVIG and that allocation will vary depending on what the manufacturer is able to provide for the month.
Assessment: MLH Pharmacy Department will continue to make IVIG available for patients based on our wholesaler allocation and we commit to redistributing supply within MLH to maximize availability. A warning message has been placed in Epic alerting prescribers that there is a national shortage of IVIG and to consult with pharmacy prior to ordering.
General strategies to conserve IVIG for all MLH sites:
- Assess the indication, benefit, and evidence of IVIG for your patient (please see attached reference).
- Emergency use of IVIG for inpatients, provided it is FDA approved and demonstrated to be beneficial, will take priority.
- For the short term, consider using a lower dose or longer frequency to conserve supply for a larger pool of patients.
- Doses should always be rounded down to the nearest vial size to limit the amount of waste
- Before ordering or scheduling an IVIG patient, confirm available supply with MLH pharmacy department
- Consult with an MLH clinical pharmacist (if needed)
Recommendation: Please review the attached reference for IVIG and help to support a conservation strategy for the foreseeable future.