Can IVIG Help Fight Lymphoma?

Published on by Dr. Robert Hakim, PharmD

Lymphoma is a type of cancer that affects the immune system. Over 80,000 people are diagnosed with this cancer every year and turn to chemotherapy and radiation therapy to fight it.

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But another option for treating this form of cancer is intravenous immunoglobulin (IVIG) therapy. While IVIG is not lymphoma’s first-line treatment, it’s a noteworthy therapy with significant potential.

Below, we will explore the research looking at the effectiveness of IVIG for lymphoma.

Understanding Lymphoma

Lymphoma is a type of blood cancer that starts in the lymphocytes. Lymphocytes are white blood cells that are a part of your immune system and are responsible for fighting infectious agents, such as bacteria, viruses, and fungi.

Lymphocytes are present throughout your body in areas like the lymph nodes, spleen, and bone marrow. When these cells change and grow uncontrollably, they cause lymphoma. The cancer can progress at a fast or slow pace. In certain cases, IVIG therapy might be considered to manage immune-related complications in lymphoma patients.

Many people mistake lymphoma for other blood disorders. Diseases like chronic lymphocytic leukemia and hemophagocytic lymphohistiocytosis are two of them. However, these conditions are not the same because they each start in different types of cells.

Types of Lymphoma

Lymphoma has 2 primary types as well as over 70 subtypes. The 2 main types of lymphoma are:

  • Non-Hodgkin’s Lymphoma: Non-Hodgkin is the most common form of lymphoma that accounts for nearly 4% of all cancers in the US and can start at any part of the body.
  • Hodgkin’s Lymphoma: Hodgkin accounts for 0.5% of all cancers in the US. It differs from non-Hodgkin due to the presence of Reed-Sternberg cells. This type of lymphoma typically starts in the upper body.

Both types of lymphoma may benefit from IVIG treatment.

Symptoms of Lymphoma

The warning signs of lymphoma can include:

  • Itching
  • Fatigue
  • Coughing
  • Chest pain
  • Night sweats
  • Abdominal pain
  • Fever and chills
  • Reduced appetite
  • Unexplained weight loss
  • Shortness of breath (dyspnea)
  • Painless, swollen glands (in the neck, armpit, or groin)

Using IVIG for lymphoma can alleviate these symptoms and slow the progression of the disease. However, note that these symptoms can also be signs of other diseases. If you experience any of them, consult a healthcare provider immediately.

Causes of Lymphoma

Before understanding how IVIG might help with lymphoma, it’s important to learn what causes this disease. Like other cancers, lymphoma occurs due to genetic problems that cause cells to grow out of control.

You might be at a higher risk of developing lymphoma if you:

  • Are male
  • Have a weak immune system
  • Have an autoimmune condition
  • Have a family history of lymphoma
  • Are between 15 and 40 (Hodgkin) or over 60 (non-Hodgkin)
  • Have been infected with viruses like HIV, Epstein-Barr, or Kaposi sarcoma human immunodeficiency virus

Diagnostic Tests for Lymphoma

Test tubes containing blood

The first step your healthcare provider takes to diagnose lymphoma and decide whether IVIG is suitable for you is doing a physical examination and checking your medical history.

Further tests for confirming the diagnosis include:

  • MRI
  • Biopsy
  • PET scan
  • Blood tests
  • Chest X-ray
  • Molecular test

Once the healthcare provider confirms your condition, they can determine whether to use IVIG for your lymphoma or turn to other therapies.

Treatments for Lymphoma

Lymphoma is a very treatable type of cancer. However, the best course of treatment will depend on the type and stage of the disease.

The most common treatments for lymphoma are:

  • Chemotherapy: Medications that kill cancer cells
  • Radiation Therapy: High-powered energy beams that destroy cancer cells
  • Bone Marrow Transplant: Infuses healthy bone marrow stem cells into your body to rebuild bone marrow and healthy lymphocytes
  • IVIG: Provides the body with antibodies (a type of protein) to help fight off cancer cells

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What is IVIG and How Can It Help with Lymphoma?

Intravenous immunoglobulin (IVIG) is a therapy that uses antibodies derived from the blood plasma of healthy donors. IVIG is commonly used to treat various conditions, like autoimmune neurological diseases, immunodeficiencies, dermatological issues, and blood disorders like lymphoma.

IVIG’s Mechanism of Action for Lymphoma

IVIG is a concentrated formula of immunoglobulins, which are proteins that function as antibodies in the immune system. These antibodies are crucial in recognizing and neutralizing foreign invaders like viruses and bacteria.

In the case of lymphoma, IVIG therapy can help boost the body’s natural defenses by providing an additional source of antibodies to target and attack cancerous cells.

While the exact mechanism for how IVIG works isn’t well understood, these are some possible ways it might help with lymphoma:

  • Interaction of infused antibodies with various components of the immune system and enhancing their ability to recognize and destroy cancer cells
  • Modulation of the activity of immune cells, such as T lymphocytes and B lymphocytes, and enhancing their anti-tumor response
  • Possible targeting of specific molecular pathways involved in cancer cell growth and survival
  • Mitigating the risk of infections in patients who experience immunosuppression as a result of lymphoma

Can IVIG Fight Lymphoma: A Look at Studies

Let’s examine the available research to see if IVIG is effective for lymphoma. Here are some of the most notable studies performed throughout the years.

IVIG and Blood Transfusion Complications

Some patients who receive blood transfusions experience recurrent hemolytic transfusion reactions. A 2005 study evaluated the effects of IVIG therapy on three patients with lymphoma who had these reactions.

After administering IVIG treatment, these reactions went away while hemoglobin levels stayed stable. These results suggest that IVIG can be helpful in those with lymphoid malignancies who experience recurrent non-antibody-mediated hemolytic transfusion reactions.

IVIG as an Anti-cancer Agent

We know that IVIG therapy has the potential to lower inflammation. Researchers in a 2013 study believed that this ability of IVIG contributes to stopping malignant cell growth in lymphoma patients, especially given the relationship between inflammation and cancer.

They reviewed the effectiveness of IVIG in patients with lymphoma and other malignancies like Kaposi’s sarcoma and thyroid cancer. Some had experienced remissions after receiving therapy, pointing to the unrealized potential of IVIG for lymphoma and other types of cancer.

To investigate the effects of IVIG, scientists treated a panel of lymphoma cells with infusions. They also evaluated the effects of IVIG in combination with various other agents. In all cases, treatments successfully suppressed the growth of malignant cells.

The results of this study suggest that IVIG can help suppress lymphoma. They also show that other supplemental anti-cancer agents can potentially intensify the effects of IVIG.

IVIG’s Efficacy in Boosting Immunity

Malignancies like lymphoma can weaken the immune system and make patients more likely to get infections. They typically need antibiotic therapy and other supplemental treatments to fight these infections.

A 1988 study reviewed the effectiveness of IVIG infusion treatment against infectious diseases in patients with severe viral infections.

Scientists found that lymphoma patients who received IVIG therapy experienced less fever, skin lesions, and neuralgia (nerve pain). IVIG also managed to prevent their disease from worsening. A 2015 study assessed the effects of IVIG on infections in people with indolent non-Hodgkin lymphoma.

They examined 57 patients who received a median of 11 IVIG doses over 9.5 months.

Results showed that the incidence of infections were lowered by 46% in those who received IVIG for lymphoma, confirming that infusions can be effective in some patients.

IVIG as an Infection Shield for Chemotherapy Patients

Older patients are at a higher risk of developing lymphoma-related infections. A 2023 study assessed 118 elderly patients with diffuse large B cell lymphoma who received IVIG infusions with R-mini-CHOP therapy.

Those who completed the treatment experienced remission rates of over 79% with fewer infections. Those who didn’t receive infusions had more severe infections.

The results of this study indicate that the combination of IVIG and R-mini-CHOP therapy can be safe and effective against infections.

How to Receive IVIG for Lymphoma?

A gloved hand filling a syringe


While IVIG is not the first treatment option for lymphoma, it’s still a safe and helpful treatment that might be able to slow down the disease’s progression and help you fight off infections.

Here is how you can manage your lymphoma with IVIG:

  1. Consult your healthcare provider to determine if IVIG is the right option for you.
  2. If your healthcare provider determines that IVIG treatment is right for you, they will write you a prescription.
  3. Before starting therapy, discuss the costs of IVIG treatment with your provider and talk to your insurance to understand coverage.
  4. Visit an infusion center or opt for at-home infusion services to receive treatment.
  5. Follow up with your healthcare provider to assess IVIG’s effectiveness and make the necessary adjustments.

Receive IVIG for Lymphoma from AmeriPharma® Specialty Pharmacy

Speak with your healthcare provider to see if you’re a good candidate for IVIG infusion treatment. If the doctor confirms your lymphoma can benefit from IVIG, you can contact AmeriPharma® Specialty Pharmacy for help.

We offer home infusion services and hard-to-find medications to patients with debilitating conditions such as lymphoma. You can manage your illness with our full-service coordination, 24/7/365 support, and thorough copay assistance.

Our ACHC-accredited specialty pharmacy can service over 40 US states and guide you through the process. Contact us now to speak to a patient navigator and receive specialty care at home.

Does TPN Cause Diarrhea?

Published on by Dr. Saba Rassouli, PharmD

While TPN can be a life-saving treatment option for people who cannot get enough nutrition through conventional ways, it also has some potential side effects.

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Some patients who receive TPN experience diarrhea, which can be concerning for both patients and healthcare providers, as it can lead to dehydration and electrolyte imbalances. However, their diarrhea can also be the result of other factors.

So, can TPN cause diarrhea?

That is the question we will answer here as we look closer at TPN therapy and its potential side effects.

Understanding TPN

Total parenteral nutrition (TPN) is a feeding method for people who cannot tolerate enteral feeding, such as:

TPN delivers all the necessary nutrients through an IV line to the bloodstream. It bypasses the digestive system altogether. What is in a TPN solution determines the risk of diarrhea.

A nutritionist will examine a person’s age, sex, weight, and medical condition to suggest a specific mixture of nutrients that meets their needs. The solution usually contains a balanced mix of macronutrients, essential fatty acids, electrolytes, vitamins, and trace elements.

How Can TPN Cause Diarrhea?

How can TPN cause this side effect, while some studies show that parenteral nutrition can help manage chronic diarrhea?

It all depends on the individual, their medical condition, and the mixture of nutrients they receive through TPN.

Here are some of the ways TPN might cause diarrhea:

Excessive Glucose

TPN solutions contain a high concentration of glucose. Glucose is the primary source of fuel for the body. It is included in TPN solutions to meet the body’s energy needs.

A high glucose concentration in the body can lead to hyperglycemia, an excess of sugar in the blood, which can overwhelm the gastrointestinal system.

When the body receives more glucose than it can absorb, the excess glucose pulls water into the intestines, leading to loose stools and diarrhea.

Excessive Fat

Lipids are another component of TPN solutions that might lead to diarrhea. TPN solutions often have an excessive fat content to provide the body with essential fatty acids and extra calories.

However, some patients may have difficulty tolerating this fat load. They might experience malabsorption that contributes to the development of steatorrhea, a condition characterized by fatty, greasy stools.

Excessive amounts of fat can also lead to the production of short-chain fatty acids in the gut. These fatty acids can cause irritation and inflammation of the intestinal lining, leading to diarrhea.

Hyperosmolar Solutions

Another way TPN can cause diarrhea is through the osmotic effect. TPN solutions are highly concentrated and can be hyperosmolar. This hyperosmolarity means they have a higher concentration of substances like glucose and electrolytes than the body’s natural fluids.

The hyperosmolarity caused by TPN is what leads to diarrhea. It can create an osmotic effect, drawing water into the intestines and leading to increased bowel movements and diarrhea.

This osmotic diarrhea is more prominent in people with compromised gastrointestinal function, such as those with inflammatory bowel disease or short bowel syndrome.

Changes in Nutritional Absorption

Changes in nutrient absorption are among TPN’s complications that many might experience.

These changes occur due to direct delivery of nutrients into the bloodstream. Bypassing the digestive system in this way can disrupt normal digestion and absorption, causing undigested nutrients to pass through, leading to irritation and inflammation.

This effect of TPN can contribute to diarrhea by altering the structure and function of the intestines and causing irregular bowel movements.

Bowel Problems

TPN can also cause diarrhea by creating bowel problems.

Patients on TPN are more susceptible to bowel disorders, such as the overgrowth of bacteria in the small intestines. This overgrowth can lead to excessive fermentation, producing gas and other by-products that result in diarrhea.

Bypassing the gastrointestinal tract and not using the intestines while on TPN can also lead to intestinal atrophy. This lack of physical stimulation of the small intestine can reduce gastrointestinal motility.

All of these bowel problems caused by TPN can lead to diarrhea.

Imbalance of Gut Flora

The gut flora is a diverse community of beneficial bacteria, yeasts, and other microorganisms that help with proper digestion and absorption of nutrients.

TPN can disrupt the balance of natural gut microbiota by bypassing the regular route of nutrient delivery through the digestive tract. As a result, the gut will have more harmful microorganisms than beneficial ones.

The imbalance caused by TPN therapy can lead to changes in bowel habits and cause gastrointestinal symptoms like diarrhea.

Overfeeding

Overfeeding or rapid infusion of TPN can also lead to diarrhea by overwhelming the digestive system and causing gastrointestinal distress.

Overfeeding means providing more nutrients than the body can handle. It can overwhelm the digestive system’s absorptive capacity and lead to diarrhea.

Rapid infusion of TPN can also exceed the body’s ability to manage the incoming nutrients, leading to an osmotic effect and causing diarrhea as the body attempts to eliminate the excess nutrients.

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Infections

One of TPN’s side effects that can cause diarrhea is infection. Infections caused by TPN lead to diarrhea as the body’s immune system attempts to expel the invading pathogens.
Using central venous catheters in TPN therapy can increase the risk of infections, such as bloodstream infections and sepsis. This risk increases if the TPN catheter site becomes contaminated and the administrator doesn’t follow standard hygiene protocols.
Infections such as Clostridium difficile (C. diff) are also more common among TPN patients. This bacteria can lead to antibiotic-associated diarrhea, while the infection can spread to other body parts and cause further complications.
 

How to Prevent Diarrhea in TPN Patients

A woman holding her stomach in pain


Adjusting to your life with TPN is challenging as it is. While diarrhea is a rare occurrence in patients receiving TPN, having to deal with it only adds to the challenges of this treatment.
There are several strategies healthcare providers and patients can use to prevent or manage diarrhea with TPN. Let’s look at some of them.

Proper TPN Formulation

Proper TPN formulation is critical in preventing diarrhea.
The TPN formula must be balanced with appropriate amounts of carbohydrates, proteins, fats, vitamins, and minerals to meet the patient’s needs without overloading the digestive system.
Ensuring the solution is mixed and sterilized well can also reduce the risk of diarrhea developing from TPN.

Gradual Introduction

By gradually introducing TPN, you can avoid causing diarrhea. The body needs time to adjust to receiving nutrition through the bloodstream, and a sudden influx of nutrients can overwhelm the digestive system.
Start slow and gradually increase the infusion rate to allow the patient’s digestive system to adjust to the delivery route.

Monitor for Tolerance and Overfeeding

Monitoring for tolerance and overfeeding is another crucial aspect of preventing diarrhea. Watch the recipient closely for signs of:

  • Malabsorption
  • Gastrointestinal distress
  • Changes in bowel habits

Regular assessment of bowel function and stool output can help identify early signs of intolerance or overfeeding. This allows you to adjust the formula or infusion rate and prevent diarrhea from TPN therapy.

Infection Control

Implement strict infection control measures such as proper hand hygiene, cleansing, and disinfecting of equipment to prevent central line-associated bloodstream infections.
Adhering to sterile techniques during TPN administration, regular catheter care, and prompt management of any signs of infection can help you avoid causing diarrhea with TPN therapy.

Address Fluid Balance

People receiving TPN are at a higher risk of dehydration due to the absence of oral intake.
You must ensure proper hydration and manage fluid balance to prevent dehydration, reduce the risk of diarrhea, and maintain gut integrity and function.

Watch Out for Electrolyte Imbalances

Keeping a close eye on the patient’s electrolyte levels is another crucial aspect of preventing diarrhea in TPN patients.
Imbalances in electrolytes such as potassium, sodium, and magnesium can lead to gastrointestinal disturbances. Detecting these imbalances allows you to adjust the formula and minimize the risk of diarrhea.
 

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Dietary and Lifestyle Modifications

While the TPN solution provides essential nutrients, recipients may still experience gastrointestinal discomfort if they eat food orally.
Making dietary and lifestyle modifications, such as exercising, can help manage gastrointestinal function and reduce the likelihood of diarrhea.

Medications

If you are still experiencing diarrhea from TPN therapy after implementing these strategies, you can turn to medications for help.
Consult your doctor to find the most effective medications for your condition and stick to your treatment plan to avoid further complications.
 

Receive At-Home TPN Therapy with AmeriPharma® Specialty Pharmacy

Now that you know that TPN can cause diarrhea, you can implement our strategies to avoid it and consult your healthcare provider if you notice any unusual signs.
If you want to receive at-home TPN therapy with a reduced risk of diarrhea, AmeriPharma® Specialty Pharmacy can help.
We deliver TPN home infusion materials to your door in discreet packaging and help you troubleshoot any problems. Our specialty pharmacy can also send specialized infusion nurses to your home to administer your treatment. You can meet your dietary needs with our full-service coordination, 24/7/365 support, and copay assistance.
Contact us now to speak to a patient navigator and receive specialty care at home.
 

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Can IVIG Help with Gastroparesis?

Published on by Dr. Christine Leduc, PharmD

Gastroparesis is a rare functional disorder affecting normal muscle movement in the stomach. While IVIG is not the primary treatment for gastroparesis, there is growing interest in its potential benefits.

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So, can IVIG help with gastroparesis?

That is what we will discuss here as we look closer at gastroparesis and various studies that have evaluated the effectiveness of IVIG for this disorder.

Understanding Gastroparesis

Gastroparesis, or stomach paralysis, is a chronic condition that affects nearly 1% of adults in the US.

This condition interferes with the nerve and muscle activity in your stomach, causing weakness in your gastrointestinal tract and preventing food digestion at a normal rate.

As a result, the food you eat sits longer in your stomach and leads to various digestive symptoms.

Symptoms of Gastroparesis

Some of the most common symptoms of gastroparesis that IVIG might alleviate include:

  • Nausea
  • Vomiting
  • Heartburn
  • Acid reflux
  • Indigestion
  • Malnutrition
  • Weight loss
  • Constipation
  • Abdominal pain
  • Loss of appetite
  • Feeling full quickly
  • Blood sugar fluctuations
  • Feeling full for a long time
  • Delayed bowel movements
  • Bloated or distended stomach
  • Changes in blood sugar levels

The symptoms will vary from one person to another. Some will feel more pain due to a lack of digestion, while others won’t experience any noticeable signs.

The type of symptom that IVIG treatment for gastroparesis targets can be related to the underlying cause of the disease.

Causes of Gastroparesis

When studying the effectiveness of IVIG for gastroparesis, scientists found that this condition most commonly occurs when the stomach nerves are damaged. Sometimes, it can even be due to direct damage to the muscles.

What can cause this damage? Here are the most common culprits:

  • Diabetes: High blood sugar levels in diabetic patients can cause nerve damage. Almost one-third of people with diabetes experience gastroparesis.
  • Surgery: Those who undergo surgery near their stomach can experience post-surgical gastroparesis. This condition happens when the vagus nerve is injured.
  • Infections: Viral and bacterial infections of the gastrointestinal tract can also cause gastroparesis.
  • Autoimmune Disorders: Autoantibodies that attack your cells may also damage the nerves in your stomach. One of the most effective therapies for autoimmune disorders is IVIG, which might be helpful for gastroparesis.
  • Medications: Some medications and recreational drugs can lead to temporary gastroparesis. These drugs work by blocking the nerve signals that activate the stomach muscles.

The less common causes of this condition can include:

  • Cystic fibrosis
  • Neurological disorders like Parkinson’s disease
  • Chronic inflammatory connective tissue disorders like scleroderma

How is Gastroparesis Diagnosed?

Doctors must determine whether gastroparesis is present due to an autoimmune disorder in order to recommend IVIG treatment for you. They can do that by asking about your symptoms, evaluating your health history, and performing various tests such as:

  • MRI
  • CT scan
  • Blood tests
  • Upper GI series
  • Upper endoscopy
  • Capsule endoscopy
  • Abdominal ultrasound
  • Gastric motility breath test (GEBT)
  • Gastric emptying scintigraphy (GES)

After confirming you have gastroparesis, doctors can decide if IVIG is the best treatment for you or whether you can benefit more from another form of therapy.

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Treatments for Gastroparesis

A bottle of pills


Although doctors can’t directly repair the damage causing the problem, they can provide treatments to encourage stomach emptying.
The goal of treatment for gastroparesis is to:

  • Hydrate and nourish the body
  • Alleviate symptoms and side effects
  • Prevent the condition from worsening
  • Stimulate contraction in the stomach muscles

Here are some forms of treatment that achieve these goals.

Medications

IVIG is not the first line of therapy for gastroparesis. The primary treatment for this condition is prokinetic agents. These are medications that stimulate gastrointestinal motility.
Some of the most commonly used drugs from this group include:

  • Metoclopramide
  • Erythromycin

Nutritional Therapy

Nutritional therapy is another form of treatment for gastroparesis besides IVIG. You could consult with a dietician to adjust your diet and make digestion easier. For instance, eating more easily digestible foods.
Doctors may also prescribe you dietary supplements, tube feeding, or TPN to compensate for the missing nutrients in your diet.

Surgery

The last resort is surgery. Surgical procedures modify your stomach to aid digestion.
Some of the most common surgical procedures for gastroparesis include:

  • Pyloroplasty
  • Gastric bypass

IVIG

Lastly, there is IVIG treatment for gastroparesis. IVIG, or intravenous immunoglobulin therapy, involves administering immunoglobulins intravenously. Immunoglobulins are antibodies that help the immune system fight off infections and diseases.
We don’t yet know the exact mechanism of how IVIG helps with gastroparesis. However, it’s believed to modulate the immune response and reduce inflammation in the gut, leading to improved gastrointestinal motility.
IVIG therapy can also strengthen the body’s immune system, which may influence the nerves and muscles to function more effectively.
 

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Can IVIG Treat Gastroparesis: A Look At Studies

We must explore the available research to determine whether IVIG is effective for this gastrointestinal condition. Here are four studies with results that suggest the off label treatment may be beneficial for some patients.

Treating Refractory Gastroparesis with Immunomodulation

Some patients with autoimmune dysautonomia may also develop gastroparesis. In 2016, 11 female patients with this autoimmune disorder and coexisting gastroparesis who didn’t respond well to drugs and surgical interventions participated in a study.
The scientists used IVIG treatment for this type of gastroparesis. They administered mycophenolate mofetil (an immunosuppressive agent) to some patients while giving others a combination of MM and IVIG. Treatment continued for 8 – 12 weeks.
At the end of the study, those who had received IVIG therapy saw the most improvement in their symptoms. An estimated 55% of patients had improvement in vomiting, while 45% experienced less bloating, nausea, and abdominal pain.
This study shows that immunomodulatory therapy can alleviate symptoms in patients with drug and device refractory gastroparesis who have a coexisting autoimmune condition.

Studying the Effects of IVIG on Patients with Symptoms of Drug and Device Refractory Gastroparesis

In a study in 2017, scientists evaluated the effects of IVIG on gastroparesis patients who were refractory to drug and device treatments and had suspected autoimmune gastrointestinal dysmotility.
A total of 14 patients with evidence of immunological abnormality participated in this study. They underwent psychiatric assessments to rule out eating disorders. They received 400 mg/kg of infusions for 12 weeks.
After receiving a course of IVIG treatment for gastroparesis, they saw significant improvements in various symptoms such as nausea, vomiting, early satiety, and stomach pain.
This study is another testament that IVIG may be effective for cases of gastroparesis that do not respond well to other forms of treatment.

Comparing the Effectiveness of IVIG by Itself and Combined with Other Treatments

A study in 2021 compared the effectiveness of IVIG infusion treatment alone and combined with gastric electrical stimulation (GES) and pyloric therapy.
In this study, 112 patients with gastroparesis who were non-responsive to other treatments participated. Patients were divided into three groups:

  • One group only received IVIG
  • One group received IVIG and GES
  • One group received IVIG, GES, and pyloric therapy

After a 12-week course of treatment, scientists evaluated each group. Over 28.6% of participants responded well to IVIG therapy alone for gastroparesis. Results showed that IVIG solo therapy had higher response rates, while combination therapy reduced the duration of treatment.

Evaluating the Response to IVIG Treatment for Gastroparesis

A recent study in 2023 evaluated patient responses to IVIG therapy. Researchers hypothesized that patients with serologic neuromuscular markers will respond better to treatment.
For this research, they evaluated 47 patients who had failed previous treatments with medications and surgical interventions. Patients received 400 mg/kg of IVIG for 12 weeks.
From this group, 14 patients responded well to the treatment and had a higher level of glutamic acid decarboxylase 65 (a serologic marker). They also received IVIG for gastroparesis for longer than 12 weeks.
Results from this study show that extended therapy and the presence of serologic markers might lead to better response rates. However, more clinical studies are needed to confirm these results.
 

How to Receive IVIG Treatment for Gastroparesis?

An IV drip hanging from a pole


As you can see from the above studies, IVIG can be a promising option for patients who have not responded to first-line treatments for gastroparesis.
While more studies are needed to determine the efficacy of IVIG for gastroparesis, you can still receive this treatment if your doctor deems it appropriate.
Here are the steps for receiving IVIG therapy:

  1. Visit a gastroenterologist and undergo the necessary tests to determine if IVIG is a suitable treatment option for you.
  2. Receive a prescription for IVIG.
  3. Find an infusion center or at-home infusion service and schedule treatment.
  4. Receive treatment and monitor your symptoms.
  5. Follow up with your doctor to see if IVIG works for your condition.

 

Receive IVIG Treatment for Gastroparesis at Home with AmeriPharma® Specialty Pharmacy

If you’re eligible to receive IVIG for gastroparesis, AmeriPharma® Specialty Pharmacy can help.
We offer home infusion services and hard-to-find medications to patients with debilitating conditions. You can effectively manage gastroparesis with our full-service coordination, 24/7/365 support, and thorough copay assistance.
Our specialty pharmacy can service over 40 US states and guide you through the process. Contact us now to learn more about our services and receive specialty care at home.
 

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Is IVIG Effective for Lyme Disease?

Published on by Dr. Mark Alfonso, PharmD, BCMTMS

Lyme disease is one of the most common tick-borne illnesses in the world. According to statistics from the Centers for Disease Control and Prevention (CDC), it affects over 30,000 people annually in the US alone.

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However, treatments for this disease are limited. Antibiotics are the first option most doctors consider. But with increasing antibiotic resistance, they may not be effective in the future. Another possible treatment for Lyme disease may be IVIG.

IVIG has the potential to improve immune function and fight Lyme disease. However, its efficacy is still a topic of debate.

Today, we will examine the research surrounding IVIG infusions for Lyme disease to see if this option can be a reliable treatment for affected individuals. First, let’s learn more about the disease itself.

What Is Lyme Disease?

Lyme disease is an infectious disease identified for the first time in the 1970s in Old Lyme, Connecticut. In North America, it’s caused by the Borrelia burgdorferi and Borrelia mayonii bacteria transferred to the bloodstream through the bite of an infected deer tick.

Those seeking IVIG treatment for Lyme disease are often people who live in wooded areas where most of these bugs live. Regular animal ticks do not carry this type of infection.

The black-legged ticks become carriers of this specific type of bacteria when they bite an infected deer or bird. After the ticks are on your skin for 36-48 hours, they transmit the bacteria to you.

Symptoms of Lyme Disease

Lyme disease evolves in stages, each with specific symptoms that may sometimes overlap. IVIG infusions are for the later stages of Lyme disease.

Let’s take a closer look at each stage.

Stage One: Early Localized Lyme Disease

Doctors don’t usually prescribe IVIG for this stage of Lyme disease, which occurs 3-30 days after the tick bite.

The main symptom of this stage of the disease is a bull’s-eye rash (erythema migrans) at the bite site that will gradually fade. This rash may feel warm but is not painful or itchy.

Other symptoms of this stage include:

  • Chills
  • Fever
  • Fatigue
  • Sore throat
  • Headaches
  • Muscle pain
  • Joint stiffness
  • Vision problems
  • Enlarged lymph nodes

Stage Two: Early Disseminated Lyme Disease

The second stage of the disease starts one month after the tick bite and can last up to four months. This stage of Lyme disease may not qualify for IVIG treatment either.

The early disseminated phase is more dangerous than the previous stage and signifies the spread of infection throughout the body.

Symptoms of this stage include:

  • Swollen eyelids
  • Irregular heartbeats
  • Back, hip, and leg pain
  • Eye pain and vision loss
  • Facial muscle weakness
  • Rashes throughout the body
  • Pain and stiffness in the neck
  • Numbness in the hands and feet

Stage Three: Late Disseminated Lyme Disease

IVIG infusions are most helpful for this stage of Lyme disease, known as the late disseminated or persistent phase. This stage can occur months or even years after a person has been bitten.

The dangerous symptoms of this stage of Lyme disease that necessitate IVIG usage include:

  • Arthritis of large joints (knees, etc.)
  • Brain disorders like encephalopathy that lead to:
    • Sleep difficulties
    • Mental fogginess
    • Difficulty focusing
    • Temporary memory loss
  • Hands, arms, legs, and feet numbness
  • Skin conditions like acrodermatitis chronica atrophicans

Most people experience these symptoms at each stage of the disease. However, it’s crucial to note that the symptoms may overlap. Some may not experience symptoms of the early stages and only notice the later signs.

What’s important is to visit your doctor as soon as you start noticing any of these symptoms. The earlier you treat Lyme disease with IVIG or antibiotics, the fewer complications you will experience.

 

How Is Lyme Disease Diagnosed?

Before doctors prescribe IVIG infusions for Lyme disease, they must make a correct diagnosis.

If you suspect a tick has bitten you and visit your healthcare provider, the first thing they’ll do is ask about your symptoms. They will review your health history and look for signs of a rash on your body.

They may also order the following tests to make a definitive diagnosis and prescribe IVIG for Lyme disease if it’s right:

  • An enzyme-linked immunosorbent assay (ELISA)
  • A western blot analysis to confirm the positive ELISA assessment
  • A polymerase chain reaction (PCR) test

If you have Lyme disease, the next step is to determine the best course of treatment.

Lyme Disease Treatment

Pills in a person’s hand

The first line of treatment for Lyme disease in its early stages is a course of antibiotics. Doctors usually recommend a course of doxycycline, amoxicillin, or cefuroxime axetil for most patients, whether adults or children.

The length of treatment depends on the stage of the disease. The earlier the stage is, the shorter the treatment length will be.

In more advanced stages of Lyme disease, doctors may consider IVIG infusion treatment.

IVIG Infusions for Lyme Disease

IVIG, or intravenous immunoglobulin therapy, is a form of protein-based infusion therapy. It involves administering concentrated antibody solutions obtained from the plasma of healthy donors directly into a patient’s bloodstream.

The most common conditions IVIG treats include autoimmune disorders and inflammatory diseases. However, this treatment can also be effective for infectious diseases like Lyme disease.

The healthy antibodies in IVIG can boost the immune system and give the body a better chance at fighting the bacteria. But what does the research say about the effectiveness of IVIG infusions for Lyme disease? Let’s find out.

Is IVIG Effective for Lyme Disease? A Look at Studies

IVIG serum next to a hospital bed

While more studies are required to evaluate the effectiveness of immunoglobulin therapy on Lyme disease, current research shows promising results.

Below are some of the most prominent studies evaluating IVIG therapy for this infectious disease.

Lyme Radiculoneuritis Treated with Intravenous Immunoglobulin

Lyme radiculoneuritis is a neurological complication of Lyme disease that can cause pain and numbness in the legs, hips, and back. Its treatment relies on antibiotics, but one study examined the efficacy of IVIG for this complication of Lyme disease.

This study involved a 68-year-old man who complained of muscle pain and weakness in his abdomen and was unable to walk. Upon examination, doctors found he also had weakness in the muscles of his face and upper and lower limbs.

They gave him 0.4 g/kg of IVIG infusions for Lyme disease for five days. By the fourth day, they saw significant improvements in his symptoms. He could resume walking and running.

IVIG treatment continued for six months. During this time, he received an infusion once every month and remained symptom-free without any other treatments.

IVIG for Lyme Disease-Associated Acute Demyelinating Polyneuropathy

Another study involved a 58-year-old male patient who was admitted to the hospital with signs of diffuse myalgias, chills, and fevers. He had regular muscle strength when admitted. However, his muscles became weaker during his stay at the hospital.

This weakness was more prominent in his shoulders, lower extremities, hip flexors, and knee extensors. An electromyography test (EMG) on week 2 showed signs of demyelinating sensorimotor polyneuropathy, and a western blood test confirmed Lyme disease.

He started to receive IVIG for Lyme disease on day 33. Doctors administered a total of 5 doses over five days.

On day 38, the patient was discharged with improved muscle strength and the ability to walk with the help of an assistive device. Two months later, he regained his muscle strength fully and could return to his normal activities.

IVIG Infusions for Lyme Disease and PANDAS

One of the groups that suffer most from Lyme disease is children between 5-14 years old. One study used a combination of antibiotics and IVIG to treat Lyme disease in a 7-year-old female patient with serological signs of the disease.

This patient had visited a tick-endemic area of the US six months prior with her parents and on presentation showed multiple neuropsychiatric symptoms. She also met the criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

Doctors prescribed her antibiotics and three courses of IVIG infusion treatment. She completely recovered from the disease and remained free of any symptoms.

Final Word on the Effectiveness of IVIG Infusions for Lyme Disease

As you can see from the studies above, treating Lyme disease with IVIG is possible. Intravenous immunoglobulin therapy can be a safe and effective solution for battling this infectious disease.

However, more clinical studies are required to determine the optimal dosage and treatment duration. These studies should also look into the antibiotics that will be more effective with IVIG against Lyme disease.

Adynovate: A Long-Lasting Medication for Hemophilia A Patients

Published on by Dr. Robert Hakim, PharmD

FDA-approved in November 2015, Takeda’s Adynovate is a twice-weekly treatment for hemophilia A in children and adults. 

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What Is Adynovate?

Adynovate is a brand-name prescription medication. The active substance in this product is recombinant clotting factor VIII (recombinant antihemophilic factor). It is in a class of medications called antihemophilic factors. The term “recombinant” means this product is made in a lab with recombinant DNA technology instead of being sourced from blood donors. As a result, Adynovate doesn’t have a risk of spreading blood-borne infections.

People with hemophilia A are missing the blood clotting factor called factor VIII. This results in the blood not clotting, leading to a higher risk of unexplained bleeding or, in severe cases, potentially life-threatening internal bleeding. 

How Is Adynovate Supplied and Used?

This product comes as a sterile, white to off-white powder for reconstitution for intravenous (IV) injection in single-dose vials. One international unit (IU) is equal to the quantity of factor VIII in 1 ml of fresh human plasma. The following strengths are available in the US:

  • 250 IU
  • 500 IU
  • 750 IU
  • 1,000 IU
  • 1,500 IU
  • 2,000 IU
  • 3,000 IU

Before administering the medication, your healthcare provider will determine the dose using a specific formula. Then, they will prepare the liquid for injection following instructions on the package. 

The dose and duration of treatment depend on:

  • Body weight
  • Severity of factor VIII deficiency
  • Desired factor VIII level
  • Location and severity of bleeding
  • Condition you’re receiving the infusion for

Adynovate is given as an injection into the veins (IV). It’s typically given twice per week for bleeding prevention and every 8 to 24 hours for bleeding treatment, depending on how severe the bleeding is.

The medication is typically administered over a period of 5 or fewer minutes. The liquid should be used within 3 hours after reconstitution. 

How Does Adynovate Work?

This medicine works by replacing the missing clotting factor VIII in children and adults with hemophilia A. 

What Is Adynovate Used To Treat?

A healthcare provider may prescribe Adynovate for children and adults with hemophilia A to:

  • Control and prevent bleeding episodes
  • Prevent bleeding during surgery
  • Reduce the frequency of bleeding episodes

This product isn’t used to treat another similar bleeding disorder called von Willebrand disease.

What Are the Side Effects of Adynovate?

Man with dizziness after taking Adynovate

Side effects can range from mild to severe. 

The most common side effects are:

  • Headache
  • Diarrhea
  • Rash
  • Nausea
  • Dizziness 
  • Hives

Talk to your healthcare provider if these side effects don’t go away or worsen. 

Some people receiving Adynovate may experience severe allergic reactions, including anaphylaxis. Anaphylaxis is a potentially fatal reaction that causes difficulty breathing and low blood pressure. Go to the emergency room  if you develop the following symptoms after receiving Adynovate:

  • Rash and itching
  • Hoarseness
  • Breathing difficulty
  • Trouble swallowing
  • Swelling of your hands, face, or mouth

In some people, their immune system makes proteins called inhibitors after receiving the medication. Inhibitors can make Adynovate less effective in stopping a bleeding episode. 

If you develop inhibitors, you will need special treatment until your immune system no longer makes inhibitors. Talk to your healthcare provider to learn more about inhibitors and tests to measure your inhibitor level. 

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Who Shouldn’t Receive This Medication?

People allergic to recombinant factor VIII, mouse or hamster protein, or any product component shouldn’t use Adynovate. Make sure to tell your healthcare provider about any known allergies you have. 
 

Use in Pregnancy and Lactation

There are no human or animal data about use during pregnancy. It isn’t known if this medication can harm an unborn baby. 
Likewise, it isn’t known if this medication passes into breast milk or if it harms the breastfed infant. Talk to your healthcare provider about the risks and benefits of using this medication if you are pregnant or nursing a child.
 

Can You Self-Administer Adynovate?

If your healthcare provider has trained you to self-administer this medication at home, remember the following:

  • Use Adynovate exactly as directed. 
  • Follow all directions on the prescription label. 
  • Never use this medication in larger or smaller quantities or for longer than recommended. 
  • Be sure to check the strength of the medicine on the label. 
  • Don’t self-administer if you don’t understand how to use the injection.
  • Always use sterile water and a reconstitution device that comes with the product to prepare the solution for injection. 
  • Don’t refrigerate the liquid after reconstitution. 
  • Use the liquid within 3 hours after reconstitution.
  • Before using your dose, visually check the solution. It should be clear and colorless. 
  • Discard the liquid that isn’t clear or contains particles. 
  • A single-use vial, as the name suggests, is for one use only. 
  • Put the needle, syringe, and Adynovate in a puncture-proof sharps container before disposing. Don’t dispose of any of them in ordinary household trash.
  • Keep the container away from children and pets.
  • You may need frequent blood tests to check if the treatment is working or if you need to change your doses. 

 

What Happens If I Miss a Dose?

Because this medicine is administered when needed, a dosing schedule is unlikely. However, if you are on a schedule, take the missed dose as soon as you remember. Skip the missed dose if it is time for the next scheduled dose. Never use extra medicine to compensate for the missed dose.
 

Adynovate vs. Advate: What’s the Difference?

Both medications contain the same active substance, recombinant clotting factor VIII. Additionally, both Adynovate and Advate are used to treat hemophilia A. 
However, Adynovate contains a substance that extends its half-life. A longer half-life means the medication stays in your system longer, which allows for a twice-weekly dosing schedule. 
 

Adynovate vs. Adynovi: What’s the Difference?

Adynovate is marketed as Adynovi in Europe. Both products contain the same active and inactive components.
 

How Much Does Adynovate Cost?

The amount you pay for Adynovate treatment can vary, depending on your insurance plan, geographical location, and pharmacy. Contact your insurance provider to find out if your plan covers this medicine or if you need prior authorization.
According to Takeda Pharmaceuticals U.S.A., which makes Adynovate, over 90% of commercial and Medicaid health plans cover this medicine. 
If your provider has prescribed this medicine, you may be eligible for Takeda’s HSC Co-Pay Assistance Program, which can cover up to 100% of your out-of-pocket copay costs.
New users may be eligible for 8 free trial doses with Takeda’s FREEDOM OF CHOICE program. 
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How To Prevent CLABSI With TPN

Published on by Dr. Robert Hakim, PharmD

TPN is a life-saving treatment for many patients who can’t consume food or drink by mouth. It allows them to receive the necessary nutrients the body needs to stay healthy and function properly. However, there’s a risk of complications, including central line-associated bloodstream infections (CLABSI).

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CLABSI in patients receiving TPN can lead to prolonged hospital stays, higher healthcare costs, and even death. In fact, over 28,000 patients die from this complication annually. However, preventing CLABSI with TPN is possible and easy.

This guide will show you how to prevent CLABSI with TPN by following proper guidelines and central line maintenance techniques.

Understanding TPN Therapy

Total parenteral nutrition, or TPN therapy, is a form of intravenous nutrition therapy that provides patients who can’t consume food or drink by mouth with all the essential nutrients their body needs to function.

Providers may prescribe TPN for cancer patients and those with gastrointestinal disorders, short bowel syndrome, recovering from surgery, among others.

TPN typically includes micronutrients (e.g., minerals, vitamins, electrolytes), and macronutrients (e.g., proteins, fats, and carbohydrates). The patient’s health condition and blood test values will determine what’s in a TPN solution.

Healthcare professionals should know the contents of the solution to prevent CLABSI with TPN effectively.

Administering TPN

TPN can be administered through a central venous access device (CVAD) or a peripheral intravenous catheter.

After selecting the insertion site, nurses will attach the CVAD, prepare the solution, take the necessary measures to prevent CLABSI with TPN, and administer the solution. The nutrients will enter the patient’s bloodstream and support their vital functions.

Complications of TPN

TPN is associated with various complications. Metabolic complications of TPN include conditions like hyperglycemia (high blood sugar), electrolyte imbalance, refeeding syndrome, and liver dysfunction.

There is also the risk of non-metabolic complications that can be just as dangerous. One of these complications is CLABSI, and knowing how to prevent CLABSI with TPN can be the difference between life and death for a patient.

What Is CLABSI?

CLABSI, or central line-associated bloodstream infection, is when harmful pathogens like bacteria enter the patient’s bloodstream through a central line or catheter.

While this TPN complication can be a potentially life-threatening infection, you can easily prevent CLABSI with TPN.

Risk Factors for CLABSI in Patients Receiving TPN

Several risk factors that increase the likelihood of developing CLABSI while receiving TPN include:

  • Poor catheter care
  • Long hospital stays
  • Weakened immune system
  • Prolonged need for vascular access
  • Limited access sites for central lines
  • Improper aseptic technique during TPN administration
  • Underlying medical conditions such as diabetes or cancer
  • Concurrent use of other invasive devices, such as urinary catheters

Tips to Prevent CLABSI with TPN

A female nurse putting on gloves

Healthcare providers must implement the best practice recommendations during treatment administration to prevent CLABSI with TPN. Here are some measures you can take to reduce the risk of CLABSI:

Selection of Appropriate Devices

The first step to preventing CLABSI involves choosing the appropriate devices for TPN therapy. Healthcare professionals must assess each patient’s medical history and determine their needs based on their current symptoms.

They must assess the potential health risks associated with different types of central venous access devices and select the best one, depending on the potential for complications and the patient’s duration of therapy.

Site Selection

The second factor to consider to prevent CLABSI with TPN is to select a proper site for CVAD insertion. To determine the best site, assess the patient’s activity level, age, and the size of the CVAD.

The best practice is to choose the non-dominant side of the patient’s body for CVAD insertion. Choosing this side will reduce the risk of contamination from the patient’s hand and make them more comfortable.

Selecting the appropriate site can also reduce the risk of accidental dislodgement of the device and prevent complications such as hematoma, skin necrosis, and vascular damage.

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Proper TPN Solution Preparation

The next factor that will help you prevent CLABSI with TPN is how you prepare the solution to infuse into the patient’s bloodstream. To prevent CLABSI with TPN, you must follow the hygiene protocols from the first step.
This means preparing the TPN solution in a sterile environment, following the recommended aseptic techniques and strict personal hygiene protocols. Using in-line filters is another step that can remove the pathogens from the solution and reduce the risk of infection.

Correct Insertion of the Catheter

A fundamental part of preventing CLABSI with TPN involves correct catheter insertion. Whether you’re in a hospital setting or provide home TPN therapy, you must follow strict aseptic protocols during catheter insertion.
Use the maximum barrier precautions (gloves, masks, caps, and gowns) and adhere to standard aesthetic practices. Before inserting the catheter, disinfect the patient’s skin with antiseptic swabs.
Ensure the catheter is in the subclavian vein, not the femoral or internal jugular veins. These veins are associated with higher infection rates. Don’t forget to hold tension on the catheter while inserting the CVAD.

Regular Catheter Care and Line Maintenance

The most critical step for preventing CLABSI with TPN involves proper care and maintenance of central venous catheters.
If you want to learn how to prevent CLABSI with TPN by properly maintaining the line integrity, here are some measures you can take.

Change Line Dressings Routinely

The risk of CLABSI depends heavily on how often you change TPN tubing and dressing. Routine dressing changes are necessary for reducing the risk of contamination and infection.
You must change the dressing every seven days or sooner. Schedule changes according to the dressing type and the patient’s needs.
Change the dressing in a sterile environment to minimize the risk of infection and prevent CLABSI with TPN. In addition, flush the catheter regularly with heparin or sterile saline to prevent blockages.

Inspect for Signs of Infection

Inspect the line daily for signs of infection, dislodgment, and blockage. If there are any signs of these incidents, address the underlying problem immediately to avoid further complications.

Don’t Disconnect CVADs

Lastly, don’t disconnect CVADs unless you need to make a routine assessment, changing the dressing, or administering TPN.
If you disconnect the CVADs from the TPN equipment, you risk introducing pathogens into the solution. So, disconnect the line only when necessary to prevent CLABSI with TPN.

CLABSI Detection

A man resting his face on his hand


You must know the signs of CLABSI because early recognition and treatment can help the patient avoid potentially life-threatening complications.
If you notice any swelling, redness, fever, chills, or hypotension, the patient is most likely infected.
Obtain blood cultures to determine the best course of antibiotics and start treatment immediately.

Education and Training

It’s essential that both healthcare professionals and patients are educated on ways to prevent CLABSI with TPN as well as CLABSI symptoms to watch out for.
Healthcare providers must receive ongoing education to learn the best practices for inserting and maintaining central venous catheters.
Patients must also receive education on the symptoms of CLABSI, proper care of the CVAD, and steps to take if they suspect an infection.
 

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Using Evidence-Based Guidelines

You must always use evidence-based guidelines and protocols if you want to learn how to prevent CLABSI with TPN effectively.
The most reliable TPN troubleshooting guides are regularly updated to reflect the latest current practices. By following these established guidelines, you can minimize the risk of infection, prevent CLABSI with TPN, improve patient outcomes, and ensure successful treatment.

Special Considerations for High-Risk Patients

Lastly, special considerations and protocols must be in place for patients at a higher risk of CLABSI.
For instance, people with compromised immune systems or underlying medical conditions are more prone to getting infected. So, they must receive TPN in more sterile environments and undergo more frequent catheter assessments.
These cautionary measures will ensure high-risk patients receive treatment without becoming infected.
 

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If you need TPN infusion therapy from reliable healthcare providers, AmeriPharma® Specialty Pharmacy can help. Our trained nurses know how to prevent CLABSI with TPN and ensure you receive your nutrients safely.
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A Guide to Treatments for Lambert-Eaton Syndrome

Published on by Dr. Saba Rassouli, PharmD

Lambert-Eaton syndrome is a rare and progressive disease affecting over two million people worldwide. It can cause muscle weakness by disrupting neuromuscular function. There are many treatments for Lambert-Eaton syndrome. However, their efficacy varies among patients.

Here, we will look closer at the treatment of Lambert-Eaton syndrome with different forms of therapy. From medications to surgery and IVIG infusions, we will introduce you to the most effective treatments for this disease to help you make an informed decision for your health.

What Is Lambert-Eaton Syndrome?

Lambert-Eaton syndrome is one of the many conditions IVIG can treat. It is also known as Lambert-Eaton myasthenic syndrome or LEMS.
In this

immune disorder, the immune system attacks the neuromuscular junctions between motor nerves and muscles. This area is the connection point between the neurons and muscles, where the nerve impulses are transmitted to the muscle fibers to cause contraction.
By affecting this area, LEMS disrupts the signals and weakens the muscles. Therefore, treatments for Lambert-Eaton syndrome focus on resolving this disruption and restoring connection.

People at Risk of Getting LEMS

Some groups of people are more susceptible to developing Lambert-Eaton syndrome than others.
One of these groups is older people (around 60 years old) with an underlying cancer like small-cell lung carcinoma. LEMS in this group is seen more often among men with a history of smoking. Symptoms may start before cancer diagnosis.
Another group more likely to seek the treatments of Lambert-Eaton syndrome is people with no underlying malignancies. In this group, LEMS peaks once around age 35 and another time at 60, affecting both sexes equally.
 

Symptoms of Lambert-Eaton Syndrome

The type of treatment for Lambert-Eaton syndrome will depend on the patient’s symptoms. Some of the most common symptoms of LEMS include:

  • Fatigue
  • Dry eyes
  • Dry mouth
  • Weight loss
  • Muscle pain
  • Double vision
  • Drooping eyelids
  • Trouble walking
  • Muscle stiffness
  • Trouble speaking
  • Trouble breathing
  • Muscle weakness
  • Erectile dysfunction
  • Difficulty swallowing
  • Dizziness upon standing
  • Bladder and bowel problems
  • Tingling sensation in hands and feet

 

Causes of Lambert-Eaton Syndrome

As we already mentioned, Lambert-Eaton syndrome is an autoimmune condition where the body’s natural defenders mistake your healthy nerves as invaders and attack them.
Unfortunately, at this time, we do not fully know what triggers this response. It may be an effort by the body to fight an underlying cancer in people with small-cell lung carcinoma. However, it affects people without cancer as well.
Scientists working on treatments for Lambert-Eaton syndrome link this disease to genetics, but we still have a long way to go to understand the real cause of LEMS.
 

How Is Lambert-Eaton Syndrome Diagnosed?

Successful treatment of Lambert-Eaton syndrome depends on the correct diagnosis of the disease.
If you show any signs of this disease, your doctor will refer you to a neurologist. After a thorough physical examination and medical history evaluation, the neurologist will check your reflexes and perform the following tests:

  • Blood tests – These tests will look for anti-calcium channel antibodies in your blood, which are common among people with LEMS.
  • Electromyography – This test determines how well the signals from nerves reach your muscles.
  • Scans – The doctor may perform imaging tests like CT or PET scans to see if you have small-cell lung cancer.

 

Treatments for Lambert-Eaton Syndrome

A person holding a handful of pills


LEMS has no cure yet, but several treatments can alleviate its symptoms and help patients live a relatively normal life. Here are the most effective treatments for LEMS.

Cancer Treatment

Treatment of Lambert-Eaton syndrome depends on the patient’s underlying health conditions. Since 60% of LEMS patients have an associated small-cell lung cancer, the first approach is to treat the cancer.
Cancer treatment may include surgery, chemotherapy, radiation therapy, or a combination of all, based on your doctor’s opinion and the stage of your disease.
Chemotherapy targets cancer cells across the body, while radiation therapy targets specific areas, and surgery removes the cancerous tumor. By effectively treating the underlying cancer, LEMS symptoms can significantly improve.
 

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Nerve Signal Boosting Medications

Another line of treatment for Lambert-Eaton syndrome is medications that improve signal transmission from the nerves to the muscles.
Some of the most common medications for this purpose include:

  • Amifampridine (3,4-diaminopyridine or 3,4-DAP) – This medication works by blocking the presynaptic channels and increasing calcium influx, which leads to increased acetylcholine (ACh) release (an impaired function in people with LEMS).
  • Pyridostigmine – This medication increases ACh signaling by inhibiting its breakdown at neuromuscular junctions.
  • Guanidine – This drug enhances ACh release by binding to voltage-dependent calcium channels at nerve endings. It increases calcium influx and triggers ACh release by keeping the channels open longer.

Immunosuppressants

Effective treatment of Lambert-Eaton syndrome is also possible with immunosuppressants. Doctors usually turn to this type of treatment for Lambert-Eaton syndrome when the above approaches did not work effectively.
As the name suggests, immunosuppressants suppress the immune system’s defensive mechanisms. By dampening these immune responses, immunosuppressants restore muscle strength and alleviate other symptoms of LEMS.
Some of the most common immunosuppressants used to treat LEMS include:

  • Prednisone – This medication is a corticosteroid that is also a treatment option for myasthenia gravis.
  • Azathioprine – This immunomodulator is an effective option that is also useful for treating rheumatoid arthritis.
  • Methotrexate – This antimetabolite immunosuppressant is also a chemotherapy agent used to treat cancer.

Plasma Exchange

Another type of treatment for Lambert-Eaton syndrome is plasma exchange or plasmapheresis. This procedure involves replacing plasma containing harmful antibodies with healthy plasma.
A specialist will pass your blood through a machine to separate the plasma from the blood cells. After filtering out the harmful antibodies attacking your neuromuscular junctions, they will return the healthy blood to your body.
Plasmapheresis alleviates LEMS symptoms by getting rid of the antibodies that are contributing to the condition. Your healthcare provider may consider plasma exchange if your symptoms are too severe.
For effective treatment of Lambert-Eaton syndrome, you should undergo this procedure several times regularly based on the severity of your condition to keep your antibody levels in check.

Immunoglobulin Therapy

Finally, intravenous immune globulin, or IVIG therapy, can be an effective treatment for Lambert-Eaton syndrome. IVIG is the primary form of therapy for refractory cases of LEMS that have not responded to other medications.
IVIG treatment involves infusing patients with antibody solutions derived from the blood of healthy donors. The goal is to replenish the patient’s immune system with enough healthy antibodies to combat the attack on neuromuscular junctions and improve connections.
Depending on a patient’s severity of symptoms and response to treatment, they may receive IVIG on a short or long-term basis. The typical regimen involves administering 2 g/kg over 2-5 days.
 

What Is the Best Treatment for Lambert-Eaton Syndrome?

A hospital room with a blue curtain and IVIG serum


Treatment of Lambert-Eaton syndrome varies based on the patient and the severity of their disease. However, the first line of treatment for most patients is nerve signal-boosting medications, specifically 3,4-diaminopyridine.
Some consider this the best and most effective form of treatment for LEMS, as it is generally well-tolerated by most patients and can significantly improve muscle strength.
However, responses to this medication will vary, and patients with more severe symptoms may require more intensive treatments. In these cases, the best treatment for Lambert-Eaton syndrome may be a combination of medications, IVIG, and plasmapheresis.
Patients with LEMS must work closely with their healthcare providers to determine the best treatment for their condition that meets their health needs.
 

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Living with Lambert-Eaton Syndrome

Muscle weakness caused by Lambert-Eaton syndrome can be so severe that it can make routine activities such as walking or climbing the stairs difficult. However, you can still maintain a good quality of life using the following tips:

  • Stay hydrated and follow a healthy diet
  • Exercise regularly to maintain strength and mobility
  • Avoid strenuous activities that can cause muscle fatigue
  • Wear comfortable clothes that fit well to reduce the risk of falling
  • Use assistive devices like walkers, canes, or wheelchairs to move around more easily
  • Learn all you can about different forms of treatment for Lambert-Eaton syndrome and discuss them with your doctor
  • Seek help from family, friends, and support groups to maintain a positive outlook
  • Identify and avoid triggers that worsen your symptoms (stress, certain medications, etc.)

 

Can You Prevent Lambert-Eaton Myasthenic Syndrome?

Since scientists do not know the exact cause of Lambert-Eaton syndrome, there are no sure ways of preventing it.
However, this disease is associated with small-cell lung cancer in most people. You can potentially lower your chances of developing LEMS by following these tips:

  • Quit smoking
  • Avoid second-hand smoke
  • Adopt healthier lifestyle habits
  • Check your home routinely for radon

 

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Lambert-Eaton syndrome may be a rare autoimmune disorder with no cure, but you can manage the symptoms with various available treatments. From cancer therapies to immunosuppressants and IVIG, these treatments will allow you to live a better life.
You can start treatment of Lambert-Eaton syndrome with IVIG therapy by contacting AmeriPharma® Specialty Pharmacy. Our licensed nurses will come to you at your convenience to administer the infusions and help you find relief from the debilitating symptoms of LEMS.
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IVIG and Hypotension: When Low Blood Pressure Can Be Dangerous

Published on by Dr. Saba Rassouli, PharmD

There’s a well-established link between IVIG and low blood pressure (hypotension). Though mild, hypotension can be life-threatening if it is associated with specific conditions, such as allergies, lung injuries, and infections. 

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IVIG is an effective and well-tolerated treatment for many autoimmune and inflammatory disorders. Yet some users may experience undesirable symptoms during or after IVIG therapy. The most common IVIG side effects are:

  • Headache
  • Fever
  • Chills
  • Flushing
  • Muscle or joint pain
  • Tiredness
  • Nausea
  • Vomiting
  • Rash

IVIG may cause hypotension in some users, typically within 4 hours after starting an infusion [1].

IVIG and Hypotension: Why Does IVIG Lower Blood Pressure?

While researchers know that IVIG can lower blood pressure in some users, they have yet to understand why it happens. Preliminary animal studies suggest it may have something to do with the immunoglobulin G (IgG) molecules in the IVIG preparation. 

In 2003, German researchers reported that IgG molecules clump together to form a complex called an IgG dimer. According to them, these complexes bind with specific immune cells, causing these cells to release blood pressure-lowering substances [2].

In essence, the greater the quantity of these complexes, the greater the odds of hypotension. 

Because these complexes form only in certain IVIG products, not all preparations lower blood pressure [3].

IVIG and Hypotension: When Alone, Low Blood Pressure Is Typically a Mild Reaction

IVIG-induced hypotension is usually mild and transient. Depending on the severity, your provider may recommend the following treatments:

  • Change in the infusion rate
  • Switching the IVIG preparation
  • Supportive care, such as intravenous fluids and oxygen
  • Medicines to raise blood pressure

If your condition does not improve or worsens, they may pause or terminate IVIG treatment. 

IVIG and Hypotension: With Other Symptoms, Low Blood Pressure Can Be Life-Threatening

When you develop hypotension with other symptoms, it could be indicative of something serious. For example, hypotension is a common feature of a potentially life-threatening allergic reaction called anaphylaxis. 

In this section, we will learn about the conditions that have hypotension as a feature. 

Anaphylaxis

Woman with difficulty breathing due to anaphylaxis

Some people may develop severe allergic reactions to an IVIG product or product components. Anaphylaxis symptoms (other than hypotension) include:

  • Difficulty breathing
  • Increased heart rate
  • Swelling of the face or tongue
  • Rash
  • Itching

Acute Hemolysis

Hemolysis is when your red blood cells rupture faster than your body can replace them. In addition to low blood pressure, hemolysis can cause:

  • Fever
  • Difficulty breathing
  • Red/brown/tea-colored urine
  • Increased heart rate
  • Back pain

Transfusion Related Acute Lung Injury (TRALI)

TRALI is a potentially fatal IVIG reaction. It occurs during or within 6 hours of infusion. Symptoms, besides hypotension, include:

  • Rapid breathing 
  • Shortness of breath
  • Fever
  • Rapid heart rate

Bacterial Infection

Bacterial infections occur extremely rarely. Infection could result from contamination during IVIG administration. Symptoms include:

  • High fever (during or up to 4 hours after IVIG infusion)
  • Difficulty breathing
  • Rapid heart rate

If you develop any of these conditions, your provider will first stop IVIG treatment. Then, they will give you condition-specific medicines. Medicines can include epinephrine, steroids, and allergy medications.  

Supportive care, such as oxygen and respiratory support, may be necessary in some cases. The decision to resume infusion is case-specific. After reassessing your condition, your provider might switch to another IVIG preparation. 

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Can IVIG Cause High Blood Pressure?

Your blood pressure might get too high while you are on IVIG therapy. High blood pressure (hyPERtension) may cause headaches, dizziness, or blurred vision. If you think you have high blood pressure, talk to your provider immediately. 
 

What Medications Should Be Avoided With Hemophilia?

Published on by Dr. Christine Leduc, PharmD

If you’ve been diagnosed with hemophilia, you must be cautious about what medications to avoid. For instance, aspirin, while safe for some people, could be dangerous for you. 

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Hemophilia is a bleeding disorder in which blood does not clot properly due to a deficiency of some blood clotting proteins (factor VIII or factor IX). People with this condition can bleed excessively, even from minor injuries. Therefore, those with hemophilia should be aware of things that can worsen their condition. 

In this article, we have compiled a list of medications that are potentially harmful to hemophilic patients and described how each medication could affect their condition. 

Medications that Hemophilic Patients MUST Avoid

The following are some of the medications that you must avoid if you have hemophilia A or B:

Aspirin

Aspirin is a drug that is usually prescribed to ease pain. People with moderate to severe hemophilia should not take aspirin or aspirin-containing medications (such as Alka-Seltzer or Excedrin), as these drugs can interfere with the process of blood clotting by affecting platelet function, which results in prolonged bleeding time. 

Moreover, aspirin can also increase the risk of bleeding in your stomach or digestive tract. Therefore, instead of aspirin, hemophilia patients can use acetaminophen (Tylenol) for pain, fever, minor injuries, and headaches. 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are prescribed to reduce inflammation and pain in the body. The signs of inflammation include heat, pain, swelling, and redness in a particular part of the body. 

Hemophilia patients should avoid taking NSAIDs to reduce redness and swelling. NSAIDs such as ibuprofen (Advil, Motrin), naproxen (Aleve), and indomethacin can affect the functions of platelets and interfere with blood clotting. Instead of NSAIDS, acetaminophen should be used to reduce fever or pain.

Blood Thinner (Anticoagulants) Medications

Woman taking pills from a bottle

Blood thinners or anticoagulants are used to prevent the blood from clotting. Since blood does not clot properly in hemophilia, taking blood thinning medications can put patients at significant risk of excessive and prolonged bleeding. 

Some of the anticoagulants to avoid are as follows:

  • Heparin
  • Warfarin (Coumadin)
  • Clopidogrel (Plavix)
  • Prasugrel (Effient)
  • Ticagrelor (Brilinta)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Dabigatran (Pradaxa)

Antidepressants

Antidepressants such as fluoxetine, paroxetine, and sertraline have mild-inhibiting effects on platelets, which may increase the bleeding tendency in some patients with hemophilia.

Some Antibiotics

Antibiotics treat infections caused by bacteria or viruses. Some antibiotics, particularly those in the cephalosporin and sulfa drug classes, can interfere with blood clotting and should be used cautiously in individuals with hemophilia. 

These antibiotics include ceftriaxone, cephalexin, and sulfamethoxazole-trimethoprim (Bactrim). If you have an infection, always consult your healthcare provider about what antibiotic you should take. 

Herbal Supplements

In some cases, when people with hemophilia use herbal supplements to relieve their pain or reduce inflammation, they can experience bleeding episodes. Though herbal drugs are natural and seem harmless, they have been reported to be associated with bleeding due to their anticoagulant properties. 

Some of the herbal supplements that you should not take or must consult your healthcare provider before taking include:

  • Ginkgo biloba
  • Garlic in large amounts
  • Ginger 
  • Ginseng
  • Feverfew
  • Saw Palmetto 

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Conclusion

Though there is no cure for hemophilia, healthcare providers typically prescribe certain medications and treatments to patients that can help them stop bleeding so they can engage in ordinary activities. Some commonly prescribed medications, such as aspirin, NSAIDs, antidepressants, antibiotics, and herbal drugs, can put patients at risk of uncontrolled, excessive bleeding if taken unknowingly or without a doctor’s prescription. Hence, patients must be aware of which medications to avoid for hemophilia.  
 

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Does IVIG Cause Hair Loss?

Published on by Dr. Samantha Kaeberlein, PharmD

Intravenous immunoglobulin (IVIG) therapy has many potential benefits for patients suffering from autoimmune disorders and immune deficiencies. Although this therapy has become a lifeline treatment for these patients, it also raises some concerns. One such concern that patients typically worry about before undergoing IVIG treatment is hair loss. 

Hair loss during IVIG therapy is rare, but some anecdotal case reports (reports that are based on personal experiences, testimonies, or observations and not scientifically documented) demonstrated that IVIG therapy may play a role in hair loss in some patients. 

Furthermore, researchers believe that hair loss during IVIG therapy can also occur due to several other factors, not solely by IVIG itself. 

In this article, we will discuss IVIG and its potential to cause hair loss and what other factors can contribute to hair loss during IVIG treatment. 

Connection Between IVIG and Hair Loss

Hair loss is not a commonly reported side effect of IVIG treatment. Clinical studies and medical literature typically DO NOT list hair loss as a direct consequence of IVIG therapy. 

However, a recent case study reported that an adult patient with autoimmune autonomic neuropathy experienced selective loss of pigmented hair while being treated with IVIG. Still, further detailed studies are required to find out the direct link of IVIG therapy with hair loss. 

In other words, based on one case report, we cannot conclude that IVIG causes hair loss; other factors may also be involved. Hence, some patients may experience hair loss while some may not. 

Factors That May Contribute to Hair Loss During IVIG Therapy

Man with hair loss looking into the mirrorSeveral potential factors may contribute to hair loss during IVIG treatment, as follows:

Stress

In many cases, stress can trigger telogen effluvium– a type of hair loss in which stress pushes the hair follicles to enter the shedding phase prematurely and results in increased hair loss within a few months time. 

Patients undergoing regular IVIG infusions often have increased stress levels, which could lead to increased hair loss. 

Underlying Disease

Many patients who require IVIG therapy may also have other underlying health conditions, such as diabetes or thyroid problems, along with diagnosed autoimmune disorders. This may cause hair loss independent of the IVIG treatment. For example, autoimmune disorders, like alopecia areata, can cause inflammation that directly affects the hair follicles and causes hair loss or bald spots. 

Poor Nutrition

Patients receiving IVIG treatment sometimes also experience nutritional deficiencies. Deficiency in essential nutrients can directly impact your hair growth and health. Therefore, adequate nutrients such as iron, vitamin B12, vitamin D, and folate are crucial for maintaining healthy hair along with other metabolic body processes. 

Multiple Medications Interactions

The interaction of multiple medications that are administered alongside IVIG therapy could contribute to hair loss. Although IVIG itself may not directly cause hair loss, other medications taken concurrently for other health conditions may cause hair loss as a side effect. 

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Steps You Can Take To Avoid Hair Loss During IVIG Therapy

If you’ve scheduled an IVIG therapy session and are worried about hair loss, you can take the following steps to avoid hair loss risk:

  • Talk to your healthcare provider and discuss any concern you have related to hair loss with them. A healthcare provider will evaluate your medical and medication history and recommend the best intervention. 
  • During your IVIG treatment course, you can engage in stress-reducing practices such as yoga, meditation, mindfulness, or deep breathing exercises. 
  • Consume a balanced diet rich in vitamins and minerals to prevent nutrient deficiency during or after the treatment. This will also help to prevent the risk of hair loss. 
  • Follow a gentle hair care routine and avoid using harsh shampoos. 

In summary, IVIG probably does not directly cause hair loss. However, several other factors, such as stress, underlying health conditions, poor nutrition, and medication interactions, can contribute to the thinning of hair during IVIG therapy. 

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