CIDP and Home Infusion: IVIG Treatment, Dosing Schedule, and Long-Term Management

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neurological disorder in which the body's immune system attacks the myelin sheath surrounding peripheral nerves, causing progressive weakness, numbness, and functional impairment. CIDP is rare, affecting approximately 1 to 9 per 100,000 people, but it is one of the most common treatable immune-mediated neuropathies, and intravenous immunoglobulin (IVIG) is one of its most effective and widely used treatments.

For many CIDP patients on stable maintenance IVIG therapy, home infusion is the most convenient and clinically appropriate setting for ongoing treatment. Pharmko supports CIDP patients and their neurologists across 22+ states with the clinical coordination and nursing support that makes home IVIG reliable for this specific patient population.

How IVIG Works for CIDP

The exact mechanism by which IVIG benefits CIDP patients is not fully understood, but several pathways have been identified. IVIG appears to modulate the immune system by:

Neutralizing pathological antibodies that target myelin-associated glycoprotein and other peripheral nerve components
Blocking Fc receptors on macrophages and other immune cells, reducing their ability to damage nerve tissue
Providing anti-idiotypic antibodies that regulate autoreactive B cells
Modulating complement activation and cytokine signaling involved in nerve inflammation

The clinical result is stabilization or improvement of neurological function, reduced weakness, improved sensation, and better functional capacity, that is maintained as long as IVIG is continued on schedule.

Diagnosis: How CIDP Is Confirmed

CIDP diagnosis can be challenging because its presentation overlaps with other neuropathies. The European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria are the most widely used diagnostic framework and require:

Progressive or relapsing weakness and sensory dysfunction in more than one limb for at least 8 weeks
Electrodiagnostic (nerve conduction study) evidence of demyelination in at least two nerves
In atypical presentations: supporting evidence from CSF analysis, nerve biopsy, or MRI

CIDP variants, including multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), pure motor CIDP, and sensory CIDP, may present differently and may respond differently to IVIG compared to typical CIDP.

IVIG Dosing Schedule for CIDP

Induction phase

Treatment typically begins with a loading course of IVIG to establish therapeutic IgG levels and achieve initial clinical response. Standard induction dosing is 2 g/kg total, divided over 2 to 5 consecutive days. Some neurologists use a 1 g/kg single-day loading dose as an alternative in patients who tolerate rapid infusions well.

Most patients begin to notice improvement within 2 to 6 weeks of the loading course. If there is no meaningful response after a full induction course, the diagnosis of CIDP should be reconsidered.

Maintenance phase

Patients who respond to induction therapy require ongoing maintenance IVIG to prevent relapse. Standard maintenance dosing is 1 g/kg every 3 weeks, or 0.5 g/kg every 2 weeks, though the optimal schedule is individualized based on clinical response, symptom trajectory between doses, and patient lifestyle.

Some patients require more frequent dosing to maintain function throughout the dosing interval (a phenomenon called 'wearing off' before the next dose is due). Others achieve durable remission and can extend intervals or attempt tapering after a period of sustained stability, always under neurologist guidance.

Transitioning from Infusion Center to Home IVIG

Most CIDP patients begin IVIG at an infusion center or hospital outpatient department during the induction phase, where reactions can be monitored and dosing adjusted. Once:

The maintenance dose and schedule are established
The patient has tolerated infusions without significant reactions across multiple doses
The neurologist has assessed the patient as appropriate for home-based administration

...home IVIG becomes a natural and practical transition. Our guide on IVIG therapy at home covers the home setup process, what nursing visits include, and how supply delivery is coordinated. For patients newly diagnosed with an immune-mediated condition and just beginning to research IVIG, our broader guide on primary immune deficiency and IVIG provides useful foundational context.

What to Expect from Long-Term CIDP Management

CIDP is typically a long-term condition. Some patients achieve remission and can eventually discontinue IVIG; many require indefinite maintenance therapy. Long-term management considerations include:

Regular neurological assessment, strength testing, functional scales, and nerve conduction studies at defined intervals to confirm continued response and detect relapse early
IgG trough monitoring, measuring IgG levels before each maintenance dose to confirm therapeutic levels are being maintained
Dose adjustment over time, weight changes, clinical status changes, or evolving response patterns may require formula or schedule modifications
Alternative therapies, subcutaneous immunoglobulin (SCIG) is an option for some CIDP patients who prefer self-administered weekly dosing over monthly IV infusions

Know which symptoms should prompt an immediate call between IVIG doses, worsening weakness, new falls, or significant functional decline before the next scheduled infusion may indicate the need for a supplemental dose or schedule change. Our after-hours support line is available for urgent concerns.

Insurance Coverage for CIDP IVIG

IVIG for CIDP is covered by Medicare Part B and most commercial insurance plans when the diagnosis is confirmed by nerve conduction studies and the patient meets clinical response criteria. Prior authorization is required and must include diagnostic criteria, evidence of functional impairment, and documentation of clinical response to prior IVIG therapy. Pharmko manages the full authorization process and coordinates with your neurologist's office to compile the supporting documentation.

→ Contact Pharmko to start CIDP IVIG therapy: 1-877-540-2003

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Compounded IV Medications: When Are They Necessary and How Are They Made?

July 15, 2026

Most medications that patients receive at a hospital or pharmacy come in standardized, commercially manufactured forms, a 500mg antibiotic vial, a pre-filled syringe, a fixed-concentration IV bag. These products work well for many patients. But a significant portion of patients receiving IV therapy have clinical needs that commercial products cannot meet: a dose the manufacturer doesn't make, a formulation incompatible with the patient's allergy profile, or a combination of nutrients that must be tailored to individual lab values. For these patients, compounded IV medications are not optional, they are clinically necessary. Pharmko's sterile compounding services prepare customized IV medications for patients across 22+ states, with every formulation reviewed by a licensed pharmacist and prepared in a USP <797> compliant cleanroom. What Makes an IV Medication 'Compounded'? A compounded medication is one that is prepared specifically for an individual patient by a licensed pharmacist, rather than manufactured in bulk by a pharmaceutical company. Compounding involves combining, mixing, or altering ingredients, active pharmaceutical ingredients, diluents, preservatives, to create a final preparation that meets the patient's unique prescription requirements. For IV therapy specifically, compounding means preparing a sterile preparation, one that is completely free of viable microorganisms and safe to inject or infuse directly into the bloodstream. This requires specialized facilities, equipment, training, and quality systems that go far beyond what a standard retail pharmacy can provide. Pharmko is exclusively a sterile compounding pharmacy. We do not compound oral medications, topical creams, or non-sterile preparations. Every product we make is intended for intravenous, intraperitoneal, or subcutaneous administration. When Are Compounded IV Medications Necessary? The required dose doesn't exist commercially Pharmaceutical manufacturers produce medications in standardized strengths and volumes based on average patient needs. Pediatric patients, patients with renal or hepatic impairment requiring dose adjustments, or patients whose weight or clinical status falls outside standard ranges may need concentrations or volumes that no commercial product provides. Compounding fills this gap precisely. The patient has an allergy to a commercial formulation's inactive ingredients Commercial IV products often contain preservatives, stabilizers, or diluents, sulfites, benzyl alcohol, certain dyes, that some patients cannot tolerate. A compounding pharmacy can prepare an equivalent formulation without the offending ingredient, allowing the patient to receive the therapy safely. The medication requires individualized nutrient formulation Total parenteral nutrition (TPN) is the clearest example: every TPN formula must be individually compounded because no commercial product can provide the precise combination of amino acids, dextrose, lipids, electrolytes, vitamins, and trace minerals a specific patient needs. The formula changes as the patient's labs, weight, and clinical status change, making standardization impossible. The commercial product is unavailable or in shortage Drug shortages are a persistent reality in the US pharmaceutical supply chain. When a commercially manufactured IV medication becomes unavailable, compounding pharmacies can often prepare an equivalent formulation from available active pharmaceutical ingredients, bridging the gap and maintaining continuity of therapy for patients who cannot wait. The therapy requires a custom delivery format Some IV medications require specific pH, osmolarity, or concentration adjustments for compatibility with a patient's IV access device or concurrent medications. A compounding pharmacist reviews compatibility and prepares formulations that are safe and stable for the specific administration route and equipment the patient is using. How Compounded IV Medications Are Made Step 1: Prescription review Every compounded IV medication begins with a valid prescription from a licensed prescriber. Pharmko's pharmacists review the prescription for clinical appropriateness, dosing accuracy, ingredient compatibility, and stability before compounding begins. Step 2: Ingredient sourcing and verification Active pharmaceutical ingredients for compounding must come from FDA-registered suppliers and meet USP monograph specifications. Each lot is verified for identity, potency, and purity before use. Step 3: Sterile preparation in a controlled environment Preparation occurs in an ISO Class 5 laminar airflow workbench or biological safety cabinet, located within a buffer room that meets ISO Class 7 air quality standards. Pharmacy technicians follow validated, written procedures for each preparation type, using aseptic technique to prevent contamination at every step. Step 4: Pharmacist verification and release A licensed pharmacist performs a final check of every preparation, verifying appearance, volume, labeling, and documentation, before the product is released. High-risk or complex preparations may undergo sterility testing with defined beyond-use dates based on test results. Step 5: Cold-chain delivery Most compounded IV medications require refrigeration. Pharmko uses validated cold-chain packaging and delivery logistics to ensure products arrive within their stability windows and remain temperature-controlled until the patient uses them. Quality Standards That Matter Not all compounding pharmacies operate at the same standard. The relevant quality benchmarks for sterile compounding are: USP <797> compliance, the national standard for sterile compounding environments, personnel, and processes. Our guide on USP <797> and USP <800> explains what compliance means in practice ACHC accreditation, independent third-party verification that Pharmko meets clinical quality standards for home infusion and sterile compounding State pharmacy board licensure, Pharmko is licensed in every state where we serve patients Environmental and personnel monitoring, documented air and surface sampling, personnel gowning competency assessments, and media fill testing at defined intervals For a foundational overview of what sterile compounding is and how it differs from retail pharmacy, see our guide on what is sterile compounding for IV therapy . → Contact Pharmko about compounded IV medications: 1-877-540-2003