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Category: Therapies

  • What Is TPN? All You Need To Know About This Life-Saving Treatment

    What Is TPN? All You Need To Know About This Life-Saving Treatment

    For patients who cannot absorb nutrients through their digestive system, total parenteral nutrition (TPN) can provide the essential nourishment needed to survive, recover, and maintain their health. This life-sustaining treatment delivers nutrients directly into the bloodstream when eating or tube feeding is not possible. 

    A Quick Overview of TPN

    Also called: Hyperalimentation, Intravenous (IV) Feeding/Nutrition, Central Venous Nutrition (CVN), Total Nutrient Admixture (TNA), and Home Parental Nutrition (HPN). 

    TPN is a nutritional support method that bypasses your digestive tract. This method delivers most of the nutrients your body needs directly into the bloodstream through a vein. For patients who cannot safely use their digestive systems, TPN may provide all the nutrients their bodies need.  

    When Is TPN Used?

    You may need TPN if you lack a functioning digestive system or when enteral nutrition is contraindicated. It may be used in all patients, regardless of their age (neonates, infants, children, adolescents, and adults). Depending on the underlying condition, a person may need parenteral nutrition for weeks, months, or a lifetime. 

    A healthcare provider may prescribe total parenteral nutrition for patients with [1]: 

    • Long-term obstruction of the intestine
    • Blockage in the small intestine
    • Intestinal movement problems that mimic a blockage without a physical obstruction 
    • Severe injuries or trauma that increase the body’s nutritional demands 
    • Severe diarrhea or vomiting 
    • Digestive tract fistulas that interfere with normal nutrient absorption 
    • Leaks that occur after intestinal surgery 
    • Inflammatory bowel disease (IBD) or critical illness, requiring the patients to avoid eating or drinking for longer than 7 days
    • Immature digestive system or defects in the digestive system at birth

    Use in Specific Conditions

    Stroke Patients

    Stroke is a medical emergency. It occurs when a certain part of the brain does not get enough blood flow. Stroke patients often experience problems swallowing foods or liquids. While enteral nutrition (EN) is the primary treatment in such cases, TPN may be considered if EN fails to fulfill the patient’s nutritional needs. 

    Cancer Patients

    Both cancer and its treatments can cause malnutrition. For example, intestinal cancer can cause obstruction, which limits the body’s ability to absorb nutrients. Likewise, cancer treatments can cause nausea, vomiting, loss of appetite, and difficulty swallowing. 

    A healthcare provider may prescribe TPN as an alternative feeding method when regular oral intake fails to meet the patient’s nutritional needs. 

    Patients with liver or kidney disease may still receive TPN, but healthcare providers carefully monitor them because these conditions can affect how the body processes nutrients. 

    How Is TPN Administered? 

    A team of doctors, nurses, pharmacists, and nutritionists will work together to determine your nutritional needs. For this purpose, they will check your medical history, lab results, and body mass index (BMI).

    A doctor or pharmacist then prepares a customized nutrition formula, which is delivered through a central venous catheter (CVC). A CVC, also called a central line, is a long, flexible pipe that carries nutrients to a large blood vessel in the chest. 

    Short-term TPN is typically administered as a 24-hour continuous infusion, while cyclic TPN is preferred for home infusion. 

    What Is in a TPN Bag?

    Nurse helping a patient set up a TPN bag and pump at home

    A TPN bag is a specialized container that stores the TPN formula. It is an all-in-one system in which all nutrients of the formula are mixed in a single bag and administered simultaneously. 

    A TPN bag contains lipids (fatty acids), sugar, minerals, amino acids, vitamins, electrolytes, and trace elements. The major macronutrients in a TPN admixture are [2]: 

    • Essential and non-essential amino acids excluding arginine and glutamine
    • Carbohydrate in various strengths, commonly 40%, 50%, and 70% 
    • Fatty acids, accounting for 25% to 30% of the total energy

    What Are the Benefits and Risks of TPN?

    TPN can play a critical role in supporting recovery and long-term health in patients who cannot use their digestive systems. 

    The primary benefit is providing essential nutrients when a person cannot meet their nutritional needs through oral intake. Besides, TPN is an optimal choice when enteral nutrition (tube feeding) is ineffective or contraindicated. 

    Certain medical conditions or surgery require you to temporarily avoid using the digestive tract. TPN can help sustain nutritional status and well-being during this period, allowing you to heal.

    Likewise, TPN is a useful therapy for newborns with an immature digestive system or defects in the digestive system. 

    Though TPN is safe, it comes with several risks, such as:

    • High or low blood sugar levels
    • Catheter-related complications, such as catheter sepsis, blood clots, and catheter blockage
    • Electrolyte imbalance
    • Liver problems, such as fatty liver, swelling of the gall bladder, and gallstones
    • Brittle or soft bones
    • High blood levels of blood fats called triglycerides

    Regular blood tests and medical monitoring can help reduce the risk of complications. It can include tests for blood sugar, electrolytes, minerals, and liver enzymes. 

    Can You Live on Parenteral Nutrition Forever?

    The long-term survival depends on the underlying condition behind intestinal failure rather than parenteral nutrition. TPN-related complications cause death in less than 10% of patients. In fact, TPN can help extend survival in patients with intestinal failure. 

    Does Medicare Cover TPN?

    Yes. Medicare may cover it, provided it is medically necessary. It may provide partial or full coverage depending on the medical condition and whether you meet the criteria for coverage. 

    What Is the Difference Between Partial Parenteral Nutrition (PPN) and TPN?

    Unlike TPN, PPN is often used for a short period, usually less than 14 days. PPN solution is more dilute and is intended to supplement nutritional requirements instead of completely replacing nutrients.

    References:

    1. Berlana, David. “Parenteral Nutrition Overview.” Nutrients vol. 14,21 4480. 25 Oct. 2022, doi:10.3390/nu14214480
    2. Hamdan M, Puckett Y. Total Parenteral Nutrition. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559036/
  • What Is IVIG? Uses, Benefits, Side Effects & Cost Explained

    What Is IVIG? Uses, Benefits, Side Effects & Cost Explained

    Your body has a defense system that protects you against various bacteria, viruses, and other harmful pathogens. Normally, your body makes special kinds of proteins called antibodies that attack these pathogens to help keep you disease-free. But have you ever wondered what happens if your body doesn’t produce enough of these antibodies? Or what happens if your body makes faulty ones that attack your own tissues and organs?

    IVIG (Intravenous Immunoglobulin) can help these situations. It is a therapy that strengthens your immune system against various autoimmune and inflammatory diseases. In this article, we’ll discuss everything you need to know about IVIG.

    What Is IVIG?

    IVIG (Intravenous Immunoglobulin) is a blood-based medicine derived from the plasma of thousands of healthy donors. IVIG is made up of antibodies, also known as immunoglobulins. These are special proteins that help your body fight off infections [1]. 

    Sometimes our bodies are unable to produce enough antibodies, or worse, make faulty antibodies that attack our own tissues and organs. IVIG provides a wide range of normal antibodies from donors that support or regulate your immune system [2].

    As IVIG is made from human plasma, it is purified to ensure it is effective and safe for our bodies. IVIG is given directly into your veins (intravenously). Depending on your condition, you may receive IVIG once every few weeks or as long-term treatment.

    What Is IVIG Used for?

    IVIG is used to treat various autoimmune and inflammatory diseases. Here are some of them:

    Immune Deficiency Disorders: Some people are born with a weak immune system. For others, the immune system may become weak later in life due to the onset of disease. As a result, their body can’t produce enough antibodies to fight infections. IVIG helps by replacing missing antibodies. Some examples include [3,4]:

    • Primary Immunodeficiency Diseases (PIDs)
    • Chronic Lymphocytic Leukemia (CLL) with low antibodies
    • HIV-related immune deficiency

    Autoimmune Diseases: In autoimmune diseases, the immune system mistakenly attacks the body’s own tissues and organs. IVIG helps regulate and calm an overactive immune system [5]. Some common conditions where IVIG is helpful include:

    Neurological Disorders: Doctors widely use IVIG in conditions where the immune system attacks the nerves. Examples of such conditions include [6]:

    • Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
    • Multifocal Motor Neuropathy

    Blood Disorders: IVIG is used in blood-related conditions like [7,8]:

    • Immune Thrombocytopenic Purpura (ITP)
    • Autoimmune Hemolytic Anemia

    Infectious Diseases and Other Uses: In some cases, you may require IVIG for immediate protection against infections or inflammatory conditions. Here are some of those conditions [1,7]:

    • Kawasaki Disease
    • Severe infections in immunocompromised patients

    How Does IVIG Work?

    Nurse standing next to pole set up with IVIG bottle and pump

    Your immune system is like a defense team that normally stays perfectly balanced. It is neither too weak nor too aggressive. But when this balance is lost, you face different autoimmune and inflammatory diseases as well as an overall increased risk of infection. When you have a shortage of antibodies or harmful ones that attack your own cells, IVIG can help you in several ways [1,2].

    Firstly, IVIG can replace missing antibodies. If you have a weakened immune system, your body can’t produce enough antibodies to fight off infections. IVIG provides ready-made antibodies that can help you fight infections.

    Secondly, it can modulate your immune system. In autoimmune diseases, the immune system mistakenly attacks its own healthy cells. IVIG helps “calm down” this overreaction and prevents unnecessary damage.

    Thirdly, IVIG can reduce inflammation. It interrupts the interactions between immune cells and signaling pathways that promote inflammation, helping you with inflammatory diseases.

    Finally, IVIG restores the immune balance. It helps your immune system function properly. 

    IVIG Side Effects

    Like any other medication, IVIG can also have some side effects. Some of them are mild, while others can be severe. Here are some mild to severe side effects of IVIG [1]:

    Mild Side Effects

    The most common side effects of IVIG are mild. They include:

    • Headache
    • Fever
    • Chills
    • Fatigue
    • Vomiting
    • Muscle pain

    These side effects usually go away on their own within a few days. However, you can take over-the-counter pain relievers for headaches and muscle pain. Slowing the infusion rate also helps with the headache and chills.

    Severe Side Effects

    Serious side effects from IVIG are rare, but they can happen. Here are some of them:

    Severe Allergic Reactions: In rare cases, you may experience serious allergic reactions. Contact your doctor immediately if you have symptoms like difficulty breathing, chest pain, itching, rash, swelling, or a fast or irregular heartbeat.

    Kidney Problems: IVIG may affect your kidneys. Symptoms include reduced urination; swelling in your legs, face, or ankles; fatigue; and nausea.

    Blood Clots: IVIG can increase the risk of clot formation, which may lead to stroke or heart attack.

    Aseptic Meningitis: This is a rare condition that causes severe headaches, neck stiffness, and sensitivity to light.

    Hemolysis: IVIG can cause destruction of blood cells in some patients.

    Please note that this is not a complete list of all possible side effects. Contact your doctor immediately if you encounter any severe side effects of IVIG.

    IVIG Therapy Cost

    IVIG is a very costly treatment because it is made from human plasma and requires a complex process to produce. A single treatment can cost between $1,000 and $10,000 [9]. However, the actual cost depends on several factors, including your dosage, location, treatment frequency, insurance coverage, and the pharmacy you visit. 

    Before Starting IVIG

    To ensure that IVIG is safe and effective for you, consult your doctor about your medical history before starting IVIG therapy. Inform your doctor if you:

    • Have or ever had an allergic reaction to immunoglobulin products
    • Have kidney disease or diabetes
    • Have a history of blood clots
    • Are taking medications that affect kidney functions
    • Are pregnant or planning to become pregnant

    FAQs

    Here are some frequently asked questions about IVIG:

    1. How long does an IVIG infusion take?

    IVIG infusion can take several hours to complete. It takes between 2 and 6 hours, depending on the dose and your tolerance.

    2. How often is IVIG given?

    The frequency of IVIG infusion depends on your condition. For chronic conditions like an immune deficiency or CIDP, most people receive IVIG infusion once a month. But for acute flares (like GBS or ITP), you may receive it as a one-time high dose or daily for up to 5 consecutive days.

    3. Can I take IVIG at home?

    Yes. In some cases, you can take IVIG at home. But it must be administered by trained healthcare professionals.

    4. How quickly does IVIG work?

    The response time depends on your condition. For issues like ITP, it may work within 24–48 hours. For neurological conditions like GBS, improvements can appear in a few days to a few weeks. However, for chronic autoimmune conditions like CIDP, it may take 2-4 weeks or longer to feel a significant difference.

    References

    1. Arumugham, V. B., & Rayi, A. (2023, July 3). Intravenous immunoglobulin (IVIG). StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK554446/
    2. Wikipedia contributors. (2026, February 15). Immunoglobulin therapy. Wikipedia. https://en.wikipedia.org/wiki/Immunoglobulin_therapy
    3. Eight Guiding Principles for Effective use of IVIG for patients with primary Immunodeficiency. (n.d.). https://www.aaaai.org/Aaaai/media/Media-Library-PDFs/Practice%20Management/Practice%20Tools/IVIG-guiding-principles.pdf?utm_source=copilot.com
    4. Khan, S., Allsup, D., & Molica, S. (2023). An updated perspective on immunoglobulin replacement in chronic lymphocytic leukaemia in the era of targeted therapies. Frontiers in Oncology, 13, 1135812. https://doi.org/10.3389/fonc.2023.1135812
    5. Velikova, T., Sekulovski, M., Bogdanova, S., Vasilev, G., Peshevska-Sekulovska, M., Miteva, D., & Georgiev, T. (2023). Intravenous immunoglobulins as immunomodulators in autoimmune diseases and reproductive medicine. Antibodies, 12(1), 20. https://doi.org/10.3390/antib12010020
    6. Limited, T. P. C. (2025, June 4). Takeda’s GAMMAGARD LIQUID® Approved by U.S. FDA for Adults with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). Takeda Pharmaceutical Company Limited. https://www.takeda.com/newsroom/newsreleases/2024/takedas-gammagard-liquid-approved-for-adults-with-cidp-in-united-states/
    7. 18. Intravenous Immune globulin (IVIG) | Hospital handbook. (n.d.). https://hospitalhandbook.ucsf.edu/content/18-intravenous-immune-globulin-ivig
    8. PharmD, S. R. (2025, July 16). A Guide to IVIG Treatment for ITP. AmeriPharma® Specialty Care. https://ameripharmaspecialty.com/ivig/a-guide-to-ivig-treatment-for-itp/
    9. IV Therapy Catonsville MD, Jean Walter Infusion Center – Dr. Nasser Nasseri, MD. (2025, May 8). IVIG Therapy cost in Edgewater MD | Jean Walter Infusion. https://jeanwalterinfusion.com/ivig-therapy-cost
  • What Are Biologics? Understanding Their Role in Treating Complex Diseases

    What Are Biologics? Understanding Their Role in Treating Complex Diseases

    Modern medicine has come a long way in treating complex diseases. However, conditions like cancer, autoimmune diseases, and chronic inflammatory diseases can still be difficult to treat. Traditional medications are often effective, but they may not be the most suitable for all patients.

    This is where biologics play an important role. They have changed the way these complex diseases are treated. Biologics are more targeted and, in certain cases, more effective, potentially improving the quality of life for many patients.

    In this article, we’ll discuss everything you need to know about biologics, including what they are, their advantages, side effects, and much more.

    What Are Biologics?

    Biologics (also known as biological medications or biopharmaceuticals) are a class of medications derived from living organisms or their components, such as proteins or sugars [2].  In contrast to traditional medications, which are made using chemical processes, biologics are produced using biotechnology. In certain conditions — particularly complex or immune-mediated diseases — they can be more effective than traditional medicines [3].

    To make biologics, scientists first extract or copy genes that make the proteins they need. These genes are then inserted into host cells such as bacteria, yeast, or mammalian cells. These cells act as biological factories, producing large quantities of the therapeutic protein. For example, insulin is made using modified bacteria, and antibodies for cancer treatment are produced using engineered cells.

    Common biologics include vaccines, monoclonal antibodies, insulin, and gene therapies. Many are known as targeted therapies because they focus on specific parts of the immune system or certain proteins that cause disease, rather than affecting the whole body. For example, in some cancers, biologics such as monoclonal antibodies bind to cancer cells, helping the immune system find and destroy them more effectively.

    How Do Biologics Work?

    Biologics work differently from most traditional medications. Many traditional medications can affect multiple biological pathways, whereas biologics are designed to target specific molecules or cells. For example, some biologics can block specific proteins that trigger inflammation in autoimmune or inflammatory diseases. Others work by targeting abnormal cells, such as cancer cells, without harming most healthy cells. Another class of biologics works by replacing missing or defective proteins in the body. Because of this targeted action, they can be more effective in certain conditions and may reduce some side effects, although they can introduce others.

    Types of Biologics

    There are several types of biologics, each designed for different purposes. Here are some of the main types [1]:

    Monoclonal Antibodies: These are lab-made proteins that mimic your body’s immune defenses. They can recognize and bind to specific targets such as cancer cells. Because of this precision, they are widely used in cancer and autoimmune diseases. For example, Herceptin (trastuzumab) is used to treat certain breast cancers by targeting a specific protein called HER2 that’s found in some breast cancer cells [4]. By attaching to this protein, trastuzumab slows cancer cell growth and helps your immune system destroy them.

    Patient receiving a vaccine shot, which is one of the most cost-effective biologics

    Vaccines: Vaccines usually contain weakened or inactive parts of viruses or bacteria. They train your immune system to recognize and fight harmful pathogens without causing the disease. Vaccines are among the most cost-effective biologics, saving about 3 million lives globally each year [2].

    Recombinant Proteins: These are proteins produced using genetic engineering when the body cannot produce sufficient amounts naturally. They replace missing or deficient proteins and restore normal body functions. Examples include insulin, coagulation (or clotting) factors, and growth hormones.

    Gene Therapy: This type of therapy offers a long-term solution or even one-time treatment for certain inherited genetic disorders. Gene therapy works by correcting or replacing faulty genes. For example, Luxturna is a gene therapy used for inherited retinal disease. It delivers a healthy copy of a defective gene directly into your retinal cells [5].

    What Are Biologics Used To Treat?

    Biologics are used to treat a wide range of diseases. In many cases, they provide benefits where traditional treatments are insufficient. Here are some of the conditions that they treat: 

    Cancers: Biologics can target cancer cells more selectively, reducing damage to healthy cells. Examples include targeted therapies and immunotherapies that help your immune system recognize and destroy cancer cells.

    Autoimmune Diseases: In these conditions, your immune system attacks your own body’s tissues and organs. Biologics help control this by blocking inflammatory pathways. Healthcare providers commonly prescribe them to treat autoimmune diseases such as rheumatoid arthritis, psoriasis, and Crohn’s disease.

    Diabetes: Insulin is one of the earliest biologics. It helps people with diabetes regulate blood sugar levels and prevent complications.

    Infectious Diseases: Vaccines are biologics that protect millions of people worldwide against infections. They contain weakened or inactive parts of viruses or bacteria that train your immune system to recognize those pathogens without causing the disease.

    Rare Genetic Disorders: Biologics can also provide missing or defective genes, helping patients manage inherited diseases. 

    Limitations

    Despite their benefits, biologics also have some limitations: 

    High Cost: Most biologics are very costly due to their complex manufacturing processes. For example, Cerezyme is used to treat Gaucher disease, but this treatment can cost hundreds of thousands of dollars per year [6].

    Your Body May Reject the Biologic: Biologics are made of large proteins. As a result, the immune system may recognize them as foreign and mount a response. This can reduce the medication’s effectiveness over time. For example, some patients taking Humira (adalimumab) may develop anti-drug antibodies, making the treatment less effective [7].

    Higher Risk of Infections: To control autoimmune diseases, some biologics suppress your immune system. This can increase the risk of infections. For example, TNF blockers used to treat arthritis increase your risk of infections such as tuberculosis.

    Requires Injection: Most biologics are fragile and are destroyed in your stomach. So, you need to take them as infusions or injections, typically under the skin (subcutaneous) or into the veins (intravenous), but can also be into the muscle (intramuscular), though rare.

    Cost

    Biologics are much more expensive than traditional medications because they are made from living cells using advanced biotechnology. This process is complex and highly sensitive. Production facilities must maintain strict sterile conditions to prevent contamination. Even minor variations in conditions can compromise production. This complex production process increases cost. As a result, treatment can cost thousands of dollars per month. 

    Due to these high costs, insurance companies often limit access. They may tell you to try cheaper options first. Some biologics may not be covered by insurance.it

    To solve this, another class of medications, called biosimilars, is also available. These are similar versions of existing biologics. They have similar effectiveness and safety profiles. But they are available at a much lower cost. For example, Humira (adalimumab) can cost around $7,000 per month, while its biosimilar, Amjevita, may cost about 50% less.

    Future Outlook

    Biologics represent one of the fastest-growing areas in modern medicine. Scientists are developing personalized treatments based on a person’s genetics to improve effectiveness and reduce side effects. Advances in gene-editing technologies such as CRISPR may one day help cure certain genetic diseases rather than just manage them. 

    Cancer immunotherapy is also improving. These approaches may lead to more precise and effective treatment options. Researchers are also exploring biologics for neurological and age-related diseases. Due to their ability to target diseases at a molecular level, biologics may one day shape the future of healthcare.

    References

    1. Wikipedia contributors. (2026, February 25). Biopharmaceutical. Wikipedia. https://en.wikipedia.org/wiki/Biopharmaceutical
    2. World Health Organization: WHO. (2020, February 18). Biologicals. https://www.who.int/health-topics/biologicals#tab=tab_1
    3. Research, C. F. B. E. A. (2018, February 6). What are “Biologics” Questions and answers. U.S. Food And Drug Administration. https://www.fda.gov/about-fda/center-biologics-evaluation-and-research-cber/what-are-biologics-questions-and-answers
    4. Genentech. (n.d.). HER2+ Breast & Stomach Cancer Treatment Option | Herceptin® (trastuzumab). Herceptin. https://www.herceptin.com/
    5. LUXTURNA® (voretigene neparvovec-rzyl). (n.d.). LUXTURNA® (voretigene neparvovec-rzyl) – Inherited Retinal Disease. LUXTURNA® (Voretigene Neparvovec-rzyl). https://luxturna.com/
    6. Cerezyme Prices, Coupons, Copay Cards & Patient Assistance. (n.d.). Drugs.com. https://www.drugs.com/price-guide/cerezyme
    7. HUMIRA® (adalimumab) – A Biologic Medication. (n.d.). https://www.humira.com/
    8. Humira Prices, Coupons, Copay Cards & Patient Assistance. (n.d.). Drugs.com. https://www.drugs.com/price-guide/humira
    9. Drugs.com. (n.d.). Amjevita vs Humira Comparison. https://www.drugs.com/compare/amjevita-vs-humira