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Background and Importance Intravenous immunoglobulins (IVIg) are used across diverse clinical conditions, including primary and secondary immunodeficiencies, autoimmune, neurological, and haematological disorders. Despite expanding applications, approved (on-label) indications remain limited. Given its substantial cost and limited global supply, evaluating prescribing practices is essential to support evidence-based use and optimise healthcare resources.Aim and Objectives This study aimed to characterise IVIg utilisation in inpatient and outpatient settings at a tertiary hospital over one year (September 2024–September 2025) and compare findings with institutional data from 2014. Objectives included assessing adherence to approved indications, quantifying off-label and non-recommended use, and evaluating economic impact.Material and Methods A retrospective observational study was conducted using data from electronic health records and pharmacy information systems. Patient demographics, IVIg indications, and direct treatment costs were analysed. Indications were classified according to the British Clinical Guidelines for Immunoglobulin Use (3rd edition, 2021). Comparative analysis was performed against data from 2014.Results A total of 153 patients received IVIg during the study period (median age: 65 years; 50.9% female), with 40.3% managed as inpatients. On-label indications accounted for 72.5% of prescriptions, most commonly common variable immunodeficiency (48/153, 31.4%) and secondary immunodeficiency (26/153, 17.0%). Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP, 16/153, 10.5%) and multifocal motor neuropathy (MMN,1/153, 0.7%) were newly classified as on-label. Evidence-supported off-label use represented 20.3%, with myasthenia gravis being the most common indication (13/153, 8.5%). While unsupported off-label and non-recommended indications accounted for 4.6% and 2.6%, respectively.Compared to 2014, the number of patients treated increased by 10.9%. On-label use improved (67.4% in 2014 vs. 72.5% in 2024), with reductions in non-recommended indications.Despite increased patient volume, IVIg expenditure declined from 1,730,002€ to 1,681,662€, reflecting enhanced cost-efficiency and prescribing behaviour.Conclusion and Relevance This analysis shows a positive trend toward more appropriate and economically sustainable IVIg use in comparison with 2014. The formal inclusion of CIDP and MMN as on-label indications, alongside enhanced guideline adherence and reduced unsupported use, reflects effective stewardship. Reduced expenditure despite increased utilisation underscores improved resource management, optimising healthcare expenditure.Conflict of Interest No conflict of interest