Rabies immunoglobulin: Indication, Dosage, Side Effect, Precaution

Generic Medicine Info Patient Medicine Information

This information is not country-specific. Please refer to the Indonesia prescribing information.

Generic Medicine Info

Indications and Dosage

Parenteral
Postexposure prophylaxis of rabies

Adult: In conjunction with rabies vaccine in unvaccinated individuals: As human rabies immunoglobulin (HRIG): 20 IU/kg. As equine rabies immunoglobulin (ERIG): 40 IU/kg. Administer as a single dose on the 1st day of rabies vaccine (or within 7 days after) via infiltration into and around the cleansed wound. If infiltration of the whole volume is not possible, any remaining dose may be injected intramuscularly in the deltoid muscle of the upper arm or anterolateral thigh (distant from the site of rabies vaccine administration).
Child: Same as adult dose.

Contraindications

Hypersensitivity.

Special Precautions

Patients with IgA deficiency, bleeding disorders (e.g. thrombocytopenia) or those who are at risk of thrombosis (e.g. prolonged immobilisation, history of thrombosis, hyperviscosity syndrome). Children. Pregnancy and lactation.

Adverse Reactions

Significant: Haemolysis, bleeding, haematoma, fever; injection site reactions (e.g. swelling, pain, erythema, warmth).
Cardiac disorders: Tachycardia.
Gastrointestinal disorders: Nausea and vomiting.
General disorders and administration site conditions: Fatigue, malaise, influenza like illness.
Musculoskeletal and connective tissue disorders: Chills, arthralgia.
Nervous system disorders: Headache.
Skin and subcutaneous tissue disorders: Pruritus, rash, urticaria.
Potentially Fatal: Rarely, severe hypersensitivity reactions (e.g. anaphylactic shock).

Pregnancy Category (US FDA)

IM/Parenteral: C

Monitoring Parameters

Perform skin testing prior to administration of ERIG.

Drug Interactions

May interfere with immune response to live attenuated virus vaccines. Immunosuppresive agents (e.g. alkylating agents, metabolites, corticosteroids, radiation) may increase risk of rabies infection due to decrease in antibody response to postexposure prophylaxis. Increased risk of bleeding with anticoagulants.

Lab Interference

May cause false-positive results in serological tests.

Action

Description:
Mechanism of Action: Rabies immunoglobulin (RIG) is used for passive immunisation for individuals who are exposed to rabies virus and who have not been vaccinated against rabies. It provides immediate, temporary virus-neutralising antibodies until response to active immunisation with rabies vaccine is achieved. There are 2 kinds of rabies immunoglobulin based on their sources: human rabies immunoglobulin (HRIG) and highly purified equine rabies immunoglobulin (ERIG).
Pharmacokinetics:
Absorption: Absorbed slowly after IM administration.
Excretion: Serum half-life: Approx 21 days (IM).

Storage

Store between 2-8°C. Do not freeze. Protect from light.

MIMS Class

Vaccines, Antisera & Immunologicals

ATC Classification

J06BB05 - rabies immunoglobulin ; Belongs to the class of specific immunoglobulins. Used in passive immunizations.

References

Anon. Rabies Immune Globulin (Human). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 08/11/2018.

Anon. Rabies Immune Globulin. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 08/11/2018.

Buckingham R (ed). Rabies Immunoglobulins. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/11/2018.

Hyperrab (Grifols USA, LLC.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 08/11/2018.

Joint Formulary Committee. Rabies Immunoglobulin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 08/11/2018.

Rabies Vaccines and Immunoglobulins: WHO Position. World Health Organization. http://www.who.int/. Accessed 09/11/2018.

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