ParenteralPostexposure prophylaxis of rabiesAdult: Perform immediate and thorough wound cleansing with soap and water. For passive immunisation in conjunction with rabies vaccine in previously unvaccinated patients: As human rabies immunoglobulin (HRIg): 20 international units/kg as a single dose. As equine rabies immunoglobulin (HRIg): 40 international units/kg as a single dose. Administer as soon as possible after exposure at the time of the 1st rabies vaccine dose. In case rabies vaccination was started without the HRIg, dose may be given within 7 days after the 1st dose (Day 0) of rabies vaccine. If anatomically feasible, give the full rabies immunoglobulin dose via local infiltration into and around the wound(s); any remaining dose may be injected via IM (separate needle) at the site distant from the rabies vaccination site. Do not give more than the recommended dose. Decision for administration must be based on the patient's vaccination status, category of exposure, and animal type or status. Recommendations may vary among individual products and between countries (refer to detailed product or official local guidelines).
Child: Same as adult dose.
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Do not mix rabies immunoglobulin and rabies vaccine in the same syringe or administer at the same inj site.
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Patient with history of hypersensitivity to human Ig or equine serum; IgA deficiency, bleeding disorders (e.g. thrombocytopenia, haemophilia), risk factors of thrombosis (e.g. history of thrombosis, acquired or hereditary hypercoagulable states, hyperviscosity syndrome, prolonged immobilisation, CV risk factors, hypertension, diabetes mellitus, severely hypovolaemic patients); non-O blood group types, underlying inflammatory conditions. Patients receiving anticoagulant therapy. Not for IV administration. Not to be used in patients with a history of complete rabies vaccination (preexposure or postexposure prophylaxis) and documentation of antibody response. Children. Pregnancy and lactation.
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Significant: Haemolysis, thrombosis or arterial/venous thromboembolic events; bleeding and haematoma (following IM inj); hypersensitivity reactions, including anaphylactic reactions.
Cardiac disorders: Tachycardia.
Gastrointestinal disorders: Abdominal pain, nausea, vomiting, diarrhoea, flatulence.
General disorders and administration site conditions: Fatigue, fever, malaise, chills, inj site reactions (e.g. pain, tenderness, swelling, nodule, erythema, induration, warmth).
Musculoskeletal and connective tissue disorders: Arthralgia, myalgia.
Nervous system disorders: Headache, dizziness.
Respiratory, thoracic and mediastinal disorders: URTI, nasal congestion, oropharyngeal pain.
Skin and subcutaneous tissue disorders: Pruritus, rash.
Vascular disorders: Hypotension.
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Perform skin testing prior to administration of ERIg. Monitor for signs and symptoms of hypersensitivity reactions (including anaphylaxis), thrombosis (in at-risk patients), and haemolysis (e.g. chills, fever, dark urine) after administration.
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May interfere with the immune response to live attenuated virus vaccines, including MMR, varicella and rotavirus vaccines. May partially suppress the active antibody response to rabies vaccine; do not give additional (repeat) doses once rabies vaccination has been initiated.
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May cause false-positive results in serological tests due to a transient increase of passively transferred antibodies; may interfere with the serologic test for red cell antibodies (e.g. Coombs test).
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Description:
Mechanism of Action: Rabies immunoglobulin, a specific immune globulin containing antibodies to rabies antigen, is used for passive immunisation against rabies. It provides immediate, temporary virus-neutralising antibodies until response to active immunisation with rabies vaccine is achieved. Rabies immunoglobulin may be prepared from the plasma or serum of donors immunised with rabies vaccine and developed high titres of rabies antibody (human rabies immunoglobulin [HRIg]), or obtained from the serum of healthy equines immunised against rabies by vaccination (equine rabies immunoglobulin [ERIg]).
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Store between 2-8°C. Do not freeze. Protect from light. Storage recommendations may vary among individual products or between countries (refer to detailed product or local guidelines).
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J06BB05 - rabies immunoglobulin ; Belongs to the class of specific immunoglobulins. Used in passive immunizations.
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Anon. Rabies Immune Globulin (Human). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 29/09/2023. Anon. Rabies Immune Globulin. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 19/01/2024. Berirab P (Zuellig Pharma Corporation). MIMS Philippines. http://www.mims.com/philippines. Accessed 29/09/2023. Buckingham R (ed). Rabies Immunoglobulins. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 29/09/2023. Equirab (BioNet-Asia Co., Ltd.). MIMS Thailand. http://www.mims.com/thailand. Accessed 19/01/2024. Human Rabies Immunoglobulin Solution for Injection (Bio Products Laboratory Limited). MHRA. https://products.mhra.gov.uk. Accessed 29/09/2023. Imogam Rabies-HT (Sanofi Pasteur Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 29/09/2023. Joint Formulary Committee. Rabies Immunoglobulin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 29/09/2023. Rabies Immune Globulin, Human RIG. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 29/09/2023. Vinrab 200 IU/mL Solution for Injection (Ambica International Corporation). MIMS Philippines. http://www.mims.com/philippines. Accessed 19/01/2024.
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