Rabies Immune Globulin
Generic name: human rabies virus immune globulin
Dosage form: injection, solution
Drug class: Immune globulins
Rabies Immune Globulin (HyperRAB) is used for the post-exposure prophylaxis of rabies. It should be administered not later than one week after a bite by a suspected rabid animal.
Rabies immune globulin Uses:
Postexposure prophylaxis of Rabies:
- Recommended for prophylaxis after suspected rabies exposure. Gives protection in the window period until active immunity develops from the rabies vaccine. Not required for individuals previously immunized and have adequate antibody titers.
- Consider the animal species, whether animal provoked, the immunization status of animal, and rabies incidence of the area.
Rabies Immune Globulin (HyperRAB) Dose in the treatment of Rabies (for postexposure prophylaxis):
- Recommended infusing full dose (20 IU/Kg) locally around the wound (IM) as a single dose. Any remaining volume to be given IM at a site away from the vaccination site.
- To be given as soon as possible after exposure and at the same time giving rabies vaccine. If rabies vaccine was initiated without HRIG, HRIG may be administered through the seventh day after the giving of the first dose of the vaccine.
- It is not recommended after 1 week of rabies vaccination as antibody response starts appearing at that time.
Note: Not required for individuals previously immunized and have adequate antibody titers.
Rabies Immune Globulin (HyperRAB) Dose in the Postexposure prophylaxis:
Infants, Children, and Adolescents:
- Recommended infusing full dose (20 IU/Kg) locally around the wound (IM) as a single dose. Any remaining volume to be given IM at a site away from the vaccination site.
- It should be given as soon as possible after exposure and at the same time giving rabies vaccine. If rabies vaccine was initiated without HRIG, HRIG may be administered through the seventh day after the giving of the first dose of the vaccine.
- It is not recommended after 1 week of rabies vaccination as antibody response starts appearing at that time.
Pregnancy Risk Factor C
- Pregnancy does not preclude the use of postexposure prophylaxis.
- If the risk of exposure to rabies during pregnancy is high, pre-exposure prophylaxis might be recommended.
Use during breastfeeding:
- Breast milk contains immunoglobulins.
- According to the manufacturer the decision should be based on the balance between the benefit to mother and the risk to infant.
Dose in Kidney Disease:
There are no dosage adjustments provided in the manufacturer’s labeling.
Dose in Liver disease:
There are no dosage adjustments provided in the manufacturer’s labeling.
Common Side Effects of Rabies Immune Globulin (HyperRAB):
Central Nervous System:
- Headache
Local:
- Pain At Injection Site
Less Common Side Effects of Rabies Immune Globulin (HyperRAB):
Central Nervous System:
- Fatigue
- Dizziness
Dermatologic:
- Sunburn
Gastrointestinal:
- Diarrhea
- Flatulence
- Nausea
- Abdominal Pain
Genitourinary:
- Leukocyturia
- Hematuria
Hematologic & Oncologic:
- Bruise
Local:
- Injection Site Nodule
Neuromuscular & Skeletal:
- Myalgia
- Arthralgia
Respiratory:
- Upper Respiratory Tract Infection
- Nasal Congestion
- Oropharyngeal Pain
Frequency of side effects not defined:
Central Nervous System:
- Malaise
Dermatologic:
- Skin Rash
Genitourinary:
- Nephrotic Syndrome
Hypersensitivity:
- Anaphylaxis
- Angioedema
Local:
- Local Soreness/Soreness at Injection Site
- Tenderness at Injection Site
Neuromuscular & Skeletal:
- Stiffness (At Injection Site)
Miscellaneous:
- Fever (Mild)
Contraindications to Rabies Immune Globulin (HyperRAB):
Imogam Rabies-HT:Do not give repeated doses of vaccine once treatment has been started. This could interfere with active immunity.
HyperRAB, HyperRAB S/D. KedrabThe manufacturer’s labeling does not list any contraindications.
Warnings and precautions
Anaphylaxis/hypersensitivity reactions:
- If you have an allergic reaction or anaphylactic reaction, you will need to immediately withdraw with the emergency measures.
- Individuals with IgA deficiencies or past histories of hypersensitivity to human immuneglobulins should be cautious.
Hemolysis
- This may occur. Risk is higher in patients with non O blood types, underlying inflammatory conditions, or those who have received high cumulative immune globulin doses for several days.
- Watch out for hemolysis symptoms such as fever, chills and dark urine.
Thrombosis:
- Be aware of the risk factors for thrombosis in patients who are bedbound, those receiving estrogen therapy, and those with hereditary thrombotic conditions.
- These patients should be monitored for at least one day after administration; it is worth measuring baseline blood viscosity for patients at high risk of hyperviscosity.
Bleeding disorders:
- Patients on anticoagulant therapy or with a history or tendency to have bleeding, thrombocytopenia or other bleeding issues should be cautious.
Monitoring Parameters:
Monitor for hypersensitivity reactions after the injection. Monitor blood pressure, pulse rate, and observe for cutanous allergic reactions.
How to administer Rabies Immune Globulin (HyperRAB)?
The full rabies immune globulin (human) (HRIG) dose should be infiltrated around and into the wound(s) (IM) post-exposure; any left-over dose should be administered IM in the deltoid muscle of the upper arm or lateral thigh muscle at a site away from vaccine administration.
The gluteal muscle at best is avoided unless directly exposed. IV use should be avoided. If the wound is small or on a finger, then a small dose (eg, 0.5 mL or more) may be injected around the wound. In any case, giving more than the calculated dose is not recommended.
If additional volume is needed to infiltrate the wound(s), may dilute with an equal volume of D5W (HyperRAB) or NS (Kedrab, Imogam); HyperRAB should not be diluted with NS.
Where IM, not possible subcutaneous to be considered as IV is not recommended.
Mechanism of action of Rabies Immune Globulin (HyperRAB):
Preformed immunoglobulins provide passive immunity by neutralizing antigens; in this instance, rabies. This is crucial for the time frame in which active immunity develops after the rabies vaccine.
International Brand Names of Rabies immune globulin:
- HyperRAB
- HyperRAB S/D
- Imogam Rabies-HT
- Kedrab
- Bayrab
- Berirab P
- Berirab-P
- Equirab
- Favirab
- Hyperrab S D
- Imogam
- Imogam Rabia
- Imogam Rabies
- Imogan Rabia
- Imogan Rabies
- Kamrab
- PARS
- Rabigam
- Rabix-IG
- Rabuman Berna
- SII Rabivax
- Vinrab
- Yi Sheng Bao Er
