Rabies Immunoglobulin USP
Indications
Rabies Immunoglobulin USP is used for:
Postexposure prophylaxis of rabies.
Adult Dose
Injection
Postexposure prophylaxis of rabies
Adult: In conjunction with rabies vaccine in previously unvaccinated individuals: HRIG 20 IU/kg admin as soon as possible at the same time as vaccine, or up to 7 days after vaccine
inj. Recommended dose to be infiltrated thoroughly in and around the cleansed wound; any remainder to be injected via IM inj in area distant to that of vaccine inoculation e.g. in gluteal or lateral thigh muscle.
If calculated dose is not enough to infiltrate all wounds, dilute 2-3 folds with sterile saline to allow thorough infiltration.
Previously vaccinated individuals with adequate rabies antibody titer: Rabies immunoglobulin should not be admin; only vaccine should be given.
Child Dose
Injection
Postexposure prophylaxis of rabies
Child: In conjunction with rabies vaccine in previously unvaccinated individuals: HRIG 20 IU/kg admin as soon as possible at the same time as vaccine, or up to 7 days after vaccine
inj. Recommended dose to be infiltrated thoroughly in and around the cleansed wound; any remainder to be injected via IM inj in area distant to that of vaccine inoculation e.g. in gluteal or lateral thigh muscle.
If calculated dose is not enough to infiltrate all wounds, dilute 2-3 folds with sterile saline to allow thorough infiltration.
Previously vaccinated individuals with adequate rabies antibody titer: Rabies immunoglobulin should not be admin; only vaccine should be given.
Renal Dose
Administration
Contra Indications
Known history of allergic symptoms to horse proteins. Do not give repeated doses of rabies immunoglobulin once rabies vaccine is given as this may reduce the immunologic response to the vaccine.
Precautions
Hypersensitivity to human immune globulin preparations, increased risk of hypersensitivity with specific immunoglobulin A deficiency; epinephrine should be available for management of possible anaphylactic reactions. Thrombocytopenia or bleeding disorders. If IM inj is contra-indicated, inj may be given by SC with pressure and compress applied to site after inj.
Do not exceed recommended doses as this may reduce the immune response to rabies vaccine. Patients preciously immunised with rabies vaccine and have adequate rabies antibody titer should receive rabies vaccine without the rabies immunoglobulin. Avoid IV admin, and IM inj into central region of gluteal area. Admin rabies immunoglobulin and vaccine in separate syringes and to different sites with different lymphatic drainage.
The safety of rabies immunoglobulin when used during pregnancy has not been established in clinical trials in human beings. Considering the lethal risk associated with rabies, pregnancy may not be a contraindication to the administration or rabies immunoglobulin subsequent to exposure.
This vaccine should not be used during pregnancy unless the benefit outweighs the risk to the fetus. US FDA pregnancy category: C. If there is substantial risk of rabies exposure, pre-exposure prophylaxis may be indicated. Because of the consequences of inadequately treated rabies exposure, pregnancy is not a contraindication to post-exposure prophylaxis.
Pregnancy-Lactation
Interactions
Decreased response to live virus vaccine (e.g. measles, mumps, rubella and varicella), admin at least 4 mth after human rabies immunoglobulin admin.
Adverse Effects
Side effects of Rabies Immunoglobulin USP :
Soreness at inj site, fever, chest or joint pain, dyspnoea, tremor, dizziness, oedema of the face, glossitis, buccal ulceration. The observed immediate reactions are hypotension, dyspnoea, and urticaria. Delayed reactions consist of inflammatory reaction, fever, pruritis, rash or urticaria, adenopathy and arthralgia. Rare risk of disease transmission by infective agents.
Potentially Fatal: Anaphylactic reactions.
Mechanism of Action
Rabies immunoglobulins provide passive immunity to rabies. 2 types of immunoglobulin are available namely, human rabies immunoglobulin (HRIG) and purified equine rabies immunoglobulin (ERIG). HRIG is prepared from the plasma of human donors hyperimmunised with rabies vaccine and is preferred over ERIG.