Rabies immunoglobulin

Rabies immunoglobulin (RIG) is a medication made up of antibodies against the rabies virus.[9] It is used to prevent rabies following exposure.[9] It is given after the wound is cleaned with soap and water or povidone-iodine and is followed by a course of rabies vaccine.[9] It is given by injection into the site of the wound and into a muscle.[9] It is not needed in people who have been previously vaccinated against rabies.[10]

Rabies immunoglobulin
Clinical data
Trade namesImogam Rabies-HT, Kedrab, Hyperrab, others
AHFS/Drugs.comMonograph
Pregnancy
category
Routes of
administration
Intramuscular injection
ATC code
Legal status
Legal status
Identifiers
DrugBank
ChemSpider
  • none
UNII

Common side effects include pain at the site of injection, fever, and headache.[9] Severe allergic reactions such as anaphylaxis may rarely occur.[11] Use during pregnancy is not known to harm the baby.[9] It works by binding to the rabies virus before it can enter nerve tissue.[9] After the virus has entered the central nervous system, rabies immunoglobulin is no longer useful.[9]

The use of rabies immunoglobulin in the form of blood serum dates from 1891.[12] Use became common within medicine in the 1950s.[13] It is on the World Health Organization's List of Essential Medicines.[14] Rabies immunoglobulin is expensive and hard to come by in the developing world.[15] In the United States it is estimated to be more than US$1,000.00 per dose.[16] It is made from the blood plasma of people or horses who have high levels of the antibody in their blood.[9][16] The horse version is less expensive but has a higher rate of side effects.[16][13]

Medical uses

Rabies immunoglobulin (RIG) is indicated for the passive, transient post-exposure prophylaxis of rabies infection, when given immediately after contact with a rabid or possibly rabid animal and in combination with a rabies vaccine.[17][18][1]

Society and culture

Names

There are three versions of rabies immunoglobulin licensed and available in the US.[19] Imogam Rabies-HT is produced by Sanofi Pasteur.[5] Kedrab is produced by Kedrion Biopharma.[17][6] Hyperrab is produced by Grifols.[7]

Imogam Rabies-HT and Kedrab have a nominal potency of 150 IU/mL while Hyperrab has a nominal potency of 300 IU/mL and requires smaller dosing. All three versions are used for post-exposure[20] and indicate local infusion at the wound site with additional amount intramuscularly at a site distant from vaccine administration.[21]

Kamrab is approved for medical use in Australia.[1]

References

  1. "Kamrab". Therapeutic Goods Administration (TGA). 23 August 2021. Retrieved 10 September 2021.
  2. "Kamrab PI". Health Canada. 25 April 2012. Retrieved 10 September 2021.
  3. "Imogam PI". Health Canada. 25 April 2012. Retrieved 10 September 2021.
  4. "Hyperrab S/D PI". Health Canada. 25 April 2012. Retrieved 10 September 2021.
  5. "Imogam Rabies-HT - human rabies virus immune globulin injection, solution". DailyMed. Retrieved 24 March 2020.
  6. "Kedrab- human rabies virus immune globulin injection, solution". DailyMed. Retrieved 24 March 2020.
  7. "Hyperrab (rabies immune globulin- human injection, solution". DailyMed. Retrieved 24 March 2020.
  8. "Hyperrab S/D (rabies immune globulin- human injection". DailyMed. Retrieved 10 September 2021.
  9. "Rabies Immune Globulin". The American Society of Health-System Pharmacists. Archived from the original on 18 March 2011. Retrieved 8 January 2017.
  10. World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 398. hdl:10665/44053. ISBN 9789241547659.
  11. British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 869. ISBN 9780857111562.
  12. Rupprecht, Charles E.; Plotkin, Stanley A. (2013). "Rabies Vaccines". In Plotkin, Stanley A.; Orenstein, Walter A.; Offit, Paul A. (eds.). Vaccines (6th ed.). [Edinburgh]: Elsevier/Saunders. p. 659. ISBN 978-1455700905. Archived from the original on 9 January 2017.{{cite book}}: CS1 maint: date and year (link)
  13. Jong, Elaine C.; Zuckerman, Jane N. (2004). Travelers' Vaccines. PMPH-USA. p. 205. ISBN 9781550092257. Archived from the original on 9 January 2017.
  14. World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  15. Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) (7 ed.). New York: McGraw-Hill Companies. p. 1054. ISBN 978-0-07-148480-0.
  16. Research Advances in Rabies. Academic Press. 2011. p. 351. ISBN 9780123870414. Archived from the original on 9 January 2017.
  17. "Kedrab". U.S. Food and Drug Administration (FDA). 21 March 2018. Retrieved 7 June 2020. Public Domain This article incorporates text from this source, which is in the public domain.
  18. "Summary Basis for Regulatory Action - Kedrab". FDA. 23 August 2017.
  19. "Vaccine and Immune Globulin Availability". Centers for Disease Control and Prevention (CDC). 26 February 2020. Retrieved 24 March 2020.
  20. "WHO Guide for Rabies Pre and Post Exposure Prophylaxis in Humans" (PDF). World Health Organization (WHO). 2014.
  21. "Rabies Biologics | Specific Groups | CDC". www.cdc.gov. 15 January 2021. Retrieved 18 November 2022.

Further reading

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