Rabies immunoglobulin

Rabies immunoglobulin (RIG) is a medication made up of antibodies against the rabies virus.[1] It is used to prevent rabies following exposure.[1] It is given after the wound is cleaned with soap and water or povidone-iodine and is followed by a course of rabies vaccine.[1] It is given by injection into the site of the wound and into a muscle.[1] It is not needed in people who have been previously vaccinated against rabies.[2]

Rabies immunoglobulin
Clinical data
Trade namesImogam Rabies-HT, Kedrab, HyperRab, others
AHFS/Drugs.comMonograph
Pregnancy
category
  • US: C (Risk not ruled out)
    ATC code
    Legal status
    Legal status
    Identifiers
    DrugBank
    ChemSpider
    • none
    UNII

    Common side effects include pain at the site of injection, fever, and headache.[1] Severe allergic reactions such as anaphylaxis may rarely occur.[3] Use during pregnancy is not known to harm the baby.[1] It works by binding to the rabies virus before it can enter nerve tissue.[1] After the virus has entered the central nervous system, rabies immunoglobulin is no longer useful.[1]

    The use of rabies immunoglobulin in the form of blood serum dates from 1891.[4] Use became common within medicine in the 1950s.[5] It is on the World Health Organization's List of Essential Medicines, the safest and most effective medicines needed in a health system.[6] Rabies immunoglobulin is expensive and hard to come by in the developing world.[7] In the United States it is estimated to be more than 1,000.00 USD per dose.[8] It is made from the blood plasma of people or horses who have high levels of the antibody in their blood.[1][8] The horse version is less expensive but has a higher rate of side effects.[8][5]

    Availability

    There are three versions of rabies immunoglobulin licensed and available in the US.[9] Imogam Rabies-HT is produced by Sanofi Pasteur.[10] Kedrab is produced by Kedrion Biopharma.[11][12] HyperRab is produced by Grifols.[13]

    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[14] and indicate local infusion at the wound site with additional amount intramuscularly at a site distant from vaccine administration.

    References
    1. "Rabies Immune Globulin". The American Society of Health-System Pharmacists. Archived from the original on 24 September 2017. Retrieved 8 January 2017.
    2. 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.
    3. British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 869. ISBN 9780857111562.
    4. Plotkin, [edited by] Stanley A.; Orenstein, Walter A.; Offit, Paul A. (2013). Vaccines (6th ed.). [Edinburgh]: Elsevier/Saunders. p. 659. ISBN 978-1455700905. Archived from the original on 2017-01-09.CS1 maint: extra text: authors list (link)
    5. Jong, Elaine C.; Zuckerman, Jane N. (2004). Travelers' Vaccines. PMPH-USA. p. 205. ISBN 9781550092257. Archived from the original on 2017-01-09.
    6. 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.
    7. 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.
    8. Research Advances in Rabies. Academic Press. 2011. p. 351. ISBN 9780123870414. Archived from the original on 2017-01-09.
    9. "Vaccine and Immune Globulin Availability". Centers for Disease Control and Prevention (CDC). 2020-02-26. Retrieved 2020-03-24.
    10. "Imogam Rabies-HT - human rabies virus immune globulin injection, solution". DailyMed. Retrieved 2020-03-24.
    11. "Kedrab". U.S. Food and Drug Administration (FDA). 21 March 2018. Retrieved 7 June 2020.
    12. "Kedrab- human rabies virus immune globulin injection, solution". DailyMed. Retrieved 2020-03-24.
    13. "HyperRab (rabies immune globulin- human injection, solution". DailyMed. Retrieved 2020-03-24.
    14. "WHO Guide for Rabies Pre and Post Exposure Prophylaxis in Humans" (PDF). World Health Organization (WHO). 2014.
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