Rabies immunoglobulin explained

Tradename:Imogam Rabies-HT, Kedrab, Hyperrab, others
Pregnancy Au:B2
Routes Of Administration:Intramuscular injection
Atc Prefix:J06
Legal Au:S4
Legal Au Comment:[1]
Legal Ca:Rx-only
Legal Ca Comment:/ Schedule D[2] [3] [4] [5]
Legal Us:Rx-only
Legal Us Comment:[6]
Atc Suffix:BB05
Drugbank:DB11603
Chemspiderid:none
Unii:95F619ATQ2

Rabies immunoglobulin (RIG) is a medication made up of antibodies against the rabies virus. It is used to prevent rabies following exposure. It is given after the wound is cleaned with soap and water or povidone-iodine and is followed by a course of rabies vaccine. It is given by injection into the site of the wound and into a muscle. It is not needed in people who have been previously vaccinated against rabies.[7]

Common side effects include pain at the site of injection, fever, and headache. Severe allergic reactions such as anaphylaxis may rarely occur.[8] Use during pregnancy is not known to harm the baby. It works by binding to the rabies virus before it can enter nerve tissue. 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.[10] Use became common within medicine in the 1950s.[11] It is on the World Health Organization's List of Essential Medicines.[12] Rabies immunoglobulin is expensive and hard to come by in the developing world.[13] In the United States it is estimated to be more than US$1,000.00 per dose. It is made from the blood plasma of people or horses who have high levels of the antibody in their blood.[9] [14] The horse version is less expensive but has a higher rate of side effects.[14] [11]

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.[15]

Society and culture

Names

There are three versions of rabies immunoglobulin licensed and available in the US.[16] Imogam Rabies-HT is produced by Sanofi Pasteur.[17] Kedrab is produced by Kedrion Biopharma.[18] [19] Hyperrab is produced by Grifols.[20]

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[21] and indicate local infusion at the wound site with additional amount intramuscularly at a site distant from vaccine administration.[22]

Kamrab is approved for medical use in Australia.

Further reading

Notes and References

  1. Web site: Kamrab . Therapeutic Goods Administration (TGA) . 23 August 2021 . 10 September 2021.
  2. Web site: Kamrab PI . Health Canada . 25 April 2012 . 10 September 2021.
  3. Web site: Imogam PI . Health Canada . 25 April 2012 . 10 September 2021.
  4. Web site: Hyperrab S/D PI . Health Canada . 25 April 2012 . 10 September 2021.
  5. Web site: Drug and medical device highlights 2018: Helping you maintain and improve your health . . 14 October 2020 . 17 April 2024.
  6. Web site: Hyperrab S/D (rabies immune globulin- human injection . DailyMed . 10 September 2021.
  7. Book: WHO Model Formulary 2008 . 2009 . 9789241547659 . ((World Health Organization)) . Stuart MC, Kouimtzi M, Hill SR . 10665/44053 . World Health Organization . World Health Organization . free . 398 .
  8. Book: British national formulary : BNF 69. 2015. British Medical Association. 9780857111562. 869. 69.
  9. Web site: Rabies Immune Globulin. The American Society of Health-System Pharmacists. 8 January 2017. live. https://web.archive.org/web/20110318143435/http://www.drugs.com/monograph/rabies-immune-globulin.html. 18 March 2011.
  10. Book: Rupprecht CE, Plotkin SA . Stanley Plotkin . https://books.google.com/books?id=hoigDQ6vdDQC&pg=PA659 . Vaccines . Elsevier/Saunders . 2013 . 978-1455700905 . Plotkin SA, Orenstein WA, Offit PA . Walter Orenstein . 6th . [Edinburgh] . 659 . en . Rabies Vaccines . live . https://web.archive.org/web/20170109022824/https://books.google.ca/books?id=hoigDQ6vdDQC&pg=PA659 . 9 January 2017.
  11. Book: Jong EC, Zuckerman JN . Travelers' Vaccines. 2004. PMPH-USA. 9781550092257. 205. en. live. https://web.archive.org/web/20170109022924/https://books.google.ca/books?id=E7c65R8BhPkC&pg=PA205. 9 January 2017.
  12. Book: ((World Health Organization)) . World Health Organization model list of essential medicines: 21st list 2019 . 2019 . 10665/325771 . World Health Organization . World Health Organization . Geneva . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO . free .
  13. Book: Tintinalli JE . Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)) . McGraw-Hill Companies . New York . 2010 . 1054 . 7 . 978-0-07-148480-0.
  14. Book: Research Advances in Rabies. 2011. Academic Press. 9780123870414. 351. en. live. https://web.archive.org/web/20170109022609/https://books.google.ca/books?id=_jXj0k-KVP4C&pg=PA351. 9 January 2017.
  15. Web site: Summary Basis for Regulatory Action - Kedrab . . 2017-08-23.
  16. Web site: Vaccine and Immune Globulin Availability. 26 February 2020. Centers for Disease Control and Prevention (CDC) . 24 March 2020.
  17. Web site: Imogam Rabies-HT - human rabies virus immune globulin injection, solution. DailyMed. 24 March 2020.
  18. Web site: Kedrab . U.S. Food and Drug Administration (FDA) . 21 March 2018 . 7 June 2020.
  19. Web site: Kedrab- human rabies virus immune globulin injection, solution. DailyMed. 24 March 2020.
  20. Web site: Hyperrab (rabies immune globulin- human injection, solution. DailyMed. 24 March 2020.
  21. Web site: WHO Guide for Rabies Pre and Post Exposure Prophylaxis in Humans. 2014. World Health Organization (WHO) .
  22. Web site: 2021-01-15 . Rabies Biologics Specific Groups CDC . 2022-11-18 . www.cdc.gov . en-us.

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