Rabies immunoglobulin

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Rabies immunoglobulin
Names
Trade namesImogam Rabies-HT, Kedrab, HyperRab, others
Clinical data
Pregnancy
category
  • AU: B2[1]
  • US: C (Risk not ruled out)
Defined daily doseNot established[2]
External links
AHFS/Drugs.comMonograph
Legal
Legal status


Rabies immunoglobulin (RIG) is a medication made up of antibodies against the rabies virus.[8] It is used to prevent rabies following exposure.[8] It is given after the wound is cleaned with soap and water or povidone-iodine and is followed by a course of rabies vaccine.[8] It is given by injection into the site of the wound and into a muscle.[8] It is not needed in people who have been previously vaccinated against rabies.[9]

Common side effects include pain at the site of injection, fever, and headache.[8] Severe allergic reactions such as anaphylaxis may rarely occur.[10] Use during pregnancy is not known to harm the baby.[8] It works by binding to the rabies virus before it can enter nerve tissue.[8] After the virus has entered the central nervous system, rabies immunoglobulin is no longer useful.[8]

The use of rabies immunoglobulin in the form of blood serum dates from 1891.[11] Use became common within medicine in the 1950s.[12] It is on the World Health Organization's List of Essential Medicines.[13] Rabies immunoglobulin is expensive and hard to come by in the developing world.[14] In the United States it is estimated to be more than US$1,000 per dose.[15] Some versions are made from the blood plasma of people or horses who have high levels of the antibody in their blood.[8][15] The horse version is less expensive but has a higher rate of side effects.[15][12] A number of monoclonal antibody versions are also avaialble.[16]

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][1][18]

Dosage

The defined daily dose is not established.[2]

Types

Plasma derived

  • Hyperrab, human, approved in 1974[6]
  • Imogam Rabies-HT, human[4]
  • Kedrab, human[5]

Monoclonal antibodies

Society and culture

Names

There are a number of versions of rabies immunoglobulin licensed and available in the US.[19] Imogam Rabies-HT is produced by Sanofi Pasteur.[4] Kedrab is produced by Kedrion Biopharma.[17][5] Hyperrab is produced by Grifols.[6]

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. ↑ 1.0 1.1 1.2 1.3 "Kamrab". Therapeutic Goods Administration (TGA). 23 August 2021. Archived from the original on 10 September 2021. Retrieved 10 September 2021. Archived 10 September 2021 at the Wayback Machine
  2. ↑ 2.0 2.1 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 24 September 2020. Retrieved 15 September 2020. Archived 24 September 2020 at the Wayback Machine
  3. ↑ "Kamrab PI". Health Canada. 25 April 2012. Archived from the original on 11 September 2021. Retrieved 10 September 2021. Archived 11 September 2021 at the Wayback Machine
  4. ↑ 4.0 4.1 4.2 "Imogam Rabies-HT - human rabies virus immune globulin injection, solution". DailyMed. Archived from the original on 20 October 2020. Retrieved 24 March 2020. Archived 20 October 2020 at the Wayback Machine
  5. ↑ 5.0 5.1 5.2 "Kedrab- human rabies virus immune globulin injection, solution". DailyMed. Archived from the original on 7 August 2020. Retrieved 24 March 2020. Archived 7 August 2020 at the Wayback Machine
  6. ↑ 6.0 6.1 6.2 "Hyperrab (rabies immune globulin- human injection, solution". DailyMed. Archived from the original on 22 October 2019. Retrieved 24 March 2020. Archived 22 October 2019 at the Wayback Machine
  7. ↑ "Hyperrab S/D (rabies immune globulin- human injection". DailyMed. Archived from the original on 10 September 2021. Retrieved 10 September 2021. Archived 10 September 2021 at the Wayback Machine
  8. ↑ 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 "Rabies Immune Globulin". The American Society of Health-System Pharmacists. Archived from the original on 9 January 2017. Retrieved 8 January 2017. Archived 9 January 2017 at the Wayback Machine
  9. ↑ 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.
  10. ↑ British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 869. ISBN 9780857111562.
  11. ↑ 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. Archived 2022-10-14 at the Wayback Machine
  12. ↑ 12.0 12.1 Jong, Elaine C.; Zuckerman, Jane N. (2004). Travelers' Vaccines. PMPH-USA. p. 205. ISBN 9781550092257. Archived from the original on 2017-01-09.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 15.0 15.1 15.2 Research Advances in Rabies. Academic Press. 2011. p. 351. ISBN 9780123870414. Archived from the original on 2017-01-09.
  16. ↑ 16.0 16.1 16.2 Fan, L; Zhang, L; Li, J; Zhu, F (31 December 2022). "Advances in the progress of monoclonal antibodies for rabies". Human vaccines & immunotherapeutics. 18 (1): 2026713. doi:10.1080/21645515.2022.2026713. PMID 35172707.
  17. ↑ 17.0 17.1 "Kedrab". U.S. Food and Drug Administration (FDA). 21 March 2018. Archived from the original on 17 December 2019. Retrieved 7 June 2020. Archived 17 December 2019 at the Wayback Machine Public Domain This article incorporates text from this source, which is in the public domain.
  18. ↑ "Summary Basis for Regulatory Action". Archived from the original on 11 September 2021. Retrieved 10 December 2022. Archived 11 September 2021 at the Wayback Machine
  19. ↑ "Vaccine and Immune Globulin Availability". Centers for Disease Control and Prevention (CDC). 26 February 2020. Archived from the original on 16 April 2020. Retrieved 24 March 2020. Archived 16 April 2020 at the Wayback Machine
  20. ↑ "WHO Guide for Rabies Pre and Post Exposure Prophylaxis in Humans" (PDF). World Health Organization (WHO). 2014. Archived (PDF) from the original on 2020-02-10. Retrieved 2020-03-24. Archived 2020-02-10 at the Wayback Machine
  21. ↑ "Rabies Biologics | Specific Groups | CDC". www.cdc.gov. 2021-01-15. Archived from the original on 2022-11-18. Retrieved 2022-11-18. Archived 2022-11-18 at the Wayback Machine

External links

Identifiers:
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