Rabies immunoglobulin

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Rabies immunoglobulin
Trade namesImogam Rabies-HT, Kedrab, HyperRab, others
Clinical data
  • US: C (Risk not ruled out)
Defined daily doseNot established[1]
External links
US NLMRabies immunoglobulin
Legal status

Rabies immunoglobulin (RIG) is a medication made up of antibodies against the rabies virus.[2] It is used to prevent rabies following exposure.[2] It is given after the wound is cleaned with soap and water or povidone-iodine and is followed by a course of rabies vaccine.[2] It is given by injection into the site of the wound and into a muscle.[2] It is not needed in people who have been previously vaccinated against rabies.[3]

Common side effects include pain at the site of injection, fever, and headache.[2] Severe allergic reactions such as anaphylaxis may rarely occur.[4] Use during pregnancy is not known to harm the baby.[2] It works by binding to the rabies virus before it can enter nerve tissue.[2] After the virus has entered the central nervous system, rabies immunoglobulin is no longer useful.[2]

The use of rabies immunoglobulin in the form of blood serum dates from 1891.[5] Use became common within medicine in the 1950s.[6] It is on the World Health Organization's List of Essential Medicines.[7] Rabies immunoglobulin is expensive and hard to come by in the developing world.[8] In the United States it is estimated to be more than US$1,000 per dose.[9] It is made from the blood plasma of people or horses who have high levels of the antibody in their blood.[2][9] The horse version is less expensive but has a higher rate of side effects.[9][6]

Medical uses


The defined daily dose is not established.[1]


There are three versions of rabies immunoglobulin licensed and available in the US.[10] Imogam Rabies-HT is produced by Sanofi Pasteur.[11] Kedrab is produced by Kedrion Biopharma.[12][13] HyperRab is produced by Grifols.[14]

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


  1. 1.0 1.1 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 24 September 2020. Retrieved 15 September 2020.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 "Rabies Immune Globulin". The American Society of Health-System Pharmacists. Archived from the original on 9 January 2017. Retrieved 8 January 2017.
  3. 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.
  4. British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 869. ISBN 9780857111562.
  5. 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.
  6. 6.0 6.1 Jong, Elaine C.; Zuckerman, Jane N. (2004). Travelers' Vaccines. PMPH-USA. p. 205. ISBN 9781550092257. Archived from the original on 2017-01-09.
  7. 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.
  8. 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.
  9. 9.0 9.1 9.2 Research Advances in Rabies. Academic Press. 2011. p. 351. ISBN 9780123870414. Archived from the original on 2017-01-09.
  10. "Vaccine and Immune Globulin Availability". Centers for Disease Control and Prevention (CDC). 2020-02-26. Archived from the original on 2020-04-16. Retrieved 2020-03-24.
  11. "Imogam Rabies-HT - human rabies virus immune globulin injection, solution". DailyMed. Archived from the original on 2020-10-20. Retrieved 2020-03-24.
  12. "Kedrab". U.S. Food and Drug Administration (FDA). 21 March 2018. Archived from the original on 17 December 2019. Retrieved 7 June 2020.
  13. "Kedrab- human rabies virus immune globulin injection, solution". DailyMed. Archived from the original on 2020-08-07. Retrieved 2020-03-24.
  14. "HyperRab (rabies immune globulin- human injection, solution". DailyMed. Archived from the original on 2019-10-22. Retrieved 2020-03-24.
  15. "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.

External links