Rabies immunoglobulin

Rabies immunoglobulin
Names
Trade namesImogam Rabies-HT, Kedrab, HyperRab, others
Clinical data
WHO AWaReUnlinkedWikibase error: ⧼unlinkedwikibase-error-statements-entity-not-set⧽
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

    • Rmab (brand Rabishield), approved in 2016[16]
    • RabiMabs (brand Twinrab), approved in 2019[16]

    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 2 3 4 "Kamrab". Therapeutic Goods Administration (TGA). 23 August 2021. Archived from the original on 10 September 2021. Retrieved 10 September 2021.
    2. 1 2 "WHOCC - ATC/DDD Index". www.whocc.no. Archived from the original on 24 September 2020. Retrieved 15 September 2020.
    3. ↑ "Kamrab PI". Health Canada. 25 April 2012. Archived from the original on 11 September 2021. Retrieved 10 September 2021.
    4. 1 2 3 "Imogam Rabies-HT - human rabies virus immune globulin injection, solution". DailyMed. Archived from the original on 20 October 2020. Retrieved 24 March 2020.
    5. 1 2 3 "Kedrab- human rabies virus immune globulin injection, solution". DailyMed. Archived from the original on 7 August 2020. Retrieved 24 March 2020.
    6. 1 2 3 "Hyperrab (rabies immune globulin- human injection, solution". DailyMed. Archived from the original on 22 October 2019. Retrieved 24 March 2020.
    7. ↑ "Hyperrab S/D (rabies immune globulin- human injection". DailyMed. Archived from the original on 10 September 2021. Retrieved 10 September 2021.
    8. 1 2 3 4 5 6 7 8 9 "Rabies Immune Globulin". The American Society of Health-System Pharmacists. Archived from the original on 9 January 2017. Retrieved 8 January 2017.
    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.
    12. 1 2 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. 1 2 3 Research Advances in Rabies. Academic Press. 2011. p. 351. ISBN 9780123870414. Archived from the original on 2017-01-09.
    16. 1 2 3 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. 1 2 "Kedrab". U.S. Food and Drug Administration (FDA). 21 March 2018. Archived from the original on 17 December 2019. 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". Archived from the original on 11 September 2021. Retrieved 10 December 2022.
    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.
    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.
    21. ↑ "Rabies Biologics | Specific Groups | CDC". www.cdc.gov. 2021-01-15. Archived from the original on 2022-11-18. Retrieved 2022-11-18.
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