Rabies Immunoglobulin USP

Indications

Rabies Immunoglobulin USP is used for: Post exposure prophylaxis of rabies, For the seroprophylaxis (prevention by injecting antibodies) of rabies in subjects suspected to have been exposed to the rabies virus, particularly in the event of severe exposure e.g.: Multiple transdermal bites or scratches, Contamination of mucous membrane with saliva, Severe bites located on the face, head, neck and hands, When the domestic or wild animal responsible cannot be examined or is infected or suspected to be infected by the rabies virus, Bites to young children.

Adult Dose

Injection Post exposure prophylaxis of rabies Adult: In conjunction with rabies vaccine in previously unvaccinated individuals: The recommended dose for both adults and children is 20 IU/kg of body weight of Human Rabies Immunoglobulin (HRIG) or 40 IU/kg of body weight of Equine Rabies Immunoglobulin (ERIG). Previously vaccinated individuals with adequate rabies antibody titer: Rabies immunoglobulin should not be admin; only vaccine should be given.

Child Dose

Injection Post exposure prophylaxis of rabies Child: In conjunction with rabies vaccine in previously unvaccinated individuals: The recommended dose for both adults and children is 20 IU/kg of body weight of Human Rabies Immunoglobulin (HRIG) or 40 IU/kg of body weight of Equine Rabies Immunoglobulin (ERIG). Previously vaccinated individuals with adequate rabies antibody titer: Rabies immunoglobulin should not be admin; only vaccine should be given.

Renal Dose

Administration

If anatomically feasible, as much as possible of the dose should be infiltrated around and into the wound(s). The remainder should be administered intramuscularly (into the gluteal region) in a single injection. However, for children, particularly in the case of multiple wounds, it has been proposed to dilute the dose 2-3 times in a 0.9% sodium chloride solution to obtain a sufficient quantity of equine rabies immunoglobulin to infiltrate the wound(s) correctly. Wounds in certain anatomical sites (fingertips) should be infiltrated with care so as to prevent a local increase in pressure in the tissue.

Contra Indications

Known history of allergic symptoms to horse proteins. Do not give repeated doses of rabies immunoglobulin once rabies vaccine is given as this may reduce the immunologic response to the vaccine.

Precautions

Hypersensitivity to human immune globulin preparations, increased risk of hypersensitivity with specific immunoglobulin A deficiency; epinephrine should be available for management of possible anaphylactic reactions. Thrombocytopenia or bleeding disorders. If IM inj is contra-indicated, inj may be given by SC with pressure and compress applied to site after inj. Do not exceed recommended doses as this may reduce the immune response to rabies vaccine. Patients preciously immunised with rabies vaccine and have adequate rabies antibody titer should receive rabies vaccine without the rabies immunoglobulin. Avoid IV admin, and IM inj into central region of gluteal area. Admin rabies immunoglobulin and vaccine in separate syringes and to different sites with different lymphatic drainage. The safety of rabies immunoglobulin when used during pregnancy has not been established in clinical trials in human beings. Considering the lethal risk associated with rabies, pregnancy may not be a contraindication to the administration or rabies immunoglobulin subsequent to exposure. This vaccine should not be used during pregnancy unless the benefit outweighs the risk to the fetus. US FDA pregnancy category: C. If there is substantial risk of rabies exposure, pre-exposure prophylaxis may be indicated. Because of the consequences of inadequately treated rabies exposure, pregnancy is not a contraindication to post-exposure prophylaxis.

Pregnancy-Lactation

The safety of rabies immunoglobulin when used during pregnancy has not been established in clinical trials in human beings. Considering the lethal risk associated with rabies, pregnancy may not be a contraindication to the administration or rabies immunoglobulin subsequent to exposure. This vaccine should not be used during pregnancy unless the benefit outweighs the risk to the fetus. US FDA pregnancy category: C. If there is substantial risk of rabies exposure, pre-exposure prophylaxis may be indicated. Because of the consequences of inadequately treated rabies exposure, pregnancy is not a contraindication to post-exposure prophylaxis.

Interactions

Decreased response to live virus vaccine (e.g. measles, mumps, rubella and varicella), admin at least 4 mth after human rabies immunoglobulin admin.

Adverse Effects

Side effects of Rabies Immunoglobulin USP : Soreness at inj site, fever, chest or joint pain, dyspnoea, tremor, dizziness, oedema of the face, glossitis, buccal ulceration. The observed immediate reactions are hypotension, dyspnoea, and urticaria. Delayed reactions consist of inflammatory reaction, fever, pruritis, rash or urticaria, adenopathy and arthralgia. Rare risk of disease transmission by infective agents. Potentially Fatal: Anaphylactic reactions.

Mechanism of Action

Rabies immunoglobulins provide passive immunity to rabies. 2 types of immunoglobulin are available namely, human rabies immunoglobulin (HRIG) and purified equine rabies immunoglobulin (ERIG). HRIG is prepared from the plasma of human donors hyperimmunised with rabies vaccine and is preferred over ERIG.