rabies immune globulin (RIG, Hyperab Imogam)

Indications

• passive immunity to rabies for postexposure prophylaxis

Contraindications

(& cautions)

• IV administration is contraindicated
• RIG should not be used in a vaccinated individual with documented antibody response
• use with caution in patients with thrombocytopenia, bleeding disorders or prior allergic reactions to immune globulins

pregnancy-category C

safety in lactation ?

Dosage

• 20 IU/kg 1/2 into infected wound; the other 1/2 IM (gluteal)
• post-exposure rabies prophylaxis also includes rabies vaccine
  • RVA or HDCV on days 1, 3, 7, 14 & 28 following animal bite in an unvaccinated victim
• RIG should be given within 24 hours of exposure

Injection: 150 units/mL (vials 2 mL, 10 mL)

Pharmacokinetics

• following IM administration, antibodies appear in the serum within 24 hours
• elimination: liver
• 1/2life is 24 days

Adverse effects

• most common (1-10%)
  • soreness at injection site (may last up to 3 days), fever (mild)
• uncommon (< 1%)
  • urticaria, angioedema, muscle soreness, anaphylactic shock

Drug interactions

• immunosuppressive agents may interfere with active antibody response
• live virus vaccines: RIG may interfere with immune response to some live viruses

Mechanism of action

• passive immunity by neutralizing rabies virus so that spread of the virus is retarded

More general terms

• immune globulin

Additional terms

• human diploid cell rabies vaccine (Imovax, Imovax ID, HDCV)
• rabies vaccine adsorbed (RVA, RabAvert)
• rabies virus