human diploid cell rabies vaccine (Imovax, Imovax ID, HDCV)
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Indications
- rabies exposure or rabies virus exposure
Contraindications
(& cautions)
- developing febrile illnesses
- allergy to neomycin, gentamicin or amphotericin B
- caution: administer IM only
Dosage
Post-exposure prophylaxis:
- 1.0 mL IM on days 1 & 3 post animal bite in a victim previously immunized or on days 1, 3, 7, 14 following rabies immune globulin (RIG) in an unvaccinated victim.
- Alternatively, rabies vaccine adsorbed (RVA) may be used.
- A series of 3 injections is given 0.1 mL intradermally in deltoids on days 0, 7 & 28, or
- A series of 3 doses given 1 mL IM in deltoid on days 0, 7 & 21 or 28.
- Booster doses can be given every 2 years
Injection:
Pharmacokinetics
- after IM administration, antibody appears in the serum within 7-10 days & persists for at least 1 year
- elimination: liver
Monitor
- antibody-response to vaccine in immunocompromised patients, i.e. formation of rabies immune globulin
Adverse effects
- common (> 10%)
- swelling, erythema, itching, pain, local discomfort, nausea, headache, abdominal pain, muscle aches, dizziness, malaise, neuroparalytic reactions, hypersensitivity reactions
Drug interactions
- rabies immune globulin
- chloroquine: decreased titer of antibody
- immunosuppressive agents: decreased response to vaccine
- corticosteroids
Mechanism of action
- stimulates active immunity to rabies by promoting production of rabies antibody
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1171
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998 - not on National VA formulary
- ↑ Rupprecht CE et al Use of a Reduced (4-Dose) Vaccine Schedule for Postexposure Prophylaxis to Prevent Human Rabies: Recommendations of the Advisory Committee on Immunization Practices MMWR March 19, 2010 / 59(02);1-9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20300058 <Internet> http://cdc.gov/mmwr/preview/mmwrhtml/rr5902a1.htm corresponding NGC guideline withdrawn Jan 2016