Rabies immunoglobulin

Medication made up of antibodies against the rabies virus

Pharmaceutical compound

Rabies immunoglobulinClinical data

Trade names| Imogam Rabies-HT, Kedrab, Hyperrab, others
AHFS/Drugs.com| Monograph
Pregnancy
category|

* AU: B2[1]

Routes of
administration| Intramuscular injection
ATC code|

* J06BB05 (WHO)

Legal status
Legal status|

* AU: S4 (Prescription only)[1]
* CA: ℞-only / Schedule D[2][3][4][5]
* US: ℞-only[6][7][8][9]

Identifiers
DrugBank|

* DB11603

ChemSpider|

* none

UNII|

* 95F619ATQ2

Rabies immunoglobulin (RIG) is a medication made up of antibodies against the rabies virus.[10] It is used to prevent rabies following exposure.[10] It is given after the wound is cleaned with soap and water or povidone-iodine and is followed by a course of rabies vaccine.[10] It is given by injection into the site of the wound and into a muscle.[10] It is not needed in people who have been previously vaccinated against rabies.[11]

Common side effects include pain at the site of injection, fever, and headache.[10] Severe allergic reactions such as anaphylaxis may rarely occur.[12] Use during pregnancy is not known to harm the baby.[10] It works by binding to the rabies virus before it can enter nerve tissue.[10] After the virus has entered the central nervous system, rabies immunoglobulin is no longer useful.[10]

The use of rabies immunoglobulin in the form of blood serum dates from 1891.[13] Use became common within medicine in the 1950s.[14] It is on the World Health Organization's List of Essential Medicines.[15] Rabies immunoglobulin is expensive and hard to come by in the developing world.[16] In the United States it is estimated to be more than US$1,000.00 per dose,[17] and around £600 in the United Kingdom.[18] It is made from the blood plasma of people or horses who have high levels of the antibody in their blood.[10][17] The horse version is less expensive but has a higher rate of side effects.[17][14]

## Medical uses

[edit]

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.[19][20][1]

## Society and culture

[edit]

### Names

[edit]

There are three versions of rabies immunoglobulin licensed and available in the US.[21] Imogam Rabies-HT is produced by Sanofi Pasteur.[6] Kedrab is produced by Kedrion Biopharma.[19][7] Hyperrab is produced by Grifols.[8]

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[22] and indicate local infusion at the wound site with additional amount intramuscularly at a site distant from vaccine administration.[23]

Kamrab is approved for medical use in Australia.[1]

## References

[edit]

1. ^ a b c d "Kamrab". Therapeutic Goods Administration (TGA). 23 August 2021. Retrieved 10 September 2021.
2. ^ "Kamrab PI". Health Canada. 25 April 2012. Retrieved 10 September 2021.
3. ^ "Imogam PI". Health Canada. 25 April 2012. Retrieved 10 September 2021.
4. ^ "Hyperrab S/D PI". Health Canada. 25 April 2012. Retrieved 10 September 2021.
5. ^ "Drug and medical device highlights 2018: Helping you maintain and improve your health". Health Canada. 14 October 2020. Retrieved 17 April 2024.
6. ^ a b "Imogam Rabies-HT - human rabies virus immune globulin injection, solution". DailyMed. Retrieved 24 March 2020.
7. ^ a b "Kedrab- human rabies virus immune globulin injection, solution". DailyMed. Retrieved 24 March 2020.
8. ^ a b "Hyperrab (rabies immune globulin- human injection, solution". DailyMed. Retrieved 24 March 2020.
9. ^ "Hyperrab S/D (rabies immune globulin- human injection". DailyMed. Retrieved 10 September 2021.
10. ^ a b c d e f g h i "Rabies Immune Globulin". The American Society of Health-System Pharmacists. Archived from the original on 18 March 2011. Retrieved 8 January 2017.
11. ^ 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.
12. ^ British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. p. 869\. ISBN 9780857111562.
13. ^ Rupprecht CE, Plotkin SA (2013). "Rabies Vaccines". In Plotkin SA, Orenstein WA, Offit PA (eds.). Vaccines (6th ed.). [Edinburgh]: Elsevier/Saunders. p. 659\. ISBN 978-1455700905. Archived from the original on 9 January 2017.
14. ^ a b Jong EC, Zuckerman JN (2004). Travelers' Vaccines. PMPH-USA. p. 205\. ISBN 9781550092257. Archived from the original on 9 January 2017.
15. ^ 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.
16. ^ Tintinalli JE (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.
17. ^ a b c Research Advances in Rabies. Academic Press. 2011. p. 351\. ISBN 9780123870414. Archived from the original on 9 January 2017.
18. ^ Kliff, Sarah (7 February 2018). "Why a simple, lifesaving rabies shot can cost $10,000 in America". Vox. Retrieved 26 September 2024.
19. ^ a b "Kedrab". U.S. Food and Drug Administration (FDA). 21 March 2018. Retrieved 7 June 2020. This article incorporates text from this source, which is in the public domain.
20. ^ "Summary Basis for Regulatory Action - Kedrab". FDA. 23 August 2017.
21. ^ "Vaccine and Immune Globulin Availability". Centers for Disease Control and Prevention (CDC). 26 February 2020. Retrieved 24 March 2020.
22. ^ "WHO Guide for Rabies Pre and Post Exposure Prophylaxis in Humans" (PDF). World Health Organization (WHO). 2014.
23. ^ "Rabies Biologics | Specific Groups | CDC". www.cdc.gov. 15 January 2021. Retrieved 18 November 2022.

## Further reading

[edit]

* Meeting of the Antimicrobial Drugs Advisory Committee (PDF) (Briefing Document). U.S. Food and Drug Administration (FDA). 25 April 2019.

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