rabies immune globulin, human (RIG) (Rx)

Brand and Other Names:HyperRAB S/D, KedRab, more...Imogam Rabies HT, RIG, HyperRAB
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 150 IU/mL (2mL and 10mL vials) (HyperRAB S/D, Imogam Rabies HT, KenRab)
  • 300 IU/mL (1mL, 3mL, and 5mL vials) (HyperRAB)

Rabies, Postexposure Prophylaxis

Indicated for passive, transient postexposure prophylaxis of rabies infection, when administered immediately after contact with a rabid or possibly rabid animal

20 International Units/kg, infiltrate locally around bite  

Inject any remaining volume IM into the upper arm deltoid region or, in small children, into the anterolateral aspect of the thigh

If bite site is unknown or indeterminate, or difficult to administer (eg, lips, fingers, knees); administer RIG at site(s) distant from the site of the rabies vaccine

Dosage Forms & Strengths

injectable solution

  • 150 IU/mL (2mL and 10mL vials) (HyperRAB S/D, Imogam Rabies HT, KenRab)
  • 300 IU/mL (1mL, 3mL, and 5mL vials) (HyperRAB)

Rabies, Postexposure Prophylaxis

Indicated for passive, transient postexposure prophylaxis of rabies infection, when administered immediately after contact with a rabid or possibly rabid animal

20 International Units/kg, infiltrate locally around bite  

Inject any remaining volume IM into the upper arm deltoid region or, in small children, into the anterolateral aspect of the thigh

If bite site is unknown or indeterminate, or difficult to administer (eg, lips, fingers, knees); administer RIG at site(s) distant from the site of the rabies vaccine

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Interactions

Interaction Checker

and rabies immune globulin, human (RIG)

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (6)

              • axicabtagene ciloleucel

                rabies immune globulin, human (RIG), axicabtagene ciloleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • brexucabtagene autoleucel

                rabies immune globulin, human (RIG), brexucabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • ciltacabtagene autoleucel

                rabies immune globulin, human (RIG), ciltacabtagene autoleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • idecabtagene vicleucel

                rabies immune globulin, human (RIG), idecabtagene vicleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • lisocabtagene maraleucel

                rabies immune globulin, human (RIG), lisocabtagene maraleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              • tisagenlecleucel

                rabies immune globulin, human (RIG), tisagenlecleucel. Either increases effects of the other by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.

              Monitor Closely (10)

              • BCG vaccine live

                rabies immune globulin, human (RIG) decreases effects of BCG vaccine live by Other (see comment). Use Caution/Monitor. Comment: High dose rabies immunoglobulin may impair response to active immunization.

              • efgartigimod alfa

                efgartigimod alfa will decrease the level or effect of rabies immune globulin, human (RIG) by receptor binding competition. Use Caution/Monitor. Coadministration of efgartigimod with medications that bind to the human neonatal Fc receptor may lower systemic exposures and effectiveness of such medications. Closely monitor for reduced effectiveness of medications that bind to the human neonatal Fc receptor. If long-term use of such medications is essential, consider discontinuing efgartigimod and using alternative therapies.

              • measles (rubeola) vaccine

                rabies immune globulin, human (RIG) decreases effects of measles (rubeola) vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.

              • measles mumps and rubella vaccine, live

                rabies immune globulin, human (RIG) decreases effects of measles mumps and rubella vaccine, live by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.

              • measles, mumps, rubella and varicella vaccine, live

                rabies immune globulin, human (RIG) decreases effects of measles, mumps, rubella and varicella vaccine, live by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.

              • rabies vaccine

                rabies immune globulin, human (RIG) decreases effects of rabies vaccine by Other (see comment). Use Caution/Monitor. Comment: RIG may be administered concurrently with and up to 8 days after rabies vaccine. High dose rabies immunoglobulin may impair response to active immunization. .

              • rabies vaccine chick embryo cell derived

                rabies immune globulin, human (RIG) decreases effects of rabies vaccine chick embryo cell derived by Other (see comment). Use Caution/Monitor. Comment: RIG may be administered concurrently with and up to 8 days after rabies vaccine. High dose rabies immunoglobulin may impair response to active immunization. .

              • rubella vaccine

                rabies immune globulin, human (RIG) decreases effects of rubella vaccine by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.

              • smallpox (vaccinia) vaccine, live

                rabies immune globulin, human (RIG) decreases effects of smallpox (vaccinia) vaccine, live by Other (see comment). Use Caution/Monitor. Comment: High dose rabies immunoglobulin may impair response to active immunization.

              • varicella virus vaccine live

                rabies immune globulin, human (RIG) decreases effects of varicella virus vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.

              Minor (1)

              • protein a column

                protein a column decreases levels of rabies immune globulin, human (RIG) by Other (see comment). Minor/Significance Unknown. Comment: Since Prosorba binds IgG, it could theoretically interfere with the levels and/or effects of pharmacologic immune globulins.

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              Adverse Effects

              >10%

              Injection site pain (33%)

              Headache (15%)

              1-10%

              Muscle pain (9%)

              Upper respiratory tract infection (9%)

              Joint pain (6%)

              Dizziness (6%)

              Fatigue (6%)

              Abdominal pain (4%)

              Blood in urine (4%)

              Nausea (4%)

              Feeling faint (4%)

              Bruising (3%)

              Sunburn (3%)

              WBCs in urine (3%)

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              Warnings

              Contraindications

              None

              Cautions

              Patients who can document previous complete rabies pre-exposure prophylaxis or complete postexposure prophylaxis should only receive a booster rabies vaccine without RIG, owing to RIG interference with anamnestic response to the vaccine

              Hemolysis may occur, particularly in individuals at high risk (eg, thrombocytopenia, bleeding disorders)

              Monitor patients at increased risk of thrombosis or thrombotic complications for at least 24 hr

              Caution with prior allergic reactions to immune globulins (RIG contains small quantity of IgA)

              Avoid immunization with measles vaccine within 4 months after RIG; avoid other live attenuated vaccines for 3 months

              Do NOT give IV; do not inject into a blood vessel because of the risk of severe allergic or hypersensitivity reaction, including decreased blood pressure and anaphylactic shock

              A transient rise of the various passively transferred antibodies in the patient’s blood may result in misleading positive results of serologic tests; passive transmission of antibodies to erythrocyte antigens (eg, A, B, and D), may interfere with serologic tests for red cell antibodies such as the antiglobulin test (Coombs test)

              RIG is derived from human plasma; therefore, the potential exists for viral transmission (eg, CJD)

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              Pregnancy & Lactation

              Pregnancy

              Has not been studied in pregnant women

              Animal and reproductive studies have not been conducted

              Lactation

              Unknown if excreted in human milk

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Human immune globulins from donors

              Pharmcokinetics

              Half-life: 17.9 days

              Peak plasma time: 7 days (range: 3-14 days)

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              Administration

              Injection

              Infiltrate locally around bite; inject any remaining volume IM into the upper arm deltoid region or, in small children, into the anterolateral aspect of the thigh

              If IM administration is contraindicated (eg, in patients with uncorrectable bleeding disorders), administer RIG by SC injection (there are no clinical efficacy data to support SC route)

              Always administer in conjunction with rabies vaccine (HDCV); however, do not administer into the same anatomical sites as rabies vaccine

              Preferably give concomitantly with vaccine but may be given through 7th day after first dose of vaccine

              Do not give repeated doses of RIG once rabies vaccine treatment has started, since this may interfere with the immune response to the rabies vaccine

              Do not administer RIG to patients with a history of a complete pre-exposure or postexposure vaccination regimen and confirmed adequate rabies antibody titer

              Do not mix with the rabies vaccine or administer in the same syringe with the rabies vaccine

              Storage

              KedRab

              • Refrigerate at 2-8ºC (36-46ºF); do not freeze
              • May store at room temperature not exceeding 25ºC (77ºF) for up to 1 month; do not return to refrigeration

              HyperRAB

              • Refrigerate at 2-8ºC (36-46ºF); do not freeze
              • May store at room temperature not exceeding 25ºC (77ºF) for up to 6 months; do not return to refrigeration

              Imogam Rabies HT, HyperRAB S/D

              • Refrigerate at 2-8ºC (36-46ºF); do not freeze
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Imogam Rabies-HT (PF) intramuscular
              -
              150 unit/mL vial
              HyperRAB S/D (PF) intramuscular
              -
              150 unit/mL vial
              HyperRAB S/D (PF) intramuscular
              -
              150 unit/mL vial
              Kedrab (PF) intramuscular
              -
              150 unit/mL vial
              Kedrab (PF) intramuscular
              -
              150 unit/mL vial

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              A Patient Handout is not currently available for this monograph.
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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.