rabies immune globulin, human (RIG) (Rx)

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

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 150 IU/mL (2mL and 10mL vials) (HyperRAB, Imogam Rabies HT, KenRab)
  • 300 IU/mL (1mL and 5mL vials) (HyperRAB)
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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 Unit/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, Imogam Rabies HT, KenRab)
  • 300 IU/mL (1mL and 5mL vials) (HyperRAB)
more...

Rabies, Postexposure Prophylaxis (Off-label)

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

20 International Unit/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)

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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

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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.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the 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.