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)

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            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
              Kedrab (PF) intramuscular
              -
              150 unit/mL vial
              Kedrab (PF) intramuscular
              -
              150 unit/mL vial
              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

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              rabies immune globulin (PF) intramuscular

              RABIES IMMUNE GLOBULIN - INJECTION

              (RAY-beez i-MUNE-GLOB-ue-lin)

              COMMON BRAND NAME(S): Hyperrab, Imogam Rabies-HT, KedRab

              USES: This medication is used to prevent a certain serious virus infection, rabies, in people who have been exposed to this virus under certain conditions (such as a bite wound or non-bite wound by an infected animal). This medication is made from healthy human blood that has high levels of certain defensive substances (antibodies) that help fight rabies infection.

              HOW TO USE: Part of the dose of this medication is given by direct injection by a health care professional into the area of the wound (bite or non-bite). The remainder of your dose is given by injection into a muscle by a health care professional. It is best to receive this medication as soon as possible after exposure. If you wait too long after being exposed, the medication may not work well. Your doctor may also recommend vaccination after receiving this medication. Talk with your doctor about the best treatment for you.The dosage is based on your medical condition and weight.

              SIDE EFFECTS: Redness, pain, or tenderness at the injection site may occur. Nausea, vomiting, diarrhea, dizziness, tiredness, headache, or back/joint pain may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist promptly.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before receiving rabies immune globulin, tell your doctor or pharmacist if you are allergic to it; or to other immune globulin products; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: a certain immune system problem (immunoglobulin A deficiency).This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).This medication is made from human blood. Even though the blood is carefully tested, and this medication goes through a special manufacturing process, there is an extremely small chance that you may get infections (such as Creutzfeldt-Jakob disease-CJD) from the medication. Consult your doctor or pharmacist for more information.Tell your doctor of any recent or planned immunizations/vaccinations. This medication may prevent a good response to certain live viral vaccines (such as measles, mumps, rubella, varicella). If you have recently received any of these vaccines, your doctor may have you tested for a response or have you vaccinated again later. If you plan on getting any of these vaccines, your doctor will instruct you about the best time to receive them so you get a good response.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.This medication may interfere with certain lab tests (such as Coomb's test), possibly causing false test results. Tell all lab personnel and all your doctors and pharmacists that you use this medication.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Lab and/or medical tests (such as levels of antibody in the blood) should be done while you are using this medication. Keep all lab appointments. Consult your doctor for more details.

              MISSED DOSE: Not applicable.

              STORAGE: Not applicable. This medication is given in a hospital or doctor's office and will not be stored at home.

              Information last revised November 2021. Copyright(c) 2022 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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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.
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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.