HyperRAB, a rabies immune globulin, is used for post-exposure rabies prophylaxis. It should be given no later than one week following a bite from an animal that may be rabid.

Rabies immune globulin Uses:

• Postexposure prophylaxis of Rabies:

  • Recommended for prophylaxis after suspected rabies exposure. Gives protection in the window period until active immunity develops from the rabies vaccine. Not required for individuals previously immunized and have adequate antibody titers.
  • Consider the animal species, whether animal provoked, the immunization status of animal, and rabies incidence of the area.

Rabies Immune Globulin (HyperRAB) Dose in Adults

Rabies Immune Globulin (HyperRAB) Dose in the treatment of Rabies (for postexposure prophylaxis):

• It is advised to provide the maximum dosage (20 IU/Kg) as a single dose locally around the wound (IM). Any residual dose should be IM administered at a location other than the immunisation site.
• To be administered as soon as feasible following exposure, along with the rabies vaccine. If the rabies vaccination was started without HRIG, HRIG may be given up until seven days following the first dose of the vaccination.
• It is not recommended after 1 week of rabies vaccination as antibody response starts appearing at that time.

Rabies Immune Globulin (HyperRAB) Dose in Childrens

Note: Not required for individuals previously immunized and have adequate antibody titers.

Rabies Immune Globulin (HyperRAB) Dose in the Postexposure prophylaxis:

• Infants, Children, and Adolescents:

  • It is advised to provide the maximum dosage (20 IU/Kg) as a single dose locally around the wound (IM). Any residual dose should be IM administered at a location other than the immunisation site.
  • It must be administered as soon as possible after exposure, along with the rabies vaccine. If the rabies vaccination was started without HRIG, HRIG may be given up until seven days following the first dose of the vaccination.
  • It is not recommended after 1 week of rabies vaccination as antibody response starts appearing at that time.

Pregnancy Risk Factor C

• Pregnancy does not preclude the use of postexposure prophylaxis.
• If the risk of exposure to rabies during pregnancy is high, pre-exposure prophylaxis might be recommended.

Use during breastfeeding:

• Breast milk contains immunoglobulins.
• According to the manufacturer the decision should be based on the balance between the benefit to mother and the risk to infant.

Dose in Kidney Disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Dose in Liver disease:

There are no dosage adjustments provided in the manufacturer’s labeling.

Common Side Effects of Rabies Immune Globulin (HyperRAB):

• Central Nervous System:

  • Headache

• Local:

  • Pain At Injection Site

Less Common Side Effects of Rabies Immune Globulin (HyperRAB):

• Central Nervous System:

  • Fatigue
  • Dizziness

• Dermatologic:

  • Sunburn

• Gastrointestinal:

  • Flatulence
  • Abdominal Pain
  • Nausea
  • Diarrhea

• Genitourinary:

  • Hematuria
  • Leukocyturia

• Hematologic & Oncologic:

  • Bruise

• Local:

  • Injection Site Nodule

• Neuromuscular & Skeletal:

  • Arthralgia
  • Myalgia

• Respiratory:

  • Oropharyngeal Pain
  • Nasal Congestion
  • Upper Respiratory Tract Infection

Frequency of side effects not defined:

• Central Nervous System:

  • Malaise

• Dermatologic:

  • Skin Rash

• Genitourinary:

  • Nephrotic Syndrome

• Hypersensitivity:

  • Angioedema
  • Anaphylaxis

• Local:

  • Tenderness at Injection Site
  • Local Soreness/Soreness at Injection Site

• Neuromuscular & Skeletal:

  • Stiffness (At Injection Site)

• Miscellaneous:

  • Fever (Mild)

Contraindications to Rabies Immune Globulin (HyperRAB):

Imogam Rabies-HT: Once the course of treatment has begun, do not administer additional vaccination doses. This might obstruct immunity that is already activated.

HyperRAB, HyperRAB S/D. KedrabThe manufacturer's labeling does not list any contraindications.

Warnings and precautions

• Anaphylaxis/hypersensitivity reactions:

  • If you have an allergic reaction or anaphylactic reaction, you will need to immediately withdraw with the emergency measures.
  • Individuals with IgA deficiencies or past histories of hypersensitivity to human immuneglobulins should be cautious.

• Hemolysis

  • This might happen. Patients who have non-O blood types, underlying inflammatory diseases, or who have received high cumulative immune globulin dosages over a number of days are at higher risk.
  • Watch out for hemolysis symptoms such as fever, chills and dark urine.

• Thrombosis:

  • Be aware of the risk factors for thrombosis in patients who are bedbound, those receiving estrogen therapy, and those with hereditary thrombotic conditions.
  • Patients at high risk of hyperviscosity should be observed for at least one day following treatment; it is also important to measure baseline blood viscosity in these patients.

• Bleeding disorders:

  • Patients on anticoagulant therapy or with a history or tendency to have bleeding, thrombocytopenia or other bleeding issues should be cautious.

Rabies immune globulin (human): Drug Interaction

Monitoring Parameters:

• Monitor for hypersensitivity reactions after the injection.
• Monitor blood pressure, pulse rate, and observe for cutanous allergic reactions.

How to administer Rabies Immune Globulin (HyperRAB)?

• The complete human rabies immune globulin (HRIG) dose should be injected intramuscularly (IM) into the wound(s) following exposure; any extra doses should be injected intramuscularly (IM) into the lateral thigh muscle or the deltoid muscle of the upper arm.
• The gluteal muscle at best is avoided unless directly exposed. IV use should be avoided. 
• A little amount (e.g., 0.5 mL or more) may be injected around the wound if it is small or on a finger. Giving more than the calculated dose is not advised in any case.
• If more substance is required to adequately infiltrate the wounds, it may be diluted with an equal amount of D5W (HyperRAB) or NS (Kedrab, Imogam); HyperRAB shouldn't be diluted with NS. Where IM is not feasible, subcutaneous administration is not advised in place of IV.

Mechanism of action of Rabies Immune Globulin (HyperRAB):

• Preformed immunoglobulins provide passive immunity by neutralizing antigens; in this instance, rabies. 
• This is crucial for the time frame in which active immunity develops after the rabies vaccine.

International Brand Names of Rabies immune globulin:

• HyperRAB
• HyperRAB S/D
• Imogam Rabies-HT
• Kedrab
• Bayrab
• Berirab P
• Berirab-P
• Equirab
• Favirab
• Hyperrab S D
• Imogam
• Imogam Rabia
• Imogam Rabies
• Imogan Rabia
• Imogan Rabies
• Kamrab
• PARS
• Rabigam
• Rabix-IG
• Rabuman Berna
• SII Rabivax
• Vinrab
• Yi Sheng Bao Er

Rabies immune globulin Brand Names in Pakistan: