DrugindexOnline^{2nd edition}

( RIG ) Pronouncation: (RAY-beez ih-MYOON GLAB-byoolin)
Class: Immune globulin

Trade Names:
BayRab
- Injection 150 units/mL

Trade Names:
Imogam Rabies-HT
- Injection 150 units/mL

Mechanism of Action

Pharmacology

Directly neutralizes rabies virus.

Pharmacokinetics

Absorption

Absorbed slowly (IM). T _max is 2 to 13 days.

Distribution

Distribution into milk and across placenta likely due to passage of other immunoglobulins.

Elimination

The t _½ serum is about 24 days.

Indications and Usage

Passive, transient postexposure prevention of rabies infection in susceptible individuals.

Contraindications

Repeated doses once vaccine treatment has been initiated. Rabies immune globulin (RIG) may theoretically be contraindicated in people who have had life-threatening reactions to human IgG antibody products or any RIG components. Previous complete immunization with rabies vaccine and presence of adequate antibody titer.

Dosage and Administration

Adults and children

IM 20 units/kg (0.133 mL/kg) as soon as possible after exposure, preferably with first dose of rabies vaccine, but can be administered through the seventh day after the first dose of vaccine is given.

General Advice

• For IM administration only. Not for intradermal, subcutaneous, IV, intra-arterial, or oral administration.
• Can be administered in conjunction with rabies vaccine if not combined in the same syringe or administered in the same site.
• Infiltrate as much immune globulin as possible around the wound if anatomically feasible. Administer remaining immune globulin IM in the upper, outer quadrant of the gluteal muscle, or the deltoid muscle.
• Administer 2 injections in gluteal region if volume is greater than 5 mL.
• Inspect solution visually before administration. Do not administer if solution is cloudy, discolored, or contains particulate matter.
• Discard any unused product. Vials are for single-use only. Do not save medication for future use.

Storage/Stability

Store vials in refrigerator (36° to 46°F). Protect from freezing. Do not use if solution has been frozen.

Drug Interactions

Measles, mumps, polio, or rubella live vaccines

Other antibodies in RIG preparation may interfere with response to these live vaccines. Do not give live vaccines within 3 mo after RIG.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Dermatologic

Urticaria; skin rash.

Genitourinary

Nephrotic syndrome.

Miscellaneous

Local tenderness, pain, soreness, or stiffness of the muscles at injection site; low-grade fever; angioedema; sensitization to repeated injections; anaphylactic shock.

Precautions

Pregnancy

Category C .

Lactation

Unknown.

Hypersensitivity to human immunoglobulins

Give drug with caution.

Bloodborne viral transmission

Because RIG is made from human plasma, there is a risk of transmitting infectious agents (eg, viruses).

Patient Information

• Explain name, actions, and potential side effects of the treatment regimen. Review the treatment regimen including dosing schedule, duration of treatment, and monitoring that will be required.
• Review benefits of therapy and risks, including potential to transmit disease and unknown infectious agents.
• Advise patient, family, or caregiver that medication will be prepared and administered by a health care provider in a health care setting and that medication will not be administered at home.
• Advise patient or caregiver that most common side effects are soreness at injection site and fever. Advise patient or caregiver to use nonaspirin containing OTC analgesics (eg, acetaminophen, ibuprofen) for fever, or pain or discomfort at injection site.
• If appropriate, teach patient or caregiver wound care, and signs of infection that should be reported to health care provider.
• Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding.
• Instruct patient not to take any prescription or OTC medications, herbal preparations, or dietary supplements unless advised by health care provider.
• Advise patient or caregiver that follow-up visits and lab tests may be required to monitor response to therapy and to keep appointments.