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Drug overview for HYPERRAB (rabies immune globulin/pf):
Generic name: rabies immune globulin/PF (RAY-beez i-MUNE-GLOB-ue-lin)
Drug class: Rabies Immune Globulin
Therapeutic class: Biologicals
Rabies immune globulin (RIG) is a specific immune globulin (hyperimmune globulin) that contains antibody to rabies antigen and is used to provide antirabies antibodies for temporary passive immunity to rabies virus. RIG commercially available in the US is prepared from plasma of donors hyperimmunized with rabies vaccine and is sometimes referred to as HRIG. Other types of RIG (e.g., equine rabies immune globulin; ERIG) may be available in other countries.
No enhanced Uses information available for this drug.
Generic name: rabies immune globulin/PF (RAY-beez i-MUNE-GLOB-ue-lin)
Drug class: Rabies Immune Globulin
Therapeutic class: Biologicals
Rabies immune globulin (RIG) is a specific immune globulin (hyperimmune globulin) that contains antibody to rabies antigen and is used to provide antirabies antibodies for temporary passive immunity to rabies virus. RIG commercially available in the US is prepared from plasma of donors hyperimmunized with rabies vaccine and is sometimes referred to as HRIG. Other types of RIG (e.g., equine rabies immune globulin; ERIG) may be available in other countries.
No enhanced Uses information available for this drug.
DRUG IMAGES
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The following indications for HYPERRAB (rabies immune globulin/pf) have been approved by the FDA:
Indications:
Rabies postexposure prophylaxis
Professional Synonyms:
Hydrophobia postexposure prophylaxis
Lyssa postexposure prophylaxis
Lytta postexposure prophylaxis
Rabies post exposure prophylaxis
Rabies post-exposure prophylaxis
Rabies postexposure prevention
Indications:
Rabies postexposure prophylaxis
Professional Synonyms:
Hydrophobia postexposure prophylaxis
Lyssa postexposure prophylaxis
Lytta postexposure prophylaxis
Rabies post exposure prophylaxis
Rabies post-exposure prophylaxis
Rabies postexposure prevention
The following dosing information is available for HYPERRAB (rabies immune globulin/pf):
No enhanced Dosing information available for this drug.
Rabies immune globulin (RIG) is administered preferably by local wound infiltration and, when local infiltration accounts for only a portion of the dose or is not anatomically feasible, by IM injection. RIG should not be administered IV. (See Cautions: Precautions and Contraindications.) The full dose of RIG should be thoroughly infiltrated locally in the area around and into the wound(s) if anatomically feasible.
In cases (e.g., multiple severe wounds) where the volume required to infiltrate the wound(s) would exceed the recommended dosage of RIG, some clinicians recommend diluting the calculated dosage in saline to yield a two- to threefold increase in the volume of solution to ensure all wound areas receive RIG infiltration. After infiltrating the wound(s) area, any remaining portion of the recommended RIG dose should be administered by IM injection at a site distant from where rabies vaccine is being administered. For adults and older children, the deltoid is the only acceptable IM injection site; for younger children, the deltoid or anterolateral thigh should be used.
For children with a small muscle mass, it may be necessary to administer RIG at multiple IM sites. RIG should not be administered into the gluteal area (buttock muscle) because of the potential for injection-associated injury to the sciatic nerve. Injection into or near any blood vessels or nerves should be avoided.
The US Public Health Service Advisory Committee on Immunization Practices (ACIP) and American Academy of Pediatrics (AAP) state that aspiration (i.e., pulling back on the syringe plunger after needle insertion and before injection) is not required because large blood vessels are not present at recommended IM injection sites. To ensure delivery into muscle, IM injections should be made at a 90degrees angle to the skin using a needle length appropriate for the individual's age and body mass, the thickness of adipose tissue and muscle at the injection site, and the injection technique. RIG and rabies vaccine should not be given in the same syringe and should not be injected at the same site since neutralization of the vaccine may occur. In addition, RIG should not be mixed with other immune globulins, vaccines, or solutions.
In cases (e.g., multiple severe wounds) where the volume required to infiltrate the wound(s) would exceed the recommended dosage of RIG, some clinicians recommend diluting the calculated dosage in saline to yield a two- to threefold increase in the volume of solution to ensure all wound areas receive RIG infiltration. After infiltrating the wound(s) area, any remaining portion of the recommended RIG dose should be administered by IM injection at a site distant from where rabies vaccine is being administered. For adults and older children, the deltoid is the only acceptable IM injection site; for younger children, the deltoid or anterolateral thigh should be used.
For children with a small muscle mass, it may be necessary to administer RIG at multiple IM sites. RIG should not be administered into the gluteal area (buttock muscle) because of the potential for injection-associated injury to the sciatic nerve. Injection into or near any blood vessels or nerves should be avoided.
The US Public Health Service Advisory Committee on Immunization Practices (ACIP) and American Academy of Pediatrics (AAP) state that aspiration (i.e., pulling back on the syringe plunger after needle insertion and before injection) is not required because large blood vessels are not present at recommended IM injection sites. To ensure delivery into muscle, IM injections should be made at a 90degrees angle to the skin using a needle length appropriate for the individual's age and body mass, the thickness of adipose tissue and muscle at the injection site, and the injection technique. RIG and rabies vaccine should not be given in the same syringe and should not be injected at the same site since neutralization of the vaccine may occur. In addition, RIG should not be mixed with other immune globulins, vaccines, or solutions.
| DRUG LABEL | DOSING TYPE | DOSING INSTRUCTIONS |
|---|---|---|
| HYPERRAB 300 UNIT/ML VIAL | Maintenance | Adults inject 20 unit/kg by intramuscular route once |
No generic dosing information available.
The following drug interaction information is available for HYPERRAB (rabies immune globulin/pf):
There are 1 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Selected Live Viral Vaccines/Selected Immunoglobulins SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: Immune globulin(IG) products may prevent the immune system from properly responding to the vaccine.(1-19) CLINICAL EFFECTS: Administration of selected live viral vaccines after immunoglobulins may impair the efficacy of the vaccine.(1-19) Administration of immunoglobulins within 2-4 weeks after selected live viral vaccines impair the efficacy of the vaccine.(1-4,15) PREDISPOSING FACTORS: The amount of antigen-specific antibody present in the administered immunoglobulin product determines the duration of this interaction.(15) PATIENT MANAGEMENT: The recommendations regarding this interaction are conflicting. The Centers for Disease Control and Prevention(CDC) immunization recommendations for spacing of live vaccines and antibody-containing products include the following(15): - Live attenuated influenza vaccine, rotavirus, zoster and Ty21a typhoid vaccines may be given any time before, concurrent, with, or after administration of any immune globulin. Yellow fever vaccine may also be given in areas where donor blood products are unlikely to contain a substantial quantity of yellow fever antibody. - Administration of measles or varicella containing vaccines should be postponed for the following intervals after immunoglobulin therapy: Hepatitis B IG, Tetanus IG - 3 months Rabies IG - 4 months Varicella IG - 5 months Measles prophylaxis IG - 6 months if nonimmunocompromised Botulinum IG Intravenous, CMV IG Intravenous, Hepatitis A IG - 6 months Intravenous Immune Globulin(IVIG) - 8 to 11 months depending upon the dose Monoclonal antibody to RSV F protein (palivizumab) - none - Administration of antibody-containing products should be delayed 2 weeks after administration of live vaccines, except for influenza, rotavirus, zoster and typhoid vaccines as noted above. CDC guidelines state that in circumstances where there is high-risk of vaccine-preventable disease, it is acceptable to administer a dose of vaccine prior to completion of these intervals.(16) Manufacturer recommendations are as follows: Administration of a live viral vaccine should be postponed for at least three months in patients who have received the following immunoglobulin therapy: anthrax immunoglobulin,(19) cytomegalovirus immunoglobulin,(1) hepatitis B immunoglobulin,(5,6) rabies immunoglobulin,(7) tetanus immunoglobulin,(8-11) vaccinia immunoglobulin,(18) and zoster immunoglobulin.(2) Administration of a live viral vaccine should be postponed for at least six months in patients who have received the following immunoglobulin therapy: botulinum neurotoxin a/b immune globulin.(17) The Australian, Canadian, and US manufacturers of human immunoglobulin state that live viral vaccines should be postponed for three months in patients who have received human immunoglobulin.(6,12,13,18) The UK manufacturer states that vaccines may be compromised for one year and vaccines should be postponed in children for at least seven months.(14) The US manufacturer of immune globulin-hyaluronidase states that immune response to live attenuated vaccines may be impaired for up to 6 months, or for a year or more in the case of measles vaccine.(15) Cytomegalovirus immunoglobulin(1) or human immunoglobulin(3) should not be administered to patients who have received a live vaccine in the previous two weeks. If a live viral vaccine is given within two weeks of zoster immunoglobulin,(1) repetition of the vaccination three months after the completion of immunoglobulin should be considered. DISCUSSION: CDC Immunization Recommendations(15)provide discussion, charts, and further details regarding appropriate use and timing of vaccine therapy.(16) |
ADENOVIRUS TYPE 4, ADENOVIRUS TYPE 4 AND TYPE 7, ADENOVIRUS TYPE 7, DENGVAXIA, M-M-R II VACCINE, PRIORIX, PROQUAD, STAMARIL, VARIVAX VACCINE, YF-VAX |
There are 2 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| IgG Antibodies and Derivatives/Efgartigimod-alfa SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The neonatal Fc receptor (FcRn) prevents catabolism and mediates recycling of IgG and albumin, which leads to their long persistence in the body.(1,2) Efgartigimod-alfa binds to FcRn and may decrease systemic exposure of other ligands of FcRn, like immunoglobulins and IgG-based antibodies.(3) CLINICAL EFFECTS: The effectiveness of medicines that bind to FcRn may be decreased.(3) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of efgartigimod-alfa states that efgartigimod-alfa should not be combined with long-term use of FcRn-binding medications. If the medication is essential for the patient, efgartigimod-alfa should be discontinued.(3) DISCUSSION: Clinical drug interaction studies with efgartigimod-alfa have not been performed. Efgartigimod-alfa may decrease concentrations of compounds that bind to the human FcRn.(3) |
VYVGART, VYVGART HYTRULO |
| IgG Antibodies and Derivatives/Nipocalimab-aahu SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: The neonatal Fc receptor (FcRn) prevents catabolism and mediates recycling of IgG and albumin, which leads to their long persistence in the body.(1,2) Nipocalimab-aahu binds to FcRn and may decrease systemic exposure of other ligands of FcRn, like immunoglobulins and IgG-based antibodies.(3) CLINICAL EFFECTS: The effectiveness of medicines that bind to FcRn may be decreased.(3) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of nipocalimab-aahu states that nipocalimab-aahu should not be combined with long-term use of FcRn-binding medications. If the medication is essential for the patient, nipocalimab-aahu should be discontinued.(3) DISCUSSION: Clinical drug interaction studies with nipocalimab-aahu have not been performed. Nipocalimab-aahu may decrease concentrations of compounds that bind to the human FcRn.(3) |
IMAAVY |
There are 1 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| IgG Antibodies and Derivatives/Rozanolixizumab-noli SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The neonatal Fc receptor (FcRn) prevents catabolism and mediates recycling of IgG and albumin, which leads to their long persistence in the body.(1,2) Rozanolixizumab-noli binds to FcRn and may decrease systemic exposure of other ligands of FcRn, like immunoglobulins and IgG-based antibodies.(3) CLINICAL EFFECTS: The effectiveness of medications that bind to FcRn may be decreased.(3) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: The manufacturer of rozanolixizumab-noli states that concurrent use with medications that bind to the human neonatal Fc receptor (FcRn) should be closely monitored for reduced effectiveness of these medications. If long-term use of such medications is essential for the patient, consider discontinuing rozanolixizumab-noli and use alternative therapies.(3) DISCUSSION: Clinical drug interaction studies with rozanolixizumab-noli have not been performed. Rozanolixizumab-noli may decrease concentrations of compounds that bind to the human FcRn.(3) |
RYSTIGGO |
The following contraindication information is available for HYPERRAB (rabies immune globulin/pf):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 0 contraindications.
There are 1 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| IgA deficiency |
There are 0 moderate contraindications.
The following adverse reaction information is available for HYPERRAB (rabies immune globulin/pf):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 0 severe adverse reactions.
There are 2 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. |
Fever Injection site sequelae |
| Rare/Very Rare |
|---|
| None. |
The following precautions are available for HYPERRAB (rabies immune globulin/pf):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
Because of the potential risks of inadequately treated rabies exposure, pregnancy is not a contraindication to postexposure prophylaxis. Animal reproduction studies have not been performed with RIG, and it is not known whether the drug can cause fetal harm when administered to pregnant women. The manufacturers state that RIG should be used during pregnancy only when clearly needed. The ACIP states that there are no known risks for the fetus from passive immunization of pregnant women with immune globulin preparations.
Information on the distribution of RIG into milk is not available; it is not known if transmission of RIG to a nursing infant presents any unusual risk.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for HYPERRAB (rabies immune globulin/pf):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for HYPERRAB (rabies immune globulin/pf)'s list of indications:
| Rabies postexposure prophylaxis | |
| Z20.3 | Contact with and (suspected) exposure to rabies |
| Z23 | Encounter for immunization |
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