HyperRAB 300 IU/mL is a higher-potency formulation of a previously Food and Drug Administration–approved rabies immune globulin (RIG; human), HyperRAB S/D, also available as 1,500 IU/10 mL.1 The original HyperRAB S/D is available as 300 IU/2 mL and 1,500 IU/10 mL.
Explore This IssueACEP Now: Vol 37 – No 09 – September 2018
Administration and Dosing
RIG is administered as postexposure prophylaxis along with the rabies vaccine in people with suspected rabies exposure.2 RIG provides passive immunity until active immunity with the rabies vaccine is recognized. RIG should not be given to anyone who has been previously immunized with rabies vaccine and has a confirmed adequate rabies antibody titer. For unvaccinated people, the combination of rabies vaccine and RIG is recommended for bite and non-bite exposures, regardless of the time between exposure and postexposure prophylaxis initiation. Do not give RIG beyond day 7 after receiving the rabies vaccine because an antibody response to the vaccine is presumed to have already occurred.
RIG is administered locally via wound infiltration as a single dose of 20 IU/kg. If feasible, the entire dose should be infiltrated around and into the wound(s). Any remaining RIG volume should be administered intramuscularly at a site distant from the vaccine administration site. Infants, children, and adolescents should all be dosed with 20 IU/kg. This new formulation provides a greater concentration per volume of anti-rabies virus antibodies to go into delicate wounds such as those of the face, with the potential for fewer injections, making it less uncomfortable for younger patients.
Adverse Reactions and Precautions
Adverse reactions include injection site pain and headache. Hemolysis can occur in patients with non-O blood groups and underlying inflammatory conditions. Anaphylaxis/hypersensitivity reactions can also occur. Use cautiously in patients at an increased risk for thrombosis or with a history of bleeding disorders and/or patients on anticoagulant therapy.
Because HyperRAB is made from human plasma, it may contain infectious agents and, theoretically, the variant Creutzfeldt-Jakob disease agent. Other unknown infectious agents may be present in RIG. Administer cautiously to patients with a prior history of systemic allergic reactions following human immunoglobulins.
Other Rabies Immune Globulin Products2
- Imogam Rabies-HT injection 300 IU/2 mL and 1,500 IU/10 mL
- Kedrab injection 300 IU/2 mL and 1,500 IU/10 mL (latex- and pyrogen-free)
- HyperRAB 300 IU/mL (1 mL) and HyperRAB S/D 300 IU/2 mL: $852.14
- HyperRAB 1,500 IU/5 mL (5 mL) and HyperRAB S/D 300 IU/2 mL: $3,889.42
- Imogam Rabies-HT 300 IU/2 mL: $867.05
- Imogam Rabies-HT 1,500 IU/10 mL: $3,977.23
- Kedrab injection: cost not known
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October 19, 2018Ursula Makker
Be advised HRIG is dosed by body weight. Since younger patients generally weigh less, and the dose (volume) is already small, now having to use half of the previous volume may make adequate infiltration difficult with 300 IU product vs. original 150 IU product. Note: as per the manufacturer, if there is not enough volume of 300 IU product to adequately infiltrate, 300 IU must be diluted with equal volume of 5% Dextrose – for which there is no existing pharmacy SOP. This also negates the double potency/half volume feature. 150 IU remains the ideal and preferred potency for HRIG when treating patients exposed to the deadly rabies virus.
November 8, 2020Mahmood Peshimam
What is the insurance reimbursement compared to the cost of RIG
a) 300 IU/ml?
b) 150 IU/ml?