What is the maximum dose of Rabishield (rabies vaccine) for a patient with a weight of 125kg?

Maximum Dose of Rabies Immunoglobulin for a 125kg Patient

The maximum dose of rabies immunoglobulin (RIG) for a patient weighing 125kg is 2,500 IU (20 IU/kg × 125kg), which should be administered according to standard guidelines with wound infiltration as the priority. 1, 2

Dosing Calculation

• The recommended dose of human rabies immunoglobulin (HRIG) is 20 IU/kg body weight, applicable to all age groups including children 1, 2
• For a 125kg patient: 20 IU/kg × 125kg = 2,500 IU total dose 1
• This formula is universally applied regardless of patient weight, with no upper limit specified in guidelines 1, 2

Administration Technique

• If anatomically feasible, the full dose should be thoroughly infiltrated in the area around and into the wounds 1, 2
• Any remaining volume should be injected intramuscularly at a site distant from vaccine administration 1, 2
• Thorough wound infiltration is critical, as rare failures of post-exposure prophylaxis have occurred when less than the full amount of RIG was infiltrated at exposure sites 1, 2

Important Timing Considerations

• RIG is administered only once at the beginning of antirabies prophylaxis 1
• If not given when vaccination was begun (day 0), RIG can still be administered up to and including day 7 of the post-exposure prophylaxis series 1
• Beyond day 7, RIG is not indicated as an antibody response to the vaccine is presumed to have occurred 1

Critical Precautions

• RIG should never be administered in the same syringe or in the same anatomical site as the first vaccine dose 1, 2
• Because RIG can partially suppress active production of antibody, the dose administered should not exceed the recommended dose of 20 IU/kg 1
• The gluteal area should never be used for vaccine injections, but can be used for RIG administration if necessary 1

Vaccination Schedule with RIG

• For previously unvaccinated persons, the current recommendation is a 4-dose vaccine schedule (days 0,3,7, and 14) along with RIG 1, 2
• For immunocompromised patients, the 5-dose schedule (days 0,3,7,14, and 28) is still recommended 1, 2
• Persons who have previously received complete rabies vaccination require only vaccine (2 doses on days 0 and 3) and no RIG 1, 2

Clinical Considerations

• The combination of RIG and vaccine is recommended for both bite and non-bite exposures reported by previously unvaccinated persons 1
• If post-exposure prophylaxis has been initiated and appropriate laboratory testing confirms the animal was not rabid, prophylaxis can be discontinued 1, 2
• Proper wound cleansing with soap and water and a virucidal agent is an essential component of rabies prevention 1, 2