What is the recommended dosage for Rabishield (rabies vaccine)

Rabishield Dosage

Rabishield (rabies human monoclonal antibody) is administered as a single dose on day 0 at the time of initiating post-exposure prophylaxis, with the full dose infiltrated around and into the wound(s) if anatomically feasible, and any remaining volume given intramuscularly at a site distant from the vaccine injection. 1

Dosing Regimen

Rabishield (Rabies Immunoglobulin) Administration

• The standard dose is 20 IU/kg body weight, administered only once on day 0 2, 3
• As much of the calculated dose as anatomically possible should be infiltrated directly into and around the wound site 2, 3
• Any remaining volume that cannot be infiltrated into the wound must be administered intramuscularly at a different anatomical site from where the vaccine is given 2, 4
• Rabishield should never be administered in the same syringe or at the same anatomical site as the rabies vaccine 2, 3, 4

Timing Considerations

• If Rabishield was not given on day 0, it can still be administered up to and including day 7 after the first vaccine dose 2, 3
• Beyond day 7, Rabishield is not indicated because antibody response to the vaccine is presumed to have occurred 2, 5

Complete Post-Exposure Prophylaxis Protocol

Wound Care (Critical First Step)

• Immediately wash all wounds thoroughly with soap and water for 15 minutes, followed by irrigation with a virucidal agent such as povidone-iodine solution 2, 3, 4
• This is the single most effective measure for preventing rabies and should never be delayed 3, 4

Vaccine Schedule (Administered with Rabishield)

• For previously unvaccinated persons: 4 doses of rabies vaccine (1.0 mL each) administered intramuscularly on days 0,3,7, and 14 2, 3
• Administer in the deltoid muscle for adults and older children, or anterolateral thigh for young children 2, 3
• Never use the gluteal area as this produces inadequate antibody response 2, 3, 4

Special Populations and Exceptions

Previously Vaccinated Persons

• Only 2 doses of vaccine are needed (days 0 and 3) 2, 3
• Rabishield should NOT be administered to previously vaccinated persons as it will inhibit the anamnestic antibody response 2, 3, 4

Immunocompromised Patients

• Require a 5-dose vaccine regimen (days 0,3,7,14, and 28) plus Rabishield at 20 IU/kg 2, 3
• Serologic testing 7-14 days after the final dose should be performed to confirm adequate seroconversion 3, 4

Pediatric Patients

• Children receive the same dose of Rabishield (20 IU/kg) as adults 2, 4
• The vaccine dose volume (1.0 mL) is also the same for children as for adults 3, 4

Critical Pitfalls to Avoid

• Do not exceed the recommended 20 IU/kg dose of Rabishield, as higher doses can suppress active antibody production 2, 3, 4
• Do not administer Rabishield to previously vaccinated individuals—this is a common error that inhibits the immune response 2, 3
• Do not give Rabishield and vaccine in the same syringe or anatomical location 2, 3
• Do not delay wound cleansing—this must be done immediately before any other intervention 3, 4

Real-World Safety Data

• Post-marketing surveillance of Rabishield in 1,000 patients with category III rabies exposure in India demonstrated excellent safety and tolerability, with no cases of rabies reported during 31-day follow-up 1
• The majority of adverse events were mild, and all patients recovered without sequelae 1