Equirab

Equine anti-rabies immunoglobulin.

Each 5 ml vial contains: Equine anti rabies immunoglobulin fragments not less than 1000 IU, water for injection U.S.P. q.s.
Preservative: Cresol B.P. NMT 0.25% v/v. Stabilizer: Glycine B.P., Excipient: Sodium Chloride B.P.
Equirab is a sterile, non-pyrogenic solution for intra muscular/subcutaneous administration, it contains antiviral substances obtained from the serum of healthy horses that has been immunized against rabies by vaccination, in addition, it also contains the antimicrobial agent cresol.
Equirab is Rabies Anti-Serum derived from Equine source, it is purified by Ion exchange chromatography.

Equirab provides passive immunization against rabies. For prevention of rabies in patients at risk of being exposed to rabies after contact with a rabid animal or a animal presumed to be rabid. Equirab itself does not constitute an antirabies treatment and should always be used in conjunction with rabies vaccine.

First-aid treatment: Prompt local treatment of bite wounds and scratches that may be contaminated with rabies virus is important, whatever the time elapsed since the contact. Recommended first-aid procedures are immediate thorough flushing and washing of the wound with soap and water, detergent or other substances of proven lethal effect on rabies virus. Rabies antiserum should be injected as soon as possible after exposure. (see Table.)

Click on icon to see table/diagram/image

For prevention of rabies, combined immunoglobulin-vaccine treatment is recommended, although experience indicates that vaccine alone could be enough for minor exposure (Category II) The recommended dose is 40 I.U./Kg of body weight. If anatomically feasible, as much as possible of the dose should be infiltrated around the wounds. The remainder should be administered intramuscularly (into the gluteal region) in a single dose. The first dose of the vaccine should be inoculated at the same time as the immunoglobulin, but in different parts of the body. In no cases should the dosage of the rabies immunoglobulin be exceeded because immunoglobulin may partially suppress active production of antibodies. Children and adults receive the same dose of 40 I.U./Kg of body weight. When indicated, begin anti-tetanus treatment and administer antimicrobial drugs to control infections other than rabies.

The study of overdose is not available.

Equirab should be use with extreme caution in subjects with a history of allergic symptoms or hypersensitivity to horse serum.

Despite the high degree of purification of the serum, it is recommended to perform a skin test before administering Anti-Rabies Serum (Equine). As per department of disease control, Thailand, the skin test consists of an intradermal injection 1:100 dilution of Anti-Rabies Serum (Equine) (0.02 mL) on the volar surface of the forearm. An equivalent of intradermal injection of physiological saline solution is used as control. The observations made 15-20 minutes after intradermal injection is considered to be positive, if >10 mm diameter of wheal appears with flare surrounded and the control is negative or if the control shows dermal reaction and sample shows a bigger reaction than the control. As per WHO, there are no scientific grounds for performing a skin test prior to administering Equine Rabies Immunoglobulin (ERIG) because testing does not predict reactions, and it should still be given whatever the result of the test. A positive test result is not a formal contraindication for the use of Equirab therapy , but it should be considered as warning. In such case, Equirab should be administered only after ensuring the facility is equipped to overcome anaphylactic shock. It should be kept in mind that a negative skin test does not guarantee that anaphylaxis would not occur.

The safety of Equirab when used during pregnancy has not been established in clinical trials in human beings. Considering the lethal risk associated with rabies, pregnancy is not a contra-indication to the administration of Equirab subsequent to exposure.

Immediate or delayed hypersensitive type reactions may be developed on administration of Equirab. The observed immediate reactions are anaphylactoid reactions with hypotension, dyspnea, urticaria. Delayed reactions consist of inflammatory reaction, fever, pruritis, rash or urticaria, adenopathy and arthralagia. Inform a doctor or pharmacist if the patient experiences any undesirable effect.

Rabies prevention after contamination risk requires simultaneous administration of antirabies immunoglobulin and vaccine. Anti rabies vaccine should be inoculated in a different part of the body, contra-laterally if possible. In this case intereference is minimised. The antiserum should not be administered in the same syringe as the vaccine.

Store between 2°C and 8°C. Do not freeze.

Vaccines, Antisera & Immunologicals

J06BB05 - rabies immunoglobulin ; Belongs to the class of specific immunoglobulins. Used in passive immunizations.

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