Pharmacology · Immunoglobulins and antitoxins
Human tetanus immunoglobulin !
Human IgG against tetanus toxin. It neutralises toxin not yet bound to nerves in tetanus-prone wounds and in the treatment of tetanus.
Updated 2026-11-01
Also called: Human tetanus immune globulin (TIG), Human tetanus antitoxin
The figure shows tetanus neurotoxin bound to the neuronal ganglioside GD1a; the immunoglobulin binds the toxin before it reaches this receptor.
Mechanism of action
Tetanospasmin travels along nerves to the spinal cord and blocks release of inhibitory neurotransmitters, causing rigidity and spasms. The immunoglobulin neutralises only free toxin; toxin already fixed to nerve endings is not reversed. It is therefore given early, together with wound care and vaccine.
- Spores germinate in the wound and release toxin
- Tetanus IgG binds the free toxin
- Neutralised toxin cannot enter the neuron
- Toxin already fixed to nerves is not reversed
Pharmacokinetics
- Distribution
- Human IgG in plasma
- Half-life
- Human IgG remains in the circulation for weeks, much longer than animal-derived antibody
Indications
- Wounds that are not clean and minor in people with fewer than three previous toxoid doses or an unknown history, together with the vaccine
- Treatment of established tetanus, with aggressive wound care, spasm control and antibiotics
Adverse effects
Common
- Local pain at the injection site
- Sterile abscess at the injection site (rare)
Contraindications
- Previous anaphylaxis to human immunoglobulins
- Caution in IgA deficiency with anti-IgA antibodies
Key interactions
- Tetanus toxoid
- Given together at different sites; the immunoglobulin protects at once and the vaccine for the long term
What is monitored
- Tetanus vaccination history and wound type
- In tetanus: airway, spasms and autonomic function
Administration and safety
- Intramuscular route
- Give at a different site from the vaccine and with a different syringe
- It is a blood product: record product and batch
Nursing care
- Classify the wound and document previous toxoid doses
- Clean and debride the wound
- Watch for allergic reaction
- In established tetanus, a quiet environment and airway monitoring
Pregnancy and breastfeeding
Not contraindicated in pregnancy when indicated.
Test yourself
Think of the answer, then tap the question to see it.
Why does tetanus immunoglobulin not reverse established spasms?
It only neutralises free toxin; toxin already bound to nerve endings keeps acting.
When is tetanus immunoglobulin added to the vaccine in wound management?
For wounds that are not clean and minor when the person has had fewer than three previous toxoid doses or does not know their history.
Which patients with a contaminated wound receive tetanus immunoglobulin regardless of vaccination history?
People with HIV or severe immunodeficiency.
Related drugs
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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Chapter 21: Tetanus | Pink Book | CDC (Centers for Disease Control and Prevention, 2021); Tetanus (World Health Organization, 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).
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Representative model, for educational purposes only.