Pharmacology · Immunoglobulins and antitoxins
Rabies immunoglobulin !
Antibodies against rabies virus that are infiltrated into the wound after severe exposures, while the vaccine builds the body's own response.
Updated 2026-11-01
Also called: Human rabies immunoglobulin (HRIG), Equine rabies immunoglobulin, Anti-rabies monoclonal antibodies
The figure shows the rabies virus glycoprotein bound to the fragment of a human neutralising antibody (RVA122); the antibodies in the immunoglobulin act on this protein.
Mechanism of action
Rabies is almost always fatal once symptoms start. The vaccine takes days to induce antibodies; during that gap, immunoglobulin infiltrated into the wound neutralises virus at the entry site before it reaches peripheral nerves. It can be human, equine or a monoclonal antibody.
- The wound is washed thoroughly
- Antibodies are infiltrated into and around the wound
- They neutralise virus before it enters nerves
- The vaccine, given at the same time, provides lasting protection
Pharmacokinetics
- Distribution
- Acts mainly in the wound tissue where it is infiltrated
- Onset and duration
- Immediate: it covers the gap until the vaccine induces antibodies
Indications
- WHO category III post-exposure prophylaxis (transdermal bites or scratches, saliva on mucosa or broken skin, direct contact with bats), together with the vaccine
Adverse effects
Common
- Pain and discomfort at the infiltration site
Contraindications
- Not given to people with documented previous rabies vaccination
- Not given more than seven days after the first vaccine dose
Key interactions
- Rabies vaccine
- Used together; the immunoglobulin does not replace the vaccine, which must be completed
What is monitored
- Exposure category (I, II or III)
- Previous rabies vaccination
- Allergic reactions during and after administration
Administration and safety
- Infiltrate into and around the wound
- Do not give with the same syringe or at the same site as the vaccine
- Equine products: keep anaphylaxis treatment at hand; prior skin testing is unreliable and WHO advises against it
Nursing care
- Wash the wound thoroughly with soap and water straight away
- Record the exposure category and the date of the first vaccine dose
- Watch for allergic reaction, especially with equine products
- Explain why the vaccine course must be completed
Pregnancy and breastfeeding
Rabies is almost always fatal once symptoms start; in pregnancy post-exposure prophylaxis is considered as for anyone exposed.
Test yourself
Think of the answer, then tap the question to see it.
In which WHO exposure category is rabies immunoglobulin added to the vaccine?
Category III: transdermal bites or scratches, saliva contamination of mucosa or broken skin, and direct contact with bats.
Where is rabies immunoglobulin given?
Infiltrated into and around the wound; WHO no longer recommends injecting the remainder at a distant site.
Who does not need immunoglobulin after a rabies exposure?
A person with documented previous rabies vaccination; it is also no longer indicated more than seven days after the first vaccine dose.
Related drugs
← Back to the class: Immunoglobulins and antitoxins
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Rabies (World Health Organization, 2026); The WHO position on rabies immunization – 2018 updates (Vaccine (PubMed Central), 2019); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); eEML - Electronic Essential Medicines List (World Health Organization, 2025).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.