📋 Indications & Clinical Dosage
*Pre-exposure prophylaxis:*
BY IM INJ: Adult & Children: 1 ml for 2 doses (on days 0 and 7), followed by 1 ml for 1 dose (on day 28), to be administered in deltoid region, for those at continuous risk, measure plasma-concentration of antirabies antibodies every 6 months and give a booster dose if the titre is less than 0.5 units/ml, final dose may be given from day 21, if insufficient time before travel.
*Pre-exposure prophylaxis booster dose:*
BY IM INJ: Adult & Children: 1 ml for 1 dose, to be given 1 year after primary course is completed, then 1 ml every 3-5 years, to be administered in deltoid region, the frequency of booster doses may alternatively be determined according to plasma concentration of antirabies antibodies; at infrequent risk of exposure booster dose may be given after 10 yrs.
*Post-exposure prophylaxis of fully immunised individuals (who have previously received pre-exposure or post-exposure prophylaxis with cell-derived rabies vaccine):*
BY IM INJ: Adult & Children: 1 ml for 1 dose, followed by 1 ml after 3-7 days for 1 dose, to be administered in deltoid region, rabies immunoglobulin is not necessary
Post-exposure treatment for unimmunised individuals (or those whose prophylaxis is possibly incomplete):*
BY IM INJ: Adult& Children: 1 ml 5 times amonth for 1 month, on days0, 3, 7, 14, and the fifth dose is given between day 28-30, to be administered in deltoid region, depending on the level of risk, rabies immunoglobulin is given to unimmunised individuals on day 0 or within 7 days of starting the course of rabies vaccine, the immunization course can be discontinued if it is proved that the individual was not at risk.
⛔ Contraindications
Pre-exposure prophylaxis in individuals with acute disorders or known allergy to components of the vaccine.
⚠️ Precautions & Warnings
Congenital or acquired immunodeficiency, pregnancy (for post-exposure prophylaxis only), lactation, post-exposure immunization in patients with known-hypersensitivity to vaccine components. Inadvertent intravascular injection may lead to shock.
🔄 Drug Interactions
Immunosuppressive agents, antimalarial drugs.
⚠️ Adverse Reactions / Side Effects
Mild reactions at inj site, fever, headache, myalgia, lymph node swelling, fatigue, arthritis, GI disorders. Rarely: circulatory reactions, sweating, chills, paresthesia, allergic & neurological reactions
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.