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# Antirabies vaccine
## Overview
Rabies vaccine is used for pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to prevent rabies infection.
## Primary Indications
* **PrEP:** For individuals at high risk of exposure to rabies virus, such as veterinarians, animal handlers, and travelers to rabies-endemic areas.
* **PEP:** For individuals who have been bitten or scratched by a potentially rabid animal, or have had mucous membrane contact with saliva or nervous tissue of a rabid animal.
## Adult Dosing
* **PrEP:** 1 mL intramuscularly (IM) on days 0, 7, and 21 (or 28).
* **PEP (Contact with unknown or rabid animal):**
* Vaccination: 1 mL IM on days 0, 3, 7, 14, and 28.
* Rabies Immune Globulin (RIG): 20 International Units (IU)/kg on day 0, infiltrated around the wound site as much as possible; administer on day 0 if not given previously (but do not delay vaccine if RIG unknown). Half of the dose should be given in the limb opposite the vaccination site.
Dosing for PEP may vary based on local protocols, the type of exposure, and the condition of the animal.
## Pediatric Dosing
Pediatric dosing is the same as adult dosing based on weight: 1 mL IM.
## Dose Adjustments
No dose adjustments are typically required for renal or hepatic impairment.
## Contraindications
* Severe allergic reaction (anaphylaxis) to a previous dose of rabies vaccine or any component of the vaccine (e.g., neomycin, polymyxin B, chondroitin sulfate-precipitated bovine serum albumin).
## Adverse Effects
Common: Pain, redness, swelling at the injection site, headache, fatigue, nausea, myalgia, dizziness. Rare: Anaphylaxis, neurological events.
## Key Drug Interactions
* Immunosuppressive therapy (e.g., corticosteroids, cytotoxic drugs) may reduce the immune response to the vaccine. If these are necessary, a booster dose may be recommended.
## Monitoring
* Vaccination site for local reactions.
* Patients for signs of systemic allergic reactions.
* For PEP, the health of the biting animal should be monitored if possible.
## Clinical Pearls
* RIG should be administered on day 0, if indicated.
* Completion of the vaccine series is crucial for both PrEP and PEP.
* For individuals with known immunosuppression, antibody titers may be checked after vaccination to ensure adequate response.
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*Disclaimer: This information is intended for clinical pharmacists and healthcare professionals. It is essential to consult the most current prescribing information and local guidelines for definitive dosing and management. This information does not substitute for professional clinical judgment.*
