HYPERRAB (RABIES IMMUNE GLOBULIN (HUMAN)) INJECTION, SOLUTION [GRIFOLS USA, LLC]

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HYPERRAB (RABIES IMMUNE GLOBULIN (HUMAN)) INJECTION, SOLUTION [GRIFOLS USA, LLC]
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NDC 13533-318-01, 13533-318-05, 13533-318-10, 13533-318-50
Set ID f82880b8-998c-4659-8f20-6dcc81f258e9
Category PLASMA DERIVATIVE
Packager GRIFOLS USA, LLC
Generic Name
Product Class
Product Number
Application Number BLA101144
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  • HIGHLIGHTS OF PRESCRIBING INFORMATION
    These highlights do not include all the information needed to use HYPERRAB® safely and effectively. See full prescribing information for HYPERRAB.

    HYPERRAB [rabies immune globulin (human)] solution for infiltration and intramuscular injection
    Initial U.S. Approval: 1974

    INDICATIONS AND USAGE

    HYPERRAB® is a human rabies immune globulin indicated for postexposure prophylaxis, along with rabies vaccine, for all persons suspected of exposure to rabies. (1) 

    Limitations of Use

    Persons previously immunized with rabies vaccine that have a confirmed adequate rabies antibody titer should receive only vaccine.

    For unvaccinated persons, the combination of HYPERRAB and vaccine is recommended for both bite and nonbite exposures regardless of the time interval between exposure and initiation of postexposure prophylaxis.

    Beyond 7 days (after the first vaccine dose), HYPERRAB is not indicated since an antibody response to vaccine is presumed to have occurred.

    DOSAGE AND ADMINISTRATION

    For infiltration and intramuscular use only.

    Administer HYPERRAB within 7 days after the first dose of rabies vaccine.

    Postexposure prophylaxis, along with rabies vaccine, after suspected exposure to rabies (2.1)HYPERRAB

    20 IU/kg body weight
    OR
    0.0665 mL/kg body weight

    Single-dose
    • Administer as soon as possible after exposure, preferably at the time of the first rabies vaccine dose.
    • Infiltrate the full dose of HYPERRAB thoroughly in the area around and into the wound(s), if anatomically feasible.
    • Inject the remainder, if any, intramuscularly.

    DOSAGE FORMS AND STRENGTHS

     

    • 300 IU/mL solution for injection supplied in 1 mL, 3mL and 5 mL single-dose vials. (3)

    CONTRAINDICATIONS

     

    • None. (4)

    WARNINGS AND PRECAUTIONS

     

    • Severe hypersensitivity reactions, including anaphylaxis, may occur with HYPERRAB. Have epinephrine available immediately to treat any acute severe hypersensitivity reactions. (5.1)

    • HYPERRAB is made from human blood, it may carry a risk of transmitting infectious agents, e.g., viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent. (5.2)

    ADVERSE REACTIONS

    The most common adverse reactions in >5% of subjects in clinical trials were injection site pain, headache, injection site nodule, abdominal pain, diarrhea, flatulence, nasal congestion, and oropharyngeal pain. (6)

    To report SUSPECTED ADVERSE REACTIONS, contact Grifols Therapeutics LLC at 1-800-520-2807 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

    DRUG INTERACTIONS

     

    • Repeated dosing after administration of rabies vaccine may suppress the immune response to the vaccine. (7)
    • Defer live vaccine (measles, mumps, rubella) administration for 4 months. (7)

    See 17 for PATIENT COUNSELING INFORMATION.

    Revised: 1/2021

  • Table of Contents

    FULL PRESCRIBING INFORMATION: CONTENTS*

    1 INDICATIONS AND USAGE

    2 DOSAGE AND ADMINISTRATION

    2.1 Dose

    2.2 Preparation

    2.3 Administration

    3 DOSAGE FORMS AND STRENGTHS

    4 CONTRAINDICATIONS

    5 WARNINGS AND PRECAUTIONS

    5.1 Hypersensitivity Reactions

    5.2 Transmissible Infectious Agents

    6 ADVERSE REACTIONS

    6.1 Clinical Trials Experience

    6.2 Postmarketing Experience

    7 DRUG INTERACTIONS

    8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    8.2 Lactation

    8.4 Pediatric Use

    8.5 Geriatric Use

    10 OVERDOSAGE

    11 DESCRIPTION

    12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    12.2 Pharmacodynamics

    12.3 Pharmacokinetics

    14 CLINICAL STUDIES

    15 REFERENCES

    16 HOW SUPPLIED/STORAGE AND HANDLING

    17 PATIENT COUNSELING INFORMATION

    *
    Sections or subsections omitted from the full prescribing information are not listed.
  • 1 INDICATIONS AND USAGE

    HYPERRAB is a human rabies immune globulin indicated for postexposure prophylaxis, along with rabies vaccine, for all persons suspected of exposure to rabies.

    Limitation of Use

    Persons who have been previously immunized with rabies vaccine and have a confirmed adequate rabies antibody titer should receive only vaccine.(1-3)

    For unvaccinated persons, the combination of HYPERRAB and vaccine is recommended for both bite and nonbite exposures regardless of the time interval between exposure and initiation of postexposure prophylaxis.(1-3)

    Beyond 7 days (after the first vaccine dose), HYPERRAB is not indicated since an antibody response to vaccine is presumed to have occurred.

  • 2 DOSAGE AND ADMINISTRATION

    For infiltration and intramuscular use only.

    The strength of HYPERRAB is 300 IU/mL.

    2.1 Dose

    Use HYPERRAB in combination with rabies vaccine series to be effective. Do not use HYPERRAB alone for prevention.

    Administer HYPERRAB within 7 days after the first dose of rabies vaccine.

    Rabies Postexposure Prophylaxis Schedule*
    Vaccination StatusTreatmentRegimen†
    *
    Adapted from reference ‎1.
    †
    These regimens are applicable for all age groups, including children.
    ‡
    Day 0 is the day the first dose of vaccine is administered. Refer to vaccine manufacturer’s instructions or to the recommendations of the Advisory Committee on Immunization Practices (ACIP)(1-3) for appropriate rabies vaccine formulations, schedules and dosages.
    §
    Any person with a history of rabies vaccination and a documented history of antibody response to the prior vaccination.
    Not previously vaccinated Wound cleansing •   Cleanse all wounds immediately and thoroughly with
        soap and water.
    •   Irrigate the wounds with a virucidal agent 
        such as a povidone-iodine solution, if available.


    HYPERRAB
    20 IU/kg body weight
    OR
    0.0665 mL/kg body weight  

    Single-dose     		•   Administer HYPERRAB as soon as possible
        after exposure, preferably at the time of the first vaccine dose.
    •   Infiltrate the full dose of HYPERRAB thoroughly in 
        the area around and into the wound(s), if anatomically
        feasible. [see Dosage and Administration (‎2.3)]
    •   Inject the remainder, if any, intramuscularly at an
        anatomical site distant from the site of vaccine
        administration. [see Dosage and Administration (‎2.3)]
    •   Do not exceed the recommended dose of 
        HYPERRAB, otherwise the active production of rabies
        antibody may be partially suppressed. [see Drug Interactions (7)]
    •   Use separate syringes, needles, and anatomical
        injection sites for HYPERRAB and for rabies vaccine.
    Rabies Vaccine •   Administer rabies vaccine on day 0‡
    •   Complete a rabies vaccination series for previously
         unvaccinated persons.†
    Previously vaccinated§ Wound cleansing •   Cleanse all wounds immediately and thoroughly with
        soap and water.
    •   Irrigate the wounds with a virucidal agent such as a
        povidone-iodine solution, if available.
    HYPERRAB •   Do not administer HYPERRAB. [see Indications and Usage (‎1)]
    Rabies Vaccine •   Administer rabies vaccine on day 0‡.
    •   Complete a rabies vaccination series for previously
         vaccinated persons.

    2.2 Preparation

    • Calculate the volume of HYPERRAB for the recommended dose of 20 IU/kg.
    • Ensure the correct strength is used for the calculation. HYPERRAB is formulated with a strength of 300 IU/mL. The predecessor product, HYPERRAB S/D was formulated at 150 IU/mL. The volume required of HYPERRAB (300 IU/mL) to achieve the recommended dose of 20 IU/kg is approximately one half of that required for the previous HYPERRAB S/D (150 IU/mL).
    • Visually inspect parenteral drug products for particulate matter and discoloration prior to administration, whenever solution and container permit. HYPERRAB is a clear or slightly opalescent, and colorless or pale yellow or light brown sterile solution.
    • Do not use HYPERRAB if the product shows any sign of tampering.  Notify Grifols Therapeutics LLC immediately [1-800-520-2807].
    • Do not freeze. Do not use any solution that has been frozen.
    • Discard unused portion.

    2.3 Administration

    • Administer HYPERRAB at the time of the first vaccine dose (day 0), but no later than day 7(1-3).
    • Infiltrate the full dose of HYPERRAB in the area around the wound, if anatomically feasible. Dilute HYPERRAB with an equal volume of dextrose, 5% (D5W), if additional volume is needed to infiltrate the entire wound.  Do not dilute with normal saline.
    • Inject the remainder, if any, of the HYPERRAB dose intramuscularly into the deltoid muscle of the upper arm or into the lateral thigh muscle, and distant from the site of vaccine administration.
    • Do not administer HYPERRAB in the same syringe or needle or in the same anatomic site as vaccine.
  • 3 DOSAGE FORMS AND STRENGTHS

    HYPERRAB is a sterile, 300 IU/mL solution for injection supplied in 1 mL, 3 mL and 5 mL single-dose vials. The 1 mL vial is sufficient for a child weighing 15 kg. The 3 mL vial is sufficient for a person weighing 45 kg. The 5 mL vial is sufficient for an adult weighing 75 kg.

    HYPERRAB is standardized against the U.S. Standard Rabies Immune Globulin to contain a potency of ≥300 IU/mL. The U.S. unit of potency is equivalent to the international unit (IU) for rabies antibody.

  • 4 CONTRAINDICATIONS

    None.

  • 5 WARNINGS AND PRECAUTIONS

    5.1 Hypersensitivity Reactions

    Severe hypersensitivity reactions may occur with HYPERRAB. Patients with a history of prior systemic allergic reactions to human immunoglobulin preparations are at a greater risk of developing severe hypersensitivity and anaphylactic reactions. Have epinephrine available for treatment of acute allergic symptoms, should they occur.

    Patients with isolated immunoglobulin A (IgA) deficiency may develop severe hypersensitivity reactions to HYPERRAB, or subsequently, to the administration of blood products that contain IgA.(4)

    5.2 Transmissible Infectious Agents

    HYPERRAB is made from human blood and may carry a risk of transmitting infectious agents, e.g., viruses, the variant Creutzfeldt-Jakob disease (vCJD) agent, and, theoretically, the Creutzfeldt-Jakob disease (CJD) agent. HYPERRAB is purified from human plasma obtained from healthy donors. When medicinal biological products are administered, infectious diseases due to transmission of pathogens cannot be totally excluded. However, in the case of products prepared from human plasma, the risk of transmission of pathogens is reduced by: (1) epidemiological controls on the donor population and selection of individual donors by a medical interview and screening of individual donations and plasma pools for viral infection markers; (2) testing of plasma for hepatitis C virus (HCV), human immunodeficiency virus (HIV), hepatitis B virus (HBV), HAV and human parvovirus (B19V) genomic material; and (3) manufacturing procedures with demonstrated capacity to inactivate/remove pathogens.

    ALL infections thought by a physician possibly to have been transmitted by this product should be reported by the physician or other healthcare provider to Grifols Therapeutics LLC [1-800-520-2807].

  • 6 ADVERSE REACTIONS

    The most common adverse reactions in >5% of subjects during clinical trials were injection site pain, headache, injection site nodule, abdominal pain, diarrhea, flatulence, nasal congestion, and oropharyngeal pain.

    6.1 Clinical Trials Experience

    Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

    The new formulation for HYPERRAB is manufactured using caprylate/chromatography purification and has a rabies antibody concentration of 300 IU/mL. The previous formulation, HYPERRAB S/D, was manufactured using a solvent detergent process and had a rabies antibody concentration of 150 IU/mL. These products were evaluated in 2 clinical trials in a total of 20 healthy subjects using a 20 IU/kg single dose. The initial study evaluated the original 150 IU/mL HYPERRAB S/D in 8 subjects and the second study evaluated HYPERRAB in 12 subjects.   The original study of HYPERRAB S/D reported headache (1/8; 13%).

    In the study with HYPERRAB at 300 IU/mL, 5 subjects (5/12; 42%) experienced at least 1 adverse reaction.  These were: injection site pain (4/12; 33%), injection site nodule (1/12; 8%), abdominal pain (1/12; 8%), diarrhea (1/12; 8%), flatulence (1/12; 8%), headache (1/12; 8%), nasal congestion (1/12; 8%), and oropharyngeal pain (1/12; 8%).

    6.2 Postmarketing Experience

    There are no data on the postmarketing use of HYPERRAB (300 IU/mL). The following adverse reactions have been identified during post approval use of the predecessor formulation, HYPERRAB S/D. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

    Among patients treated with HYPERRAB S/D, cases of allergic/hypersensitivity reactions including anaphylaxis have been reported. Soreness at the site of injection (injection site pain) may be observed following intramuscular injection of immune globulins. Sensitization to repeated injections has occurred occasionally in immunoglobulin-deficient patients.

    The following have been identified as the most frequently reported post-marketing adverse reactions:

    *
    These reactions have been manifested by dizziness, paresthesia, rash, flushing, dyspnea, tachypnea, oropharyngeal pain, hyperhidrosis, and erythema.
     
    Immune system disorder Anaphylactic reaction*
    hypersensitivity*
    Nervous system disorders Hypoesthesia
    Gastrointestinal disorders Nausea
    Musculoskeletal and connective tissue disorders Arthralgia, myalgia, pain in extremity
  • 7 DRUG INTERACTIONS

    • Do not administer repeated doses of HYPERRAB once vaccine treatment has been initiated as this could prevent the full expression of active immunity expected from the rabies vaccine.(1)
    • Other antibodies in the HYPERRAB preparation may interfere with the response to live vaccines such as measles, mumps, polio or rubella. Defer immunization with live vaccines for 4 months after HYPERRAB administration.(5)
  • 8 USE IN SPECIFIC POPULATIONS

    8.1 Pregnancy

    Risk Summary

    There are no data with HYPERRAB use in pregnant women to inform a drug-associated risk.  Animal reproduction studies have not been conducted with HYPERRAB.  It is not known whether HYPERRAB can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.  HYPERRAB should be given to a pregnant woman only if clearly needed.  In the U.S. general population, the estimated backgrounds risk of major birth defect and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.

    8.2 Lactation

    Risk Summary

    There is no information regarding the presence of HYPERRAB in human milk, the effect on the breastfed infant, or the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for HYPERRAB and any potential adverse effects on the breastfed infant from HYPERRAB.

    8.4 Pediatric Use

    Safety and effectiveness in the pediatric population have not been established.

    8.5 Geriatric Use

    Safety and effectiveness in geriatric population have not been established.

  • 10 OVERDOSAGE

    Because Rabies Immune Globulin (Human) may partially suppress active production of antibody in response to the rabies vaccine, do not give more than the recommended dose of rabies immune globulin (human).(1)

  • 11 DESCRIPTION

    HYPERRAB is a clear or slightly opalescent, and colorless or pale yellow or light brown sterile solution of human antirabies immune globulin for infiltration and intramuscular administration. HYPERRAB is provided in a single-dose vial and contains no preservative.  HYPERRAB is prepared from pools of human plasma collected from healthy donors (hyperimmunized with rabies vaccine) by a combination of cold ethanol fractionation, caprylate precipitation and filtration, caprylate incubation, anion-exchange chromatography, nanofiltration and low pH incubation. HYPERRAB consists of 15 to 18% protein at pH 4.1 to 4.8 in 0.16 to 0.26 M glycine. The product is standardized against the U.S. Standard Rabies Immune Globulin to contain a potency value of not less than 300 IU/mL. The U.S. unit of potency is equivalent to the international unit (IU) for rabies antibody.

    When medicinal biological products are administered, infectious diseases due to transmission of pathogens cannot be totally excluded. However, in the case of products prepared from human plasma, the risk of transmission of pathogens is reduced by epidemiological surveillance of the donor population and selection of individual donors by medical interview; testing of individual donations and plasma pools; and the presence in the manufacturing processes of steps with demonstrated capacity to inactivate/remove pathogens.

    In the manufacturing process of HYPERRAB, there are several steps with the capacity for virus inactivation or removal.(6) The main steps of the manufacturing process that contribute to the virus clearance capacity are as follows:

    • Caprylate precipitation/depth filtration
    • Caprylate incubation
    • Depth filtration
    • Column chromatography
    • Nanofiltration
    • Low pH final container incubation

    To provide additional assurance of the pathogen safety of the final product, the capacity of the HYPERRAB manufacturing process to remove and/or inactivate viruses has been demonstrated by laboratory spiking studies on a scaled down process model using a wide range of viruses with diverse physicochemical properties.

    The combination of all of the above mentioned measures provides the final product with a high margin of safety from the potential risk of transmission of infectious viruses.

    The caprylate/chromatography manufacturing process was also investigated for its capacity to decrease the infectivity of an experimental agent of transmissible spongiform encephalopathy (TSE), considered as a model for the variant Creutzfeldt-Jakob disease (vCJD), and Creutzfeldt-Jakob disease (CJD) agents.(6) These studies provide reasonable assurance that low levels of vCJD/CJD agent infectivity, if present in the starting material, would be removed by the caprylate/chromatography manufacturing process.

  • 12 CLINICAL PHARMACOLOGY

    12.1 Mechanism of Action

    HYPERRAB provides immediate, passive, rabies virus neutralizing antibody coverage until the previously unvaccinated patient responds to rabies vaccine by actively producing antibodies.(1)

    12.2 Pharmacodynamics

    The usefulness of prophylactic rabies antibody in preventing rabies in humans when administered immediately after exposure was dramatically demonstrated in a group of persons bitten by a rabid wolf in Iran.(7,8) Similarly, beneficial results were later reported from the U.S.S.R.(9) Studies coordinated by WHO (World Health Organization) helped determine the optimal conditions under which antirabies serum of equine origin and rabies vaccine can be used in man.(10-13) These studies showed that antirabies serum can interfere to a variable extent with the active immunity induced by the vaccine, but could be minimized by booster doses of vaccine after the end of the usual dosage series.

    Preparation of rabies immune globulin of human origin with adequate potency was reported by Cabasso et al.(14) In carefully controlled clinical studies, this globulin was used in conjunction with rabies vaccine of duck-embryo origin (DEV).(14,15) These studies determined that a human globulin dose of 20 IU/kg of rabies antibody, given simultaneously with the first DEV dose, resulted in amply detectable levels of passive rabies antibody 24 hours after injection in all recipients. The injections produced minimal, if any, interference with the subject's endogenous antibody response to DEV.

    Subsequently, human diploid cell rabies vaccines (HDCV) prepared from tissue culture fluids containing rabies virus have received substantial clinical evaluation in Europe and the United States.(14-22) In a study in adult volunteers, the administration of Rabies Immune Globulin (Human) did not interfere with antibody formation induced by HDCV when given in a dose of 20 IU per kilogram body weight simultaneously with the first dose of vaccine.(21)

    12.3 Pharmacokinetics

    In a clinical study of 12 healthy human subjects receiving a 20 IU/kg intramuscular dose of HYPERRAB detectable passive rabies neutralizing antibody was present by 24 hours and persisted through the 21 day follow-up evaluation period. Figure 1 shows the mean levels of rabies virus antibodies in IU/mL across the 21 day evaluation period and indicates that the titer remains stable during this period. This level of passive rabies neutralizing antibody is similar to that reported in the literature for administration of human rabies immune globulin, and is clinically important because it provides interim protection until the host immune response to rabies vaccine produces definitive protective titers of neutralizing rabies antibody (therefore the rabies vaccine series is also essential).(23-24)

    Figure 1

    The previous formulation, HYPERRAB S/D, was studied in 8 healthy subjects over 21 days.  As with the new formulation, rabies neutralizing antibody was present by 24 hours and persisted through the 21 day follow up period (Figure 2).

    Figure 2
  • 14 CLINICAL STUDIES

    HYPERRAB was administered to a total of 20 healthy adult subjects in two clinical trials. [see Clinical Pharmacology (12.3)]. A single intramuscular dose of 20 IU/kg HYPERRAB (12 subjects) or HYPERRAB S/D (8 subjects) was administered and rabies neutralizing antibody titers were monitored in serum for 21 days. Administration of both HYPERRAB formulations resulted in detectable titers of neutralizing antibodies to the rabies virus that persisted throughout the 21 day study period (Figure 2).

  • 15 REFERENCES

    1. Centers for Disease Control and Prevention. Human rabies prevention — United States, 2008: Recommendations of the Advisory Committee on Immunization Practices. MMWR. 2008;57(RR03):1-26, 28.

    2. World Health Organization. WHO Expert Consultation on Rabies: Second report. 2013. WHO technical report series, No. 982.

    3. Centers for Disease Control and Prevention.  Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies. Recommendations of the Advisory Committee on Immunization Practices. MMWR. 2010;59(RR02):1-9. Erratum in: MMWR 2010;59(16):493.

    4. Fudenberg HH. Sensitization to immunoglobulins and hazards of gamma globulin therapy. In: Merler E (editor). Immunoglobulins: biologic aspects and clinical uses. Washington, DC: National Academy of Science; 1970, p. 211-20.

    5. Centers for Disease Control and Prevention. General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2011;60(RR02):1-61. Erratum in: MMWR. 2011;60(29):993.

    6. Barnette D, Roth NJ, Hotta J, et al. Pathogen safety profile of a 10% IgG preparation manufactured using a depth filtration-modified process. Biologicals. 2012;40:247-53.

    7. Baltazard M, Bahmanyar M, Ghodssi M, et al. Essai pratique du sérum antirabique chez les mordus par loups enragés. [Practical test of anti-rabies serum in bites by rabid wolves]. Bull WHO. 1955;13:747-72.

    8. Habel K, Koprowski H. Laboratory data supporting the clinical trial of antirabies serum in persons bitten by a rabid wolf. Bull WHO. 1955;13:773-9.

    9. Selimov M, Boltucij L, Semenova E, et al. [The use of antirabies gamma globulin in subjects severely bitten by rabid wolves or other animals.] J Hyg Epidemiol Microbiol Immunol (Praha). 1959;3:168-80.

    10. Atanasiu P, Bahmanyar M, Baltazard M, et al. Rabies neutralizing antibody response to different schedules of serum and vaccine inoculations in non-exposed persons. Bull WHO. 1956;14:593-611.

    11. Atanasiu P, Bahmanyar M, Baltazard M, et al. Rabies neutralizing antibody response to different schedules of serum and vaccine inoculations in non-exposed persons: Part II. Bull WHO. 1957;17:911-32.

    12. Atanasiu P, Cannon DA, Dean DJ, et al. Rabies neutralizing antibody response to different schedules of serum and vaccine inoculations in non-exposed persons: Part 3. Bull WHO. 1961;25:103-14.

    13. Atanasiu P, Dean DJ, Habel K, et al. Rabies neutralizing antibody response to different schedules of serum and vaccine inoculations in non-exposed persons: Part 4. Bull WHO. 1967;36:361-5.

    14. Cabasso VJ, Loofbourow JC, Roby RE, et al. Rabies immune globulin of human origin: preparation and dosage determination in non-exposed volunteer subjects. Bull WHO. 1971;45:303-15.

    15. Loofbourow JC, Cabasso VJ, Roby RE, et al. Rabies immune globin (human): clinical trials and dose determination. JAMA. 1971;217(13):1825-31.

    16. Plotkin SA. New rabies vaccine halts disease — without severe reactions. Mod Med. 1977;45(20):45-8.

    17. Plotkin SA, Wiktor TJ, Koprowski H, et al. Immunization schedules for the new human diploid cell vaccine against rabies. Am J Epidemiol. 1976;103(1):75-80.

    18. Hafkin B, Hattwick MA, Smith JS, et al. A comparison of a WI-38 vaccine and duck embryo vaccine for preexposure rabies prophylaxis. Am J Epidemiol. 1978;107(5):439-43.

    19. Kuwert EK, Marcus I, Höher PG. Neutralizing and complement-fixing antibody responses in pre- and post-exposure vaccinees to a rabies vaccine produced in human diploid cells. J Biol Stand. 1976;4(4):249-62.

    20. Grandien M. Evaluation of tests for rabies antibody and analysis of serum responses after administration of three different types of rabies vaccines. J Clin Microbiol. 1977;5(3):263-7.

    21. Kuwert EK, Marcus I, Werner J, et al. Postexpositionelle Schutzimpfung des Menschen gegen Tollwut mit einer neu-entwickelten Gewebekulturvakzine (HDCS-Impfstoff). [Post exposure use of human diploid cell culture rabies vaccine (author's transl)]. Zentralbl Bakteriol [A].1977;239(4):437-58.

    22. Bahmanyar M, Fayaz A, Nour-Salehi S, et al. Successful protection of humans exposed to rabies infection: postexposure treatment with the new human diploid cell rabies vaccine and antirabies serum. JAMA. 1976;236(24):2751-4.

    23. Helmick CG, Johnstone C, Sumner J, et al. A clinical study of Merieux human rabies immune globulin. J Biol Stand. 1982; 10:357-67.

    24. Lang J, Gravenstein S, Briggs D, et al. Evaluation of the safety and immunogenicity of a new, heat-treated human rabies immune globulin using a sham, post-exposure prophylaxis of rabies. Biologicals 1998; 26:7-15.
  • 16 HOW SUPPLIED/STORAGE AND HANDLING

    HYPERRAB is supplied in 1 mL, 3mL and 5 mL single dose vials of ready-to-use solution with a potency value of not less than 300 IU/mL.

    HYPERRAB contains no preservative and is not made with natural rubber latex.

    NDC NumberSize
    13533-318-011 mL
    13533-318-033 mL
    13533-318-055 mL
    • Store HYPERRAB at 2 to 8°C (36 to 46°F).  Do not freeze.
      • HYPERRAB may be stored at room temperatures not to exceed 25ºC (77ºF) for up to 6 months.
      • Use within 6 months after removal from refrigeration at any time prior to the expiration date, after which the product must be used or discarded. Do not return to refrigeration.
    • Do not use after expiration date printed on the label.
    • Discard unused portion.
  • 17 PATIENT COUNSELING INFORMATION

    Discuss the risks and benefits of this product with the patient, before prescribing or administering it to the patient.

    Inform the patient who is allergic to human immune globulin products that severe, potentially life-threatening allergic reactions could occur. [see Warnings and Precautions (5.1)]

    Inform the patient who is deficient in IgA the potential for developing anti-IgA antibodies and severe potentially life threatening allergic reactions. [see Warnings and Precautions (5.1)]

    Inform the patient that HYPERRAB is made from human plasma and may carry a risk of transmitting infectious agents that can cause disease. While the risk that HYPERRAB can transmit an infectious agent has been reduced by screening plasma donors for prior exposure, testing donated plasma, and including manufacturing steps with the capacity to inactivate and/or remove pathogens, the patient should report any symptoms that concern them. [see Warnings and Precautions (‎5.2)]

    Grifols

    Grifols Therapeutics LLC
    Research Triangle Park, NC 27709 USA
    U. S. License Number 1871

    3058814

  • PACKAGE LABEL

    Rabies Immune Globulin (Human)

    HyperRAB®
    300 IU/mL

    Solution for Infiltration and Intramuscular Injection

    300 IU/mL
    Suitable for use with Rabies Vaccine

    1 mL

    NDC 13533-318-01

    GRIFOLS

    One Single-Dose Vial

    Rabies Immune Globulin (Human) is a sterile solution of immunoglobulin containing 15%–18% protein stabilized with 0.16 to 0.26 M glycine.

    The potency of each vial is 300 IU/mL based on the U.S. Standard Rabies Immune Globulin.

    Not made with natural rubber latex.

    No preservative

    Grifols Therapeutics LLC 
    Research Triangle Park, 
    NC 27709 USA 
    U.S. License No. 1871

    The patient and physician should discuss the risks and benefits of this product.

    FOR INFILTRATION AND INTRAMUSCULAR INJECTION ONLY. DO NOT GIVE INTRAVENOUSLY.

    For complete dosage and administration information, read enclosed package insert. 

    Not returnable for credit or exchange

    Rx only

    Store at 2–8ºC (36–46ºF) AND, optionally, store at room temperatures not to exceed 25ºC (77ºF) for up to 6 months at any time prior to the expiration date, after which the product must be used or discarded. Do not return to refrigeration.
    Do not use after the expiration date.

    Do not freeze.

    Discard unused portion.

    Date removed from refrigeration:

    If the shrink band is absent or shows any sign of tampering, do not use the product and notify Grifols Therapeutics LLC immediately.

    Carton: 3058806

    GTIN 00313533318017

    LOT
    XXXXXXXXXX

    EXP
    DDMMMYYYY

    SN XXXXXXXXXXXXXXXX

    HyperRAB® 300 IU/mL

    1 ml carton

    NDC 13533-318-10 

    Rabies Immune Globulin (Human)

    HyperRAB®
    300 IU/mL

    1 mL

    One Single-Dose Vial

    Do not give intravenously.

    Dosage: 20 IU/kg in conjunction with Rabies Vaccine.

    Discard unused portion.

    See directions before using.

    The patient and physician should discuss the risks and benefits of this product.

    Grifols Therapeutics LLC
    RTP, NC 27709 USA
    U.S. License No. 1871 

    Rx only
    3055092

    Lot/Exp. 

    1 ml vial

    Rabies Immune Globulin (Human)

    HyperRAB®
    900 IU/ 3 mL

    Solution for Infiltration and Intramuscular Injection

    300 IU/mL
    Suitable for use with Rabies Vaccine

    3 mL

    NDC 13533-318-03

    GRIFOLS

    One Single-Dose Vial

    Rabies Immune Globulin (Human) is a sterile solution of immunoglobulin containing 15%–18% protein stabilized with 0.16 to 0.26 M glycine.

    The potency of each vial is 300 IU/mL based on the U.S. Standard Rabies Immune Globulin.

    Not made with natural rubber latex.

    No preservative

    Grifols Therapeutics LLC 
    Research Triangle Park, 
    NC 27709 USA 
    U.S. License No. 1871

    The patient and physician should discuss the risks and benefits of this product.

    FOR INFILTRATION AND INTRAMUSCULAR INJECTION ONLY. DO NOT GIVE INTRAVENOUSLY.

    For complete dosage and administration information, read enclosed package insert. 

    Not returnable for credit or exchange

    Rx only

    Store at 2–8ºC (36–46ºF) AND, optionally, store at room temperatures not to exceed 25ºC (77ºF) for up to 6 months at any time prior to the expiration date, after which the product must be used or discarded. Do not return to refrigeration.
    Do not use after the expiration date.

    Do not freeze.

    Discard unused portion.

    Date removed from refrigeration:

    If the shrink band is absent or shows any sign of tampering, do not use the product and notify Grifols Therapeutics LLC immediately.

    Carton: 3058995

    GTIN 00313533318031

    LOT
    XXXXXXXXXX

    EXP
    DDMMMYYYY

    SN XXXXXXXXXXXXXXXX

    HyperRAB® 900 IU/3 mL

    3 ml carton

    NDC 13533-318-30 

    Rabies Immune Globulin (Human)

    HyperRAB®
    900 IU/3 mL (300 IU/mL)

    3 mL

    One Single-Dose Vial

    Do not give intravenously.

    Dosage: 20 IU/kg in conjunction with Rabies Vaccine.

    Discard unused portion.

    See directions before using.

    The patient and physician should discuss the risks and benefits of this product.

    Grifols Therapeutics LLC
    RTP, NC 27709 USA
    U.S. License No. 1871 

    Rx only
    3055093 

    Lot/Exp. 

    3 m vial

    Rabies Immune Globulin (Human)

    HyperRAB®
    1500 IU/5 mL

    Solution for Infiltration and Intramuscular Injection

    300 IU/mL
    Suitable for use with Rabies Vaccine

    5 mL

    NDC 13533-318-05

    GRIFOLS

    One Single-Dose Vial

    Rabies Immune Globulin (Human) is a sterile solution of immunoglobulin containing 15%–18% protein stabilized with 0.16 to 0.26 M glycine.

    The potency of each vial is 300 IU/mL based on the U.S. Standard Rabies Immune Globulin.

    Not made with natural rubber latex.

    No preservative

    Grifols Therapeutics LLC 
    Research Triangle Park, 
    NC 27709 USA 
    U.S. License No. 1871

    The patient and physician should discuss the risks and benefits of this product.

    FOR INFILTRATION AND INTRAMUSCULAR INJECTION ONLY. DO NOT GIVE INTRAVENOUSLY.

    For complete dosage and administration information, read enclosed package insert. 

    Not returnable for credit or exchange

    Rx only

    Store at 2–8ºC (36–46ºF) AND, optionally, store at room temperatures not to exceed 25ºC (77ºF) for up to 6 months at any time prior to the expiration date, after which the product must be used or discarded. Do not return to refrigeration.
    Do not use after the expiration date.

    Do not freeze.

    Discard unused portion.

    Date removed from refrigeration:

    If the shrink band is absent or shows any sign of tampering, do not use the product and notify Grifols Therapeutics LLC immediately.

    Carton: 3058996

    GTIN 00313533318055

    LOT
    XXXXXXXXXX

    EXP
    DDMMMYYYY

    SN XXXXXXXXXXXXXXXX

    HyperRAB® 1500 IU/5 mL

    5 ml carton

    NDC 13533-318-50  

    Rabies Immune Globulin (Human)

    HyperRAB®
    1500 IU/5 mL (300 IU/mL)

    5 mL

    One Single-Dose Vial

    Do not give intravenously.

    Dosage: 20 IU/kg in conjunction with Rabies Vaccine.

    Discard unused portion.

    See directions before using.

    The patient and physician should discuss the risks and benefits of this product.

    Grifols Therapeutics LLC
    RTP, NC 27709 USA
    U.S. License No. 1871 

    Rx only

    3055094 

    Lot/Exp. 

    5 ml vial
  • INGREDIENTS AND APPEARANCE
    HYPERRAB 
    rabies immune globulin (human) injection, solution
    Product Information
    Product TypePLASMA DERIVATIVEItem Code (Source)NDC:13533-318
    Route of AdministrationINTRAMUSCULAR, INFILTRATION
    Active Ingredient/Active Moiety
    Ingredient NameBasis of StrengthStrength
    Human Rabies Virus Immune Globulin (UNII: 95F619ATQ2) (Human Rabies Virus Immune Globulin - UNII:95F619ATQ2) Human Rabies Virus Immune Globulin300 [iU]  in 1 mL
    Inactive Ingredients
    Ingredient NameStrength
    Glycine (UNII: TE7660XO1C)  
    Water (UNII: 059QF0KO0R)  
    Product Characteristics
    ColorYELLOW (colorless or pale yellow or light brown) Score    
    ShapeSize
    FlavorImprint Code
    Contains    
    Packaging
    #Item CodePackage DescriptionMarketing Start DateMarketing End Date
    1NDC:13533-318-011 in 1 CARTON
    1NDC:13533-318-101 mL in 1 VIAL; Type 0: Not a Combination Product
    2NDC:13533-318-051 in 1 CARTON
    2NDC:13533-318-505 mL in 1 VIAL; Type 0: Not a Combination Product
    3NDC:13533-318-031 in 1 CARTON
    3NDC:13533-318-303 mL in 1 VIAL; Type 0: Not a Combination Product
    Marketing Information
    Marketing CategoryApplication Number or Monograph CitationMarketing Start DateMarketing End Date
    BLABLA10114406/12/1974
    Labeler - GRIFOLS USA, LLC (048987452)
    Establishment
    NameAddressID/FEIBusiness Operations
    Grifols Therapeutics LLC611019113manufacture(13533-318)
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