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# Tabovoihep (Hepatitis B Immune Globulin)
## Overview
Hepatitis B Immune Globulin (HBIG) is a sterile solution of antibodies against the hepatitis B surface antigen (anti-HBs). It provides passive immunity against hepatitis B virus (HBV).
## Primary Indications
* **Postexposure Prophylaxis:** To prevent hepatitis B infection following exposure to the hepatitis B virus. This includes accidental needle sticks, sexual exposure, and perinatal exposure.
* **Post-transfusion Hepatitis:** In individuals who have received transfusions of blood or blood products from donors with hepatitis B.
* **Infants Born to HBsAg-Positive Mothers:** To provide passive immunity to prevent perinatal transmission.
## Adult Dosing
* **Postexposure Prophylaxis (e.g., needle stick, sexual exposure):**
* **For unvaccinated individuals:** 0.06 mL/kg IM, administered as soon as possible, preferably within 7 days of exposure. A single dose is usually sufficient.
* **For partially vaccinated individuals:** Consider a single dose of 0.06 mL/kg IM if the anti-HBs antibody level is inadequate (e.g., <10 mIU/mL) 1-2 months after the last vaccine dose.
* **For HBsAg-positive source (e.g., needle stick):** Administer 0.06 mL/kg IM within 12 hours of exposure, in conjunction with hepatitis B vaccine.
* **Infants Born to HBsAg-Positive Mothers:** 0.5 mL IM as soon as possible after birth (preferably within 12 hours), in a separate site from the hepatitis B vaccine.
The maximum dose for adults is typically 5 mL.
## Pediatric Dosing
* **Infants Born to HBsAg-Positive Mothers:** 0.5 mL IM as soon as possible after birth (preferably within 12 hours), in a separate site from the hepatitis B vaccine.
* **Pediatric Postexposure Prophylaxis:** 0.06 mL/kg IM. Administer as soon as possible, preferably within 7 days of exposure. A single dose is usually sufficient.
The maximum pediatric dose is typically 5 mL.
## Dose Adjustments
No dose adjustments are typically required for hepatic or renal impairment.
## Contraindications
* Known hypersensitivity to immune globulin products or any component of the formulation.
* Individuals with a history of severe allergic reaction to human globulin.
## Adverse Effects
* **Common:** Pain, tenderness, redness, and swelling at the injection site. Headache, fatigue, fever.
* **Less Common:** Urticaria, angioedema, anaphylaxis (rare). Aseptic meningitis syndrome (rare, associated with IVIG but possible with IM preparations). Hemolysis (rare, particularly in individuals with blood group A, B, or AB).
## Key Drug Interactions
* **Hepatitis B Vaccine:** Can be administered concurrently with HBIG, but in separate injection sites. This is crucial for postexposure prophylaxis and for infants born to HBsAg-positive mothers.
* **Live Virus Vaccines:** Administration of HBIG may interfere with the immune response to live virus vaccines (e.g., measles, mumps, rubella, varicella). A waiting period of at least 3 months after HBIG administration is recommended before receiving live virus vaccines.
## Monitoring
* Monitor for signs of allergic reaction.
* For infants born to HBsAg-positive mothers, monitor for seroconversion (HBsAg and anti-HBs levels) at 9-12 months of age.
* For postexposure prophylaxis, assess hepatitis B surface antigen (HBsAg) and antibody (anti-HBs) status as clinically indicated.
## Clinical Pearls
* HBIG is most effective when administered soon after exposure.
* For postexposure prophylaxis in unvaccinated individuals, HBIG should be given concurrently with the first dose of hepatitis B vaccine.
* Ensure the correct dose is administered based on weight.
* Always administer HBIG intramuscularly. Do not administer intravenously.
* Store at 2-8°C (36-46°F). Do not freeze.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant institutional protocols for definitive guidance.*
