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Aralen Phosphate and Rabies vaccine human diploid cell

Determining the interaction of Aralen Phosphate and Rabies vaccine human diploid cell and the possibility of their joint administration.

Check result:
Aralen Phosphate <> Rabies vaccine human diploid cell
Relevance: 11.08.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Treatment with chloroquine may reduce the effectiveness of rabies vaccine, human diploid cell if it is given by injection into the skin (intradermally), but not if it is given by injection into the muscle (intramuscularly). Although rabies vaccine is normally intended for intramuscular use, the intradermal route may sometimes be used as a cost-saving measure, since smaller doses of the vaccine are needed when it is given by this route. Talk to your healthcare provider if you have any questions or concerns. When both chloroquine and rabies vaccine, human diploid cell are needed for prevention of disease in preparation for travel to malaria and rabies endemic areas, the intradermal route should only be used if the vaccine can be initiated early enough to allow for the entire series to be completed 30 days or more before departure. Otherwise, the intramuscular route should be used. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

ADJUST DOSING INTERVAL: Chloroquine may reduce the antibody response to primary immunization with intradermally administered rabies vaccine. The mechanism of interaction has not been established, but may involve chloroquine-mediated impairment of macrophage antigen-processing mechanisms, which would affect recognition of antigen by T cells and, ultimately, activation of B cells and antibody production. The interaction has not been reported with rabies vaccine given intramuscularly, presumably because it provides higher and more sustained antibody titers than intradermal administration. Although rabies vaccine is not approved or marketed for intradermal use, it has been given by this route in doses of 0.1 mL as a more economical alternative, particularly in resource-poor environments and developing countries. In a study of healthy volunteers who were not previously vaccinated against rabies, 26 subjects who received chloroquine (300 mg/week beginning nine days before the first dose of vaccine and continuing until day 48) concomitantly with human diploid-cell rabies vaccine (0.1 mL intradermally on days 0, 7, and 28) had a significantly lower mean rabies-neutralizing antibody titer on each day of testing (day 28, day 49, and day 105) compared to 25 controls who received the vaccine without chloroquine. However, both groups had neutralizing antibody titers on days 49 and 105 based on CDC criteria. The blood concentrations of chloroquine and its pharmacologically active metabolite, desethylchloroquine, were negatively associated with low antibody titers. Chloroquine prophylaxis given for more than 4 weeks during the vaccination period has also been associated with poor antibody response to intradermal human diploid-cell rabies vaccine in Peace Corps volunteers and may have been responsible for one death.

MANAGEMENT: Rabies vaccine should not be administered by the intradermal route during chloroquine therapy. In patients who require chloroquine for malaria prevention and rabies vaccine for preexposure prophylaxis in preparation for travel to a rabies endemic area, intradermal administration of the vaccine may be considered only if the vaccine can be initiated early enough to allow for the entire series to be completed 30 days or more before departure. Otherwise, the intramuscular route should be used. Following intradermal administration, the rabies virus neutralizing antibody (VNAb) level should be checked 14 to 21 days after completion of the series. There are no data on the effect of chloroquine on postexposure administration of rabies vaccine. Since the intradermal route may produce a slower initial immune response, the intramuscular route is recommended. There are also no reports of interaction with hydroxychloroquine, although some manufacturers recommend the same precautions as for chloroquine.

References
  • Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  • Australian Government. Department of Health "Rabies virus and other lyssavirus (including Australian bat lyssavirus) exposures and infections. CDNA National Guidelines for Public Halth Units. Available from: URL: http://www.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-abvl-rabies.htm" ([2012 Dec 22]):
  • Taylor DN, Wasi C, Bernard K "Chloroquine prophylaxis associated with a poor antibody response to human diploid cell rabies vaccine." Lancet 1 (1984): 1405
  • "Product Information. Aralen (chloroquine)." Sanofi Winthrop Pharmaceuticals, New York, NY.
  • "Product Information. RabAvert (rabies vaccine)." Chiron Therapeutics, Emeryville, CA.
  • WHO. World Health Organization "International travel and health: rabies. Available from: URL: http://www.who.int/ith/vaccines/rabies/en/" ([2014]):
  • Pappaioanou M, Fishbein DB, Dreesen DW, et al "Antibody response to preexposure human diploid-cell rabies vaccine given concurrently with chloroquine." N Engl J Med 314 (1986): 280-4
  • Shlim DR; CDC. Centers for Disease Control and Prevention "Perspectives: intradermal rabies preexposure immunization. Available from: URL: http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/perspectives-intradermal-rabies-preexposure-immunization." ([2014]):
Aralen Phosphate

Generic Name: chloroquine

Brand name: Aralen Phosphate, Aralen Hydrochloride

Synonyms: n.a.

Rabies vaccine human diploid cell

Generic Name: rabies vaccine, human diploid cell

Brand name: Imovax Rabies

Synonyms: Rabies vaccine (human diploid cell)

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.