Formulary
Rabies vaccine: Indications, Dosing, Side Effects and Interactions
Rabies vaccine is an inactivated vaccine containing rabies virus.
MedNext Academy | 10 min read
Rabies vaccine: Indications, Dosing, Side Effects and Interactions
Rabies vaccine is an inactivated vaccine containing rabies virus.
Drug action
Rabies vaccine is an inactivated vaccine containing rabies virus.
Indications and dose
**Primary pre-exposure immunisation against rabies infection**
- **Child** (By Intramuscular Injection): 0.5 mL for 3 doses (on days 0, 7, and 28), final dose may be given from day 21 if insufficient time before travel.
- **Adult** (By Intramuscular Injection): 0.5 mL for 3 doses (on days 0, 7, and 28), final dose may be given from day 21 if insufficient time before travel.
**Primary pre-exposure immunisation against rabies infection [accelerated course]**
- **Child** (By Intramuscular Injection): 0.5 mL for 3 doses (on days 0, 3, and 7), followed by 0.5 mL for 1 dose, to be given at 1 year if continued travel to high-risk areas.
- **Adult** (By Intramuscular Injection): 0.5 mL for 3 doses (on days 0, 3, and 7), followed by 0.5 mL for 1 dose, to be given at 1 year if continued travel to high-risk areas.
**Pre-exposure immunisation booster dose [patients at frequent risk of exposure e.g. laboratory workers who handle lyssavirus-containing material]**
- **Child** (By Intramuscular Injection): 0.5 mL for 1 dose, to be given 1 year after primary course is completed, then 0.5 mL, repeated if necessary, based on six-monthly antibody levels.
- **Adult** (By Intramuscular Injection): 0.5 mL for 1 dose, to be given 1 year after primary course is completed, then 0.5 mL, repeated if necessary, based on six-monthly antibody levels.
**Pre-exposure immunisation booster dose [patients who may have frequent, unrecognised exposures e.g. bat handlers]**
- **Child** (By Intramuscular Injection): 0.5 mL for 1 dose, to be given 1 year after primary course is completed, then 0.5 mL, repeated if necessary, based on antibody levels.
- **Adult** (By Intramuscular Injection): 0.5 mL for 1 dose, to be given 1 year after primary course is completed, then 0.5 mL, repeated if necessary, based on antibody levels.
**Pre-exposure immunisation booster dose [patients at infrequent risk of exposure]**
- **Child** (By Intramuscular Injection): 0.5 mL for 1 dose, to be given at least 1 year after primary course is completed based on antibody levels.
- **Adult** (By Intramuscular Injection): 0.5 mL for 1 dose, to be given at least 1 year after primary course is completed based on antibody levels.
**Post-exposure treatment [fully immunised patients with amber or red composite rabies risk] (administered on expert advice)**
- **Child** (By Intramuscular Injection): 0.5 mL for 1 dose, followed by 0.5 mL for 1 dose, to be given 3-7 days after the first dose, rabies immunoglobulin is not necessary.
- **Adult** (By Intramuscular Injection): 0.5 mL for 1 dose, followed by 0.5 mL for 1 dose, to be given 3-7 days after the first dose, rabies immunoglobulin is not necessary.
**Post-exposure treatment [partially immunised patients with amber or red composite rabies risk] (administered on expert advice)**
- **Child** (By Intramuscular Injection): 0.5 mL for 4 doses (on days 0, 3, 7, and 21), rabies immunoglobulin is not necessary.
- **Adult** (By Intramuscular Injection): 0.5 mL for 4 doses (on days 0, 3, 7, and 21), rabies immunoglobulin is not necessary.
**Post-exposure treatment [non-immunised patients with amber or red composite rabies risk] (administered on expert advice)**
- **Child** (By Intramuscular Injection): 0.5 mL for 4 doses (on days 0, 3, 7, and 21), rabies immunoglobulin also to be given to patients with red composite rabies risk (but is not required if more than 7 days have elapsed after the first dose of vaccine, or more than 1 day after the second dose of vaccine).
- **Adult** (By Intramuscular Injection): 0.5 mL for 4 doses (on days 0, 3, 7, and 21), rabies immunoglobulin also to be given to patients with red composite rabies risk (but is not required if more than 7 days have elapsed after the first dose of vaccine, or more than 1 day after the second dose of vaccine).
**Post-exposure treatment [immunosuppressed patients with amber or red composite rabies risk, regardless of immunisation status] (administered on expert advice)**
- **Child** (By Intramuscular Injection): 0.5 mL for 5 doses (on days 0, 3, 7, 14, and 30), rabies immunoglobulin also to be given.
- **Adult** (By Intramuscular Injection): 0.5 mL for 5 doses (on days 0, 3, 7, 14, and 30), rabies immunoglobulin also to be given.
**Primary pre-exposure immunisation against rabies infection for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 3 doses (on days 0, 7, and 28), final dose may be given from day 21 if insufficient time before travel.
**Primary pre-exposure immunisation against rabies infection [accelerated course] for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 3 doses (on days 0, 3, and 7), followed by 1 mL for 1 dose, to be given at 1 year if continued travel to high-risk areas.
**Pre-exposure immunisation booster dose [patients at frequent risk of exposure e.g. laboratory workers who handle lyssavirus-containing material] for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 1 dose, to be given 1 year after primary course is completed, then 1 mL, repeated if necessary, based on six-monthly antibody levels.
**Pre-exposure immunisation booster dose [patients who may have frequent, unrecognised exposures e.g. bat handlers] for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 1 dose, to be given 1 year after primary course is completed, then 1 mL, repeated if necessary, based on antibody levels.
**Pre-exposure immunisation booster dose [patients at infrequent risk of exposure] for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 1 dose, to be given at least 1 year after primary course is completed based on antibody levels.
**Post-exposure treatment [fully immunised patients with amber or red composite rabies risk] (administered on expert advice) for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 1 dose, followed by 1 mL for 1 dose, to be given 3-7 days after the first dose, rabies immunoglobulin is not necessary.
**Post-exposure treatment [partially immunised patients with amber or red composite rabies risk] (administered on expert advice) for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 4 doses (on days 0, 3, 7, and 21), rabies immunoglobulin is not necessary.
**Post-exposure treatment [non-immunised patients with amber or red composite rabies risk] (administered on expert advice) for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 4 doses (on days 0, 3, 7, and 21), rabies immunoglobulin also to be given to patients with red composite rabies risk (but is not required if more than 7 days have elapsed after the first dose of vaccine, or more than 1 day after the second dose of vaccine).
**Post-exposure treatment [immunosuppressed patients with amber or red composite rabies risk, regardless of immunisation status] (administered on expert advice) for Rabipur**
- **Child** (By intramuscular injection): 1 mL for 5 doses (on days 0, 3, 7, 14, and 30), rabies immunoglobulin also to be given.
**Primary pre-exposure immunisation against rabies infection for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 3 doses (on days 0, 7, and 28), final dose may be given from day 21 if insufficient time before travel.
**Primary pre-exposure immunisation against rabies infection [accelerated course] for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 3 doses (on days 0, 3, and 7), followed by 0.5 mL for 1 dose, to be given at 1 year if continued travel to high-risk areas.
**Pre-exposure immunisation booster dose [patients at frequent risk of exposure e.g. laboratory workers who handle lyssavirus-containing material] for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 1 dose, to be given 1 year after primary course is completed, then 0.5 mL, repeated if necessary, based on six-monthly antibody levels.
**Pre-exposure immunisation booster dose [patients who may have frequent, unrecognised exposures e.g. bat handlers] for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 1 dose, to be given 1 year after primary course is completed, then 0.5 mL, repeated if necessary, based on antibody levels.
**Pre-exposure immunisation booster dose [patients at infrequent risk of exposure] for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 1 dose, to be given at least 1 year after primary course is completed based on antibody levels.
**Post-exposure treatment [fully immunised patients with amber or red composite rabies risk] (administered on expert advice) for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 1 dose, followed by 0.5 mL for 1 dose, to be given 3-7 days after the first dose, rabies immunoglobulin is not necessary.
**Post-exposure treatment [partially immunised patients with amber or red composite rabies risk] (administered on expert advice) for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 4 doses (on days 0, 3, 7, and 21), rabies immunoglobulin is not necessary.
**Post-exposure treatment [non-immunised patients with amber or red composite rabies risk] (administered on expert advice) for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 4 doses (on days 0, 3, 7, and 21), rabies immunoglobulin also to be given to patients with red composite rabies risk (but is not required if more than 7 days have elapsed after the first dose of vaccine, or more than 1 day after the second dose of vaccine).
**Post-exposure treatment [immunosuppressed patients with amber or red composite rabies risk, regardless of immunisation status] (administered on expert advice) for Verorab**
- **Child** (By intramuscular injection): 0.5 mL for 5 doses (on days 0, 3, 7, 14, and 30), rabies immunoglobulin also to be given.
Cautions
For all vaccines, general Acute illness; minor illnesses Cautions, further information Illness UKHSA advises vaccination may be postponed if the individual is suffering from an acute illness; however, it is not necessary to postpone immunisation in patients with minor illnesses without fever or systemic upset. Predisposition to neurological problems UKHSA advises: when there is a personal or family history of febrile convulsions, there is an increased risk of these occurring during fever from any cause including immunisation, but this is not a contra-indication to immunisation. In children who have had a seizure associated with fever without neurological deterioration, immunisation is recommended ; advice on the management of fever should be given before immunisation. When a child has had a convulsion not associated with fever, and the neurological condition is not deteriorating, immunisation is recommended ; children with stable neurological disorders (e.g. spina bifida, congenital brain abnormality, and peri-natal hypoxic-ischaemic encephalopathy) should be immunised according to the recommended schedule; when there is a still evolving neurological problem , including poorly controlled epilepsy, immunisation should be deferred and the child referred to a specialist. Immunisation is recommended if a cause for the neurological disorder is identified. If a cause is not identified, immunisation should be deferred until the condition is stable. Impaired immune response and drugs affecting immune response Immune response to vaccines may be reduced in immunosuppressed patients, UKHSA advises consider seeking specialist advice.
Side effects
For all vaccines, general Common or very common Abdominal pain; appetite decreased; arthralgia; diarrhoea; dizziness; fatigue; fever; headache; lymphadenopathy; malaise; myalgia; nausea; skin reactions; vomiting Uncommon Hypersensitivity Side-effects For rabies vaccine Common or very common Abdominal discomfort; asthenia Rare or very rare Angioedema; chills; encephalitis; Guillain-Barre syndrome; hyperhidrosis; paraesthesia; syncope; vertigo
Interactions
**Other interactions (1):**
- Verorab may be administered concomitantly with a Vi polysaccharide typhoid vaccine during the same vaccination visit, using two different injection sites.
Pregnancy
Because of the potential consequences of untreated rabies exposure and because rabies vaccination has not been associated with fetal abnormalities, pregnancy is not considered a contra-indication to post-exposure prophylaxis. Immunisation against rabies is indicated during pregnancy if there is substantial risk of exposure to rabies and rapid access to post-exposure prophylaxis is likely to be limited.
Medicinal forms
Solution,Injection
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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