Usage
Miromavimab is a monoclonal antibody (mAb) used in combination with docaravimab for post-exposure prophylaxis of rabies. It is indicated for individuals exposed to the rabies virus through bites or scratches from infected animals. It is administered in conjunction with the rabies vaccine. Its pharmacological classification is antiviral, specifically a rabies immunoglobulin. Miromavimab’s mechanism of action involves binding to the rabies virus, neutralizing it, and preventing its entry into nerve cells and other cells, thus halting the progression of infection.
Alternate Names
There are no widely used alternate names for miromavimab itself. However, the combination of miromavimab and docaravimab is marketed under the brand name Twinrab™.
How It Works
Pharmacodynamics: Miromavimab, in combination with docaravimab, provides passive immunity against the rabies virus by neutralizing the virus and preventing its entry into cells. It binds to a specific site on the rabies virus glycoprotein, inhibiting the virus from binding to and infecting host cells.
Pharmacokinetics: The pharmacokinetic properties of miromavimab alone have not been extensively studied. It is administered intramuscularly and is distributed throughout the body. Specific details on absorption, metabolism, and elimination of miromavimab as a single agent are not widely available.
Mode of Action: Miromavimab and docaravimab bind to distinct but overlapping sites (site III and sites I/III, respectively) on the rabies virus glycoprotein, working synergistically to neutralize the virus. This binding blocks the interaction between the virus and host cell receptors, effectively preventing viral entry and subsequent replication.
Elimination Pathways: The specific elimination pathways for miromavimab have not been detailed in available resources.
Dosage
Miromavimab is always administered in conjunction with docaravimab and is used in combination with a rabies vaccine.
Standard Dosage
Adults and Children: 40 IU/kg body weight administered as a single intramuscular injection. It is generally administered into the deltoid muscle for adults and the anterolateral thigh muscle for children. The calculated dose should be infiltrated as much as anatomically feasible around the wound site.
Special Cases:
- Elderly Patients: Dosage adjustments are not typically required.
- Patients with Renal Impairment: No specific dosage adjustments are mentioned in available sources.
- Patients with Hepatic Dysfunction: No specific dosage adjustments are mentioned in available sources.
- Patients with Comorbid Conditions: No specific dosage adjustments are mentioned in available sources, but clinical judgment should be exercised.
Clinical Use Cases
The primary use case is post-exposure prophylaxis for all WHO category III exposures in conjunction with the rabies vaccine. There are no established dosage variations for specific clinical situations like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments:
No specific adjustments are typically necessary, but caution should be exercised in patients with allergies to monoclonal antibodies.
Side Effects
Common Side Effects:
- Injection site pain, swelling, redness
- Headache
- Dizziness
- Nausea
- Irritability
- Low-grade fever
Rare but Serious Side Effects:
- Allergic reactions, including anaphylaxis (difficulty breathing, facial swelling, hives, drop in blood pressure)
Long-Term Effects:
No long-term adverse effects have been reported.
Adverse Drug Reactions (ADR):
Anaphylaxis is a rare but serious ADR requiring immediate medical intervention.
Contraindications
Hypersensitivity to miromavimab, docaravimab, or any component of the formulation.
Drug Interactions
No specific drug interactions have been identified.
Pregnancy and Breastfeeding
Information regarding the use of miromavimab during pregnancy and breastfeeding is limited. Consult a healthcare provider before administration in these situations.
Drug Profile Summary
- Mechanism of Action: Neutralizes rabies virus by preventing its entry into cells.
- Side Effects: Common: injection site reactions, headache, dizziness, nausea, irritability, low-grade fever. Rare: allergic reactions including anaphylaxis.
- Contraindications: Hypersensitivity to components.
- Drug Interactions: None specifically identified.
- Pregnancy & Breastfeeding: Consult healthcare provider.
- Dosage: 40 IU/kg IM, single dose.
- Monitoring Parameters: Observe for signs of allergic reactions.
Popular Combinations
Miromavimab is exclusively used in combination with docaravimab and a rabies vaccine.
Precautions
Screen for any history of allergies to monoclonal antibodies. Pregnant or breastfeeding women should consult with a healthcare provider. Children should receive the injection in the anterolateral thigh.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Miromavimab?
A: Miromavimab is administered with docaravimab at a dose of 40 IU/kg, as a single intramuscular injection.
Q2: How is Miromavimab administered?
A: Intramuscular injection, ideally infiltrating the area around the wound.
Q3: Can Miromavimab be used in pregnant or breastfeeding women?
A: Consult a healthcare provider; limited information is available regarding safety in these populations.
Q4: What is the mechanism of action of Miromavimab?
A: Neutralizes rabies virus by binding to the glycoprotein and preventing viral entry into cells.
Q5: What are the common side effects of Miromavimab?
A: Injection site reactions, headache, dizziness, nausea, irritability, low-grade fever.
Q6: Are there any serious side effects of Miromavimab?
A: Rarely, allergic reactions, including anaphylaxis can occur.
Q7: Can Miromavimab be used alone for rabies prophylaxis?
A: No, it is used in combination with docaravimab and a rabies vaccine.
Q8: What should I do if a patient experiences an allergic reaction to Miromavimab?
A: Discontinue administration immediately and provide appropriate medical care for anaphylaxis, including epinephrine if necessary.
Q9: What is the role of Miromavimab in rabies post-exposure prophylaxis?
A: It provides immediate passive immunity, neutralizing the virus while the body develops an active immune response to the rabies vaccine.
