Rabies Immune Globulin Shortage: What Providers and Prescribers Need to Know in 2026

For clinicians managing rabies post-exposure prophylaxis (PEP), the logistical challenges surrounding human rabies immune globulin (HRIG) can be significant — even when no formal shortage exists. This guide covers the current availability landscape, brand-specific considerations, dosing reminders, and how to support patients who face access or cost barriers.

Current Availability Status (2026)

The CDC confirms that as of 2026, there is no national shortage of human rabies immune globulin in the United States. Three FDA-licensed HRIG products are actively distributed:

HyperRAB (Grifols, 300 IU/mL): Available in 1 mL/300 IU and 5 mL/1,500 IU vials. Uses caprylate chromatography manufacturing process. Higher concentration requires careful attention to dosing — approximately half the volume needed compared to 150 IU/mL products.

KedRAB / KEDRAB (Kedrion/Kamada, 150 IU/mL): FDA-approved August 2017. Pediatric use label expansion in June 2021. Solvent/detergent treated.

Imogam Rabies-HT (Sanofi, 150 IU/mL): Heat-treated formulation available in the US since 1974. Established safety and efficacy record.

Critical Dosing Reminder: The HyperRAB Concentration Difference

A clinically significant point: HyperRAB is formulated at 300 IU/mL, while KedRAB and Imogam Rabies-HT are 150 IU/mL. The recommended dose for all products is 20 IU/kg body weight — but the volume required differs by twofold between these products.

Example: For a 70 kg patient, the required dose is 1,400 IU.

Using HyperRAB (300 IU/mL): 4.67 mL needed

Using KedRAB or Imogam (150 IU/mL): 9.33 mL needed

Note that when dilution is necessary to ensure sufficient volume to infiltrate all wound sites, HyperRAB should be diluted with D5W (dextrose 5% in water), not normal saline. Standard 150 IU/mL products can be diluted with normal saline. The CDC emphasizes care in ensuring the correct dose is administered to allow an adequate immune response.

ACIP PEP Protocol Review: Key Points for 2026

For previously unvaccinated patients, ACIP recommends:

Thorough wound cleansing with soap and water or povidone-iodine solution.

HRIG at 20 IU/kg on Day 0 — infiltrate as much as anatomically feasible into and around the wound; deliver any remaining volume IM at a site distant from the vaccine.

Rabies vaccine IM (deltoid) on Days 0, 3, 7, and 14.

For immunocompromised patients: add a 5th vaccine dose on Day 28 and check RVNA titer 7-14 days after the final dose.

Important reminders:

Never administer HRIG in the same syringe or same anatomical site as the first vaccine dose.

HRIG can be administered up to and including Day 7 if not available on Day 0 — but do not delay starting the vaccine.

Do not exceed the recommended dose of HRIG — higher doses can suppress the vaccine-induced active immune response.

Previously vaccinated patients (full series + confirmed titer) do NOT receive HRIG — only 2 vaccine doses (Day 0 and Day 3).

Access Challenges Your Patients May Face

Even without a formal shortage, patients encounter real-world access barriers:

Geographic access: Smaller rural facilities and urgent care centers often do not stock HRIG. Patients may need to travel to a larger hospital ER.

Cost barriers: The full PEP course can cost $2,500–$7,000 out of pocket. Some patients have delayed or avoided treatment due to cost — a potentially fatal decision. Manufacturer patient assistance programs exist through Sanofi, Grifols, and Kedrion.

Insurance prior authorization: Some payers require prior auth for PEP in outpatient settings. Most plans cover PEP when medically necessary after documented exposure — help patients navigate this proactively.

Helping Your Patients Find HRIG Quickly

For providers managing patients who need to locate a stocking facility — particularly those who received the first vaccine dose elsewhere or are following up — medfinder for providers is a service that contacts facilities near your patient to identify which ones carry HRIG, reducing the time spent on hold with facility pharmacy lines and helping ensure patients receive timely PEP.

Manufacturer Contact Information for HRIG

Grifols (HyperRAB): 1-800-520-2807

Kedrion/Kamada (KedRAB): 1-855-353-7466

Sanofi (Imogam Rabies-HT): 1-800-822-2463

Also see our companion provider guide: How to Help Your Patients Find Rabies Immune Globulin in Stock