Docaravimab,Miromavimab
Overview
Docaravimab and Miromavimab are a combination of two specific monoclonal antibodies formulated as a biological cocktail used for passive immunization following potential rabies virus exposure. Each component binds to a distinct epitope on the rabies virus glycoprotein, neutralizing the virus and preventing its entry into host cells. This combination provides immediate neutralizing antibodies at the site of exposure and systemically, reducing the risk of viral spread before active immunity develops through rabies vaccination. The monoclonal antibody cocktail is designed to replace traditional human or equine rabies immunoglobulins with a standardized recombinant product that offers consistent potency and targeted viral neutralization. It is administered as part of rabies post-exposure prophylaxis in individuals who have sustained category III exposures such as transdermal bites or scratches from suspected rabid animals. Prompt administration is critical to prevent the onset of clinical rabies, which is almost universally fatal once symptoms develop.
Background and Date of Approval
The combination of Docaravimab and Miromavimab was developed as a recombinant monoclonal antibody alternative to plasma-derived rabies immunoglobulin and is marketed under the brand name TwinRab. It received regulatory authorization in India in 2019 for use in rabies post-exposure prophylaxis. In 2021, the product was included in the World Health Organization Model List of Essential Medicines, recognizing its public health importance as a standardized and effective option for passive rabies immunization. Approval was supported by clinical studies demonstrating safety, tolerability, and effective virus neutralization when used in conjunction with rabies vaccination.
Uses
Docaravimab and Miromavimab are indicated for passive immunization as part of rabies post-exposure prophylaxis in individuals exposed to rabies virus through animal bites, scratches, or contamination of wounds or mucous membranes with saliva from suspected rabid animals. The antibody cocktail is administered together with a full course of rabies vaccine. It provides immediate neutralizing antibodies while the vaccine stimulates active immunity. The product is preventive only and is not effective once clinical rabies symptoms have appeared.
Administration
The combination is administered once at the initiation of rabies post-exposure prophylaxis. The dose is calculated based on body weight and expressed in international units per kilogram. As much of the calculated dose as feasible should be infiltrated into and around the wound sites to neutralize virus locally. Any remaining volume is administered intramuscularly at a site distant from the rabies vaccine injection site. It should be given preferably on day 0 along with the first dose of rabies vaccine. If not administered on day 0, it may be given up to seven days after the first vaccine dose and should not be administered beyond this window.
Side Effects
Common side effects include pain, redness, swelling, induration, or tenderness at the injection site. Local discomfort is usually mild to moderate in intensity and resolves without intervention. Some individuals may experience low-grade fever, headache, fatigue, malaise, myalgia, or dizziness. Mild gastrointestinal symptoms such as nausea may occasionally occur. These reactions are generally transient and self-limiting. Most adverse effects do not require medical treatment and resolve within a few days following administration.
Warnings
Serious adverse events are uncommon. Rare hypersensitivity or allergic reactions, including anaphylaxis, may occur. Administration should take place in a setting equipped to manage allergic reactions. Individuals with known hypersensitivity to monoclonal antibody products should be carefully evaluated before administration.
Precautions
Docaravimab and Miromavimab must be used as part of comprehensive rabies post-exposure prophylaxis, including immediate and thorough wound washing and completion of the full rabies vaccination schedule. The product should not be mixed in the same syringe or administered at the same anatomical site as rabies vaccine. Drug interactions are uncommon because this therapy functions through passive antibody neutralization rather than metabolic drug pathways. Use in pregnant or breastfeeding individuals should be based on risk-benefit assessment, as rabies exposure constitutes a medical emergency.
Expert Tips
Administer as soon as possible after exposure, ideally on the same day as the first rabies vaccine dose. Proper wound infiltration technique significantly improves local virus neutralization. Calculate dosage accurately according to body weight and ensure separation of injection sites between antibody cocktail and vaccine. Monitor patients briefly after administration for immediate reactions. Maintain proper documentation including batch number, dose, and administration site. Reinforce the importance of completing the full rabies vaccine schedule to ensure active long-term immunity.