Tetanus Immune Globulin (TIG) consists of human antibodies derived from healthy donors used for the treatment of tetanus disease and tetanus post-exposure prophylaxis. Provides passive immunity towards tetanus by neutralizing unbound toxins produced by Clostridium tetani (tetanus toxin or tetanospasmin). It improves survival and is considered to be standard treatment.
Tetanus prophylaxis based on patient’s history of tetanus immunization and wound characteristics:
*Tetanus-prone wounds: >6 hours, >1cm depth, high risk of contamination mechanism of injury (missile, crush, burn, frostbite, agriculture-related injuries), presence of devitalized tissue, presence of contaminants (dirt, saliva, etc)
Tetanus treatment: The actual recommended dose is 500 IU IM with part of the dose infiltrated around the source wound (1; CDC 2020). Classically the sugested dose of 3000-6000 Units IM, with part of the dose infiltrated around the wound, derived from limited data from 1960-1980s studies (3; Nation 1965). HyperTET™ 2020 label for active tetanus refers that the “dosage should be adjusted according to the severity of the infection”.
Tetanus prophylaxis: 250 Units IM*.
*FDA Approved in 1957
<7 years: 4 IU/kg.
>7 years: 250 IU IM.
Tetanus Treatment: 500 IU IM recommended (1; CDC 2020). Very limited data.
Renal, hepatic, geriatric or other adjustments
No adjustments needed.
Dosage Forms: US
HyperTET™ S/D: 250 units/mL (1ml), injectable, only intramuscular administration.
Frequency not defined:
Central nervous system: increased body temperature.
Local: Local soreness at injection site, pain at injection site, tenderness at injection site
<1%, postmarketing, and/or case reports: Anaphylactic shock, angioedema, nephrotic syndrome.
Product of human plasma, may potentially contain infectious agents which could transmit disease. Screening of donors, as well as testing and/or inactivation or removal of certain viruses, reduces the risk. Infections thought to be transmitted by this product should be reported to the manufacturer.
Use with caution in individuals who have experienced allergic or other adverse effects secondary to other immunoglobulin-containing products.
Pregnancy Risk Factor and Lactation
Pregnancy Risk Factor Category C.
Animal reproduction and human pregnancy studies have not been conducted. The CDC recommends Tetanus Immune Globulin and tetanus toxoid containing vaccine as part of the standard wound management to prevent tetanus in pregnant women.
Lactation: very low risk, safe. Minimal risk for breastfeeding and infant. The secretion of immunoglobulin into breast milk may help to transfer passive immunization to the child.
Half-life elimination: individuals with normal IgG concentration: ~23 days
Time to peak, plasma: IgG concentration: IM: ~2 days
Major drug interactions
Monitor closely the administration of live vaccines: adenovirus type 4 and 7, BCG, measles (rubeola), measles-mumps-rubella, measles-mumps-rubella-varicella, varicella virus, rubella, smallpox. As tetanus immune globulin decreases their effect. Separate any by 3 months (NIH 2020).
Centers for Disease Control and Prevention (CDC), Epidemiology and Prevention of Vaccine-Preventable Diseases. Tejpratap S.P. Tiwari, MD; Pedro L. Moro, MD, MPH; and Anna M. Acosta, MD. Chapter 21: Tetanus. Updated December 2020. Visited in June 2021.
Yen LMM, Thwaites CLU. Tetanus. Lancet. 2019 Apr 20;393(10181):1657-68. doi:10.1016/S0140-6736(18)33131-3.
Nation NS, Pierce NF, Adler SJ, Chinnock RF, Wehrle PF: Tetanus: the use of human hyperimmune globulin in treatment. Calif Med 1963; 98: pp. 305-307.
NIH (National Institutes of Health). DailyMed. Label: HyperTET™ (Tetanus Immune Globuline - human injection), updated December 2020.
WHO/UNICEF. Breastfeeding and Maternal Medication Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development, 2002.