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Tetanus Toxoid and Immune Globulin


Drug Pharmacology ::

I. Pharmacology. Tetanus is caused by tetanospasmin, a protein toxin produced by Clostridium tetani (see Tetanus).


Tetanus toxoiduses modified tetanospasmin, which has been made nontoxic but stillretains the ability to stimulate the formation of antitoxin. Tetanustoxoid provides active immunization to those with known, completetetanus immunization histories as well as those with unknown orincomplete histories.

Human tetanus immune globulin(antitoxin) provides passive immunity by neutralizing circulatingtetanospasmin and unbound toxin in a wound. It does not have an effecton toxin that already is bound to neural tissue, and tetanus antibodydoes not penetrate the blood-brain barrier.

Drug Indications ::

Indications. Allwound injuries require consideration of tetanus prevention andtreatment. This includes animal and insect bites and stings, injectionsfrom contaminated hypodermic needles, deep puncture wounds (includinghigh-pressure, injection-type chemical exposures such as those frompaint guns), burns, and crush wounds.


Tetanus toxoid prophylaxis (activeimmunization) is given as a primary series of three doses in childhood.The first and second doses are given 4 to 8 weeks apart, and the thirddose is given 6 to 12 months after the second. A booster dose isrequired every 10 years.


1. Unknown or incomplete history of a previous primary series of three doses: tetanus toxoid is indicated for all wounds, including clean minor wounds.

2. Known complete histories ofa primary series of three doses: tetanus toxoid is indicated for clean,minor wounds if it has been longer than 10 years since the last doseand for all other wounds if it has been longer than 5 years since thelast dose.

Tetanus immune globulin (passiveimmunization) is indicated for persons with tetanus. Antitoxin also isindicated as prophylaxis for wounds that are neither clean nor minor inpersons who have unknown or incomplete histories of the primarythree-dose series of tetanus toxoid.

Drug Contra-Indications ::

III. Contraindications./b>




1. History of a severe allergic reaction (acute respiratory distress and collapse) after a previous dose of tetanus toxoid.

2. History of encephalopathy within 72 hours of a previous dose of tetanus toxoid.

3. Precautionsshould be taken in individuals with histories of fever greater than40.5°C (104.9°F) within 48 hours of a previous dose, collapse orshock-like state within 48 hours of a previous dose, or seizures within3 days of a previous dose.

Antitoxin. The equinetetanus antitoxin is contraindicated in persons who have had previoushypersensitivity or serum sickness reactions to other equine-derivedproducts. Preferably, use the human tetanus immune globulin product in all cases if it is available.

Drug Adverse Effects ::

IV. Adverse effects of the toxoid


Localeffects, including pain, erythema, and induration at the injectionsite. These effects are usually self-limiting and do not requiretherapy.

Exaggeratedlocal (Arthus-like) reactions. These unusual reactions may present asextensive painful swelling from the shoulder to the elbow. Theygenerally occur in individuals with preexisting very high serum tetanusantitoxin levels.

Severesystemic reactions such as generalized urticaria, anaphylaxis, andneurologic complications have been reported. A few cases of peripheralneuropathy and Guillain-Barré syndrome have also been reported.

Use in pregnancy. FDAcategory C (indeterminate). Tetanus toxoid may be used duringpregnancy. Pregnant patients not previously vaccinated should receivethe three-dose primary series (see Table III–1).

Drug Lab Interactions ::

Drug or laboratory interactions. None.

Drug Dose Management ::

Dosage and method of administration


Tetanus toxoid


1. AdultTd consists of tetanus toxoid, 5 LF U/0.5 mL, and diphtheria toxoid,adsorbed 2 LF U/0.5 mL up to 12.5 LF U/0.5 mL. A 0.5-mL dose is givenintramuscularly. Adult Td is used for routine boosters and primaryvaccination in persons 7 years old and older. Three doses constitute aprimary series of Td. The first two doses are separated by a minimum of4 weeks, with the third dose given 6–12 months after the second.Boosters are given every 10 years thereafter.

2. Inchildren less than 7 years old, primary tetanus immunization is withtetanus toxoid in combination with diphtheria toxoid and acellularpertussis (DTaP). Pediatric DT (without pertussis) also may be usedwhen there is a contraindication to pertussis vaccine. At least 4 weeksshould separate the first and second and the second and third doses. Afourth dose should be given no less than 6 months after the third dose.All doses are 0.5 mL given intramuscularly and usually contain tetanustoxoid 5 LF U/0.5 mL.

Antitoxin. Humantetanus immune globulin is given at 3000–5000 units intramuscularly, individed doses, for the treatment of tetanus in children and adults,with part of the dose infiltrated around the wound. Doses of 250–500units intramuscularly are given for postexposure prophylaxis.

Drug Chemical Formulations ::



Adult. Tetanustoxoid 5 LF U/0.5 mL in combination with diphtheria toxoid, adsorbed 2LF U/0.5 mL, supplied in 0.5-mL single-dose vials; tetanus toxoid 5 LFU/0.5 mL in combination with diphtheria toxoid, adsorbed 6.6 LF U/0.5mL to 12.5 LF U/0.5 mL, supplied in 5-mL multidose vials.

Pediatric.Pediatric DT, 0.5-mL single-dose vials, and 5-mL multidose vials; DTaP,containing diphtheria toxoid 6.7 LF U/0.5 mL, tetanus toxoid 5 LF U/0.5mL, and pertussis vaccine 4 protective units/0.5 mL.

Human tetanus immune globulin. Supplied in single-dose vials containing 250 units.

The suggested minimum stocking level to treat a 70-kg adult for the first 24 hours is a single-dose vial of Td and immune globulin.

Disclaimer ::

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