Recombivax HB

Adult Dosing .

Dosage forms:  INJ

hepatitis B infection prevention, immunocompetent pts

[<20 yo]

Dose: 5 mcg IM x1 at mo 0, 1, and 6 for 3 total doses; Info: may give SC if hemorrhage risk w/ IM; repeat series if anti-HBs level <10 milliunits/mL at least 1-2mo after 3rd dose in healthcare workers or pts w/ HBsAg-positive sex partner; search 'immunization' for epocrates Adult Immunization and CDC Pre-Travel Vaccine decision tools incl. links to CDC/ACIP schedules and recommendations

[20 yo and older]

Dose: 10 mcg IM x1 at mo 0, 1, and 6 for 3 total doses; Info: give to pts 60 yo and older w/ risk factors; may give to pts 60 yo and older w/o risk factors; may give SC if hemorrhage risk w/ IM; repeat series if anti-HBs level <10 milliunits/mL at least 1-2mo after 3rd dose in healthcare workers or pts w/ HBsAg-positive sex partner; search 'immunization' for epocrates Adult Immunization and CDC Pre-Travel Vaccine decision tools incl. links to CDC/ACIP schedules and recommendations

hepatitis B infection prevention, immunocompromised pts (off-label)

[pts w/ HIV infection]

Dose: 20 mcg IM x1 at mo 0, 1, and 6 for 3 total doses; Info: may give SC if hemorrhage risk w/ IM; repeat series if anti-HBs level <10 milliunits/mL at least 1-2mo after 3rd dose; refer to DHHS guidelines for dosing in pts w/ isolated anti-HBc

[pts w/o HIV infection]

Dose: 40 mcg IM x1 at mo 0, 1, and 6 for 3 total doses; Info: for pts 20 yo and older; may give SC if hemorrhage risk w/ IM; repeat series if anti-HBs level <10 milliunits/mL at least 1-2mo after 3rd dose

renal dosing

[<20 yo]

renal impairment: consider incr. usual dose or frequency if eGFR <30

HD/PD: no adjustment; no supplement

[20 yo and older]

renal impairment: consider incr. usual dose or frequency if eGFR <30

HD/PD: 40 mcg x1 at mo 0, 1, and 6 for 3 total doses; repeat series if anti-HBs level <10 milliunits/mL 1-2mo after 3rd dose; give 40 mcg booster x1 if annual anti-HBs level <10 milliunits/mL; no supplement

hepatic dosing

[no adjustment]

Peds Dosing .

Dosage forms:  INJ

hepatitis B infection prevention, primary

[newborn w/ HBsAg-negative mother]

Dose: 5 mcg IM x1 at birth, 1-2 mo, and 6-18 mo for 3 total doses; Start: w/in 24h of birth if wt >2 kg, otherwise at 1 mo or hospital discharge; Info: may give SC if hemorrhage risk w/ IM; search 'immunization' for epocrates Child/Adolescent Immunization and CDC Pre-Travel Vaccine decision tools incl. links to CDC/ACIP schedules and recommendations

[newborn w/ HBsAg-positive mother]

Dose: 5 mcg IM x1 at birth, 1-2 mo, and 6-18 mo for 3 total doses; Start: w/in 12h of birth; Info: may give SC if hemorrhage risk w/ IM; give w/ hepatitis B immune globulin; if wt <2 kg, give 1 dose at birth, then start 3-dose series at 1 mo for 4 total doses; search 'immunization' for epocrates Child/Adolescent Immunization and CDC Pre-Travel Vaccine decision tools incl. links to CDC/ACIP schedules and recommendations

[newborn w/ HBsAg status unknown mother]

Dose: 5 mcg IM x1 at birth, 1-2 mo, and 6-18 mo for 3 total doses; Start: w/in 12h of birth; Info: may give SC if hemorrhage risk w/ IM; if wt <2 kg, give 1 dose at birth w/ hepatitis B immune globulin, then start 3-dose series at 1 mo for 4 total doses; search 'immunization' for epocrates Child/Adolescent Immunization and CDC Pre-Travel Vaccine decision tools incl. links to CDC/ACIP schedules and recommendations

[immunocompetent pts, <11 yo]

Dose: 5 mcg IM x1 at mo 0, 1-2, and 6-18 for 3 total doses; Info: may give SC if hemorrhage risk w/ IM; search 'immunization' for epocrates Child/Adolescent Immunization and CDC Pre-Travel Vaccine decision tools incl. links to CDC/ACIP schedules and recommendations

[immunocompetent pts, 11-15 yo]

Dose: 5 mcg IM x1 at mo 0, 1-2, and 6-18 for 3 total doses; Alt: 10 mcg IM x2 doses at least 4mo apart; Info: may give SC if hemorrhage risk w/ IM; search 'immunization' for epocrates Child/Adolescent Immunization and CDC Pre-Travel Vaccine decision tools incl. links to CDC/ACIP schedules and recommendations

[immunocompetent pts, 16 yo and older]

Dose: 5 mcg IM x1 at mo 0, 1-2, and 6-18 for 3 total doses; Info: may give SC if hemorrhage risk w/ IM; search 'immunization' for epocrates Child/Adolescent Immunization and CDC Pre-Travel Vaccine decision tools incl. links to CDC/ACIP schedules and recommendations

[immunocompromised adolescents (off-label)]

Dose: 20 mcg IM x1 at mo 0, 1, and 6 for 3 total doses; Info: for pts w/ HIV infection; may give SC if hemorrhage risk w/ IM; repeat series if anti-HBs level <10 milliunits/mL at least 1-2mo after 3rd dose; refer to DHHS guidelines for dosing in pts w/ isolated anti-HBc

hepatitis B infection prevention, booster (off-label)

[5 mcg IM x1]

Info: for pts >9 mo w/ HBsAg-positive or HBsAg status unknown mother and anti-HBs level <10 milliunits/mL at least 1-2mo after last dose of primary series; may give SC if hemorrhage risk w/ IM; give subsequent doses per schedule to complete second series if anti-HBs level <10 milliunits/mL at least 1-2mo after booster dose

renal dosing

[see below]

renal impairment: consider incr. usual dose or frequency if eGFR <30

HD/PD: no adjustment; no supplement

hepatic dosing

[no adjustment]