influenza virus vaccine quadrivalent, intranasal (Rx)

Brand and Other Names:FluMist Quadrivalent
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

intranasal suspension

  • 0.2mL (prefilled single use sprayer)
more...

Influenza Prophylaxis

Indicated for prevention of influenza A and B infection in adults aged ≤49 years

Adults ≤49 years: 0.2 mL/dose (0.1 mL/nostril); 1 dose/season

Intranasal administration for age ≥50 years: Safety and efficacy not established

2019-2020 Northern Hemisphere viral strain vaccine contents

  • A/Brisbane/02/2018 (H1N1)pdm09-like virus (New for 2019-2020)
  • A/Kansas/14/2017 (H3N2)-like virus (New for 2019-2020)
  • B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage) (no change from last season)
  • B/Phuket/3073/2013-like virus (B/Yamagata lineage) (no change from last season)

Live attenuated influenza vaccine (LAIV) not indicated for the following adults who

  • have immunocompromising conditions, including HIV infection
  • have anatomical or functional asplenia
  • are pregnant
  • have close contact with or are caregivers of severely immunocompromised persons in a protected environment
  • have received influenza antiviral medications in the previous 48 hr
  • have a cerebrospinal fluid leak or cochlear implant

Dosage Forms & Strengths

intranasal suspension

  • 0.2mL (prefilled single use sprayer)
more...

Influenza Prophylaxis

Indicated for prevention of influenza A and B infection children aged ≥2 years

<2 year: Safety and efficacy not established

2-8 years: 0.2 mL/dose (0.1 mL in each nostril) x1-2 doses/season (see Administration)

≥9 years: As in adults; 0.2 mL/dose (0.1 mL/nostril); 1 dose/season

2019-2020 Northern Hemisphere viral strain vaccine contents

  • A/Brisbane/02/2018 (H1N1)pdm09-like virus (New for 2019-2020)
  • A/Kansas/14/2017 (H3N2)-like virus (New for 2019-2020)
  • B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage) (no change from last season)
  • B/Phuket/3073/2013-like virus (B/Yamagata lineage) (no change from last season)

Live attenuated influenza vaccine (LAIV) not indicated for the following children who

  • have immunocompromising conditions, including HIV infection
  • have anatomical or functional asplenia
  • are pregnant
  • have close contact with or are caregivers of severely immunocompromised persons in a protected environment
  • have received influenza antiviral medications in the previous 48 hr
  • have a cerebrospinal fluid leak or a cochlear implant
  • are aged 2-4 yr and who have received a diagnosis of asthma or wheezing within the preceding 12 months
  • are receiving aspirin- or salicylate-containing medications
  • have a history of severe allergic reaction of any component of the vaccine (except egg) or after a previous dose of any influenza vaccine
  • Caution with the following conditions
    • asthma in person aged ≥5 yr
    • other underlying medical conditions (eg, chronic pulmonary, cardiovascular [except isolated hypertension], renal, hepatic, neurologic, hematologic, or metabolic disorders [including diabetes mellitus])
Next:

Interactions

Interaction Checker

and influenza virus vaccine quadrivalent, intranasal

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            >10%

            Adults

            • Runny nose (41-45%)
            • Headache (41-45%)
            • Sore throat (26-30%)
            • Weakness (26-30%)
            • Myalgia (16-20%)
            • Cough (11-15%)

            Children

            • Runny nose/nasal congestion (46-50%)
            • Cough (36-40%)
            • Irritability (16-20%)
            • Headache (16-20%)

            1-10%

            Adults

            • Chills (6-10%)
            • Nasal congestion (6-10%)
            • Sinusitis (2-5%)
            Previous
            Next:

            Warnings

            Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967

            Contraindications

            Hypersensitivity to eggs, sulfites

            IV/IM administration

            Children/adolescents receiving aspirin

            Asthma, reactive airway disease

            Diabetes, renal dysfunction

            Hemoglobinopathies

            Immunodeficiency diseases

            Patients on immunosuppressants

            Any chronic pulmonary/cardivascular disorder

            Cautions

            Do not administer within 2 wk of inactivated vaccine or 4 week of live virus vaccine

            Treatment for anaphylactoid and/or hypersensitivity reactions must be present during vaccine use

            Use caution in patients with history of Guillain-Barre

            Nasal congestion may impair delivery of vaccine (avoid use)

            Not recommended in patients with neurologic or neuromuscular disorders

            Avoid use in children aged 2 through 4 years who had wheezing in the past 12 months, or those who have any other underlying medical conditions that predispose them to influenza complications

            Caution in patients aged ≥5 yr who have asthma

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy

            Not absorbed systemically following intranasal administration and maternal use is not expected to result in fetal exposure to the drug

            Clinical considerations

            • Pregnant women infected with seasonal influenza are at increased risk of severe illness associated with influenza infection compared with nonpregnant women
            • Pregnant women with influenza may be at increased risk for adverse pregnancy outcomes, including preterm labor and delivery

            Lactation

            Not absorbed systemically by the mother following intranasal administration and breastfeeding is not expected to result in exposure of the breastfed child

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Vaccine; vaccines convey active immunity via stimulation of production of endogenously produced antibodies

            Pharmacokinetics

            Onset: Three weeks after vaccination

            Duration: 6 months or more

            Distribution: Nasal cavity, stomach, brain, and lungs

            Previous
            Next:

            Administration

            Intranasal Administration

            Administer at beginning of influenza season

            Each sprayer contains a single dose (0.2 mL); administer one-half of the contents of the single-dose intranasal sprayer into each nostril

            With the patient in upright position, place tip of syringe applicator just inside the nostril and depress plunger as rapidly as possible

            Children aged 2 years through 8 years

            • If child requires 2 doses, administer at least 4 weeks apart (see number of doses)
            • Number of doses
              • 2 doses administered a minimum of 4 weeks apart are required during child’s first season of vaccination for optimal protection
              • Children who have previously received ≥2 total doses of trivalent or quadrivalent influenza vaccine at least 4 weeks apart, require only 1 dose for the current flu season
              • The 2 doses of influenza vaccine do not have to have been administered in the same season or consecutive seasons
              • From ACIP recommendations: MMWR 2018 Aug 24 / 67(3);1-20
            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.