Dosing & Uses
Dosage Forms & Strengths
IM injection, regular strength
- 22.5mcg/0.25mL
- 45mcg/0.5mL
- Flucelvax: New brand using mammalian culture instead of chicken embyros
IM suspension injection, high-dose
- 180mcg/0.5mL (Fluzone High-dose)
ID injection
- 27mcg/0.1mL (Fluzone Intradermal)
Influenza Prophylaxis
CDC recommends that everyone 6 months of age and older receive an annual influenza vaccination
For more vaccine information see http://www.cdc.gov/vaccines/schedules/hcp/index.html
IM regular strength
- 0.5 mL IM x1 dose
Intradermal
- Fluzone Intradermal (18-64 yr): 0.1 mL ID x1 dose
IM high-dose
- Fluzone high dose (≥65 yr): 0.5 mL IM x1 dose
Dosing Considerations
Contains the following 3 viral strains for 2019-2020 northern hemisphere season
- 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)
Dosage Forms & Strengths
injection, regular strength
- 22.5mcg/0.25mL
- 45mcg/0.5mL
Influenza Prophylaxis
CDC's ACIP recommends that everyone 6 months of age and older receive an annual influenza vaccination
See Administration section for information regarding if 1or 2 doses are required for the influenza vaccine in children aged 6 months through 8 years
Fluzone
- Approved for children >6 months
- 6-18 months: 0.25 mL IM x1-2 doses/season
- 18-35 months: 0.25 mL IM x1-2 doses/season
- 3-8 years: 0.5 mL IM x1-2 doses/season
- ≥9 years: 0.5 mL IM x1 dose/season
Fluvirin
- <4 years: Safety and efficacy not established
- 4-8 years: 0.5 mL IM x1-2 doses/season
- ≥9 years: 0.5 mL IM x1 dose/season
Afluria
- <6 months: Safety and efficacy not established
- 6-35 months: 0.25 mL IM x1-2 doses/season
- 3-8 years: 0.5 mL IM x1-2 doses/season
- 9 years or older: 0.5 mL IM xq dose/season
Flucelvax
- <4 years: Safety and efficacy not established
- 4-8 years: 0.5 mL IM x1-2 doses/season
- ≥9 years: 0.5 mL IM x1 dose/season
Dosing Considerations
Contains the following 3 viral strains for 2019-2020 northern hemisphere season
- 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)
IM suspension injection, high-dose
180mcg/0.5mL (Fluzone High-Dose)
Influenza Prophylaxis
CDC recommends that everyone 6 months of age and older receive an annual influenza vaccination
For more vaccine information see http://www.cdc.gov/vaccines/schedules/hcp/index.html
The high-dose formulation is specifically indicated for individuals aged ≥65 yr to provide a more pronounced immune response to the vaccine
Fluzone High-Dose (≥65 yr): 0.5 mL IM x1 dose
Dosing Considerations
Contains the following 3 viral strains for 2019-2020 northern hemisphere season:
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)
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967
>10%
Soreness at injection site (10-70%)
Frequency Not Defined
Fever
Malaise
Myalgia
Headache
Allergic reactions
Presyncope
Warnings
Contraindications
Hypersensitivity to eggs, sulfites (persons with hives-only allergy to eggs, can receive the inactivated influenza vaccine)
Cautions
Use split or purified surface antigen in children
Defer vaccine with febrile illnesses until illness is resolved; may administer vaccine with minor illnesses without fever (eg, URIs)
Expected immune response may not be obtained in immunocompromised individuals, including those receiving immunosuppressive therapy
Syncope (fainting) can occur in association with administration of injectable vaccines; can be accompanied by transient neurological signs such as visual disturbance, paresthesia, and tonic-clonic limb movements; procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope by maintaining a supine or Trendelenburg position
Vaccination may not protect all vaccine recipients against influenza disease
Pregnancy & Lactation
Pregnancy
Manufacturers are maintaining prospective pregnancy exposure registries to collect data on pregnancy outcomes following vaccination
Animal data
- No adverse effects observed on preweaning or vaccine-related fetal malformations when administered to female rabbits before pregnancy or during pregnancy
Clinical considerations
- Pregnant women are at increased risk of complication associated with influenza infection compared with nonpregnant women
- The CDC recommends pregnant women be immunized with influenza vaccine by injection and not the live attenuated influenza vaccine (LAIV; intranasal influenza vaccine)
- Vaccination has been shown to reduce the risk of flu-associated acute respiratory infection in pregnant women by up to 50%; immunization also confers some immunity to infants for the first several months after their birth, when they are too young to be vaccinated
Lactation
Unknown if distributed in human breast milk
Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition
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.
Pharmacology
Mechanism of Action
Inactivated influenza virus types A & B subunits
Convey active immunity via stimulation of production of endogenously produced antibodies
Pharmacokinetics
Onset: days
Duration: few months
Effectiveness: 70-90%
Administration
Instructions
Administer at beginning of influenza season
Should not be mixed with any other vaccine in the same syringe or vial
Shake well before administration
Adults and children >8 years
- IM: Administer IM in deltoid muscle of upper arm
- ID (18-64 yr): Administer ID in deltoid region of upper arm
- Afluria
- For IM injection only, by either needle and syringe (age ≥6 months) or by the PharmaJet Stratis Needle-Free Injection System (aged 18 through 64 years)
- PharmaJet Stratis is a needleless injection device that delivers an IM injection
Children aged 6 months through 8 years
- IM (aged 6-35 months): Administer IM in anterolateral thigh; do not inject in the gluteal area or areas where there may be a major nerve trunk
- IM (aged 3-8 years): Administer IM in deltoid muscle of upper arm
- 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
Images
Patient Handout
Formulary
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Adding plans allows you to:
- View the formulary and any restrictions for each plan.
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