Dosing & Uses
Dosage Forms & Strengths
IM injection, regular strength
- 22.5mcg/0.25mL
- 45mcg/0.5mL
ID injection
- 27mcg/0.1mL (Fluzone Intradermal)
Influenza Prophylaxis
United States 2022-2023 influenza season: All vaccines expected to be available are quadrivalent
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
Dosing Considerations
Contains the following 3 viral strains for 2022-2023 Northern Hemisphere season
- A/Victoria/2570/2019 (H1N1)pdm09-like virus (no change from last season)
- A/Darwin/9/2021 (H3N2)-like virus (new for 2022-2023)
- B/Austria/1359417/2021 (B/Victoria lineage)-like virus (new for 2022-2023)
Dosage Forms & Strengths
injection, regular strength
- 22.5mcg/0.25mL
- 45mcg/0.5mL
Influenza Prophylaxis
United States 2022-2023 influenza season: All vaccines expected to be available are quadrivalent
CDC's ACIP recommends that everyone 6 months of age and older receive an annual influenza vaccination
See Administration section for information regarding if 1 or 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
Dosing Considerations
Contains the following 3 viral strains for 2022-2023 Northern Hemisphere season
- A/Victoria/2570/2019 (H1N1)pdm09-like virus (no change from last season)
- A/Darwin/9/2021 (H3N2)-like virus (new for 2022-2023)
- B/Austria/1359417/2021 (B/Victoria lineage)-like virus (new for 2022-2023)
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (37)
- adalimumab
adalimumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- alefacept
alefacept decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- anakinra
anakinra decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- antithymocyte globulin equine
antithymocyte globulin equine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- antithymocyte globulin rabbit
antithymocyte globulin rabbit decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- azathioprine
azathioprine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- basiliximab
basiliximab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- budesonide
budesonide decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- canakinumab
canakinumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- cortisone
cortisone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- deflazacort
deflazacort decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- dexamethasone
dexamethasone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- etanercept
etanercept decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- everolimus
everolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- fludrocortisone
fludrocortisone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- glatiramer
glatiramer decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- golimumab
golimumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- hydrocortisone
hydrocortisone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- infliximab
infliximab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- leflunomide
leflunomide decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- methylprednisolone
methylprednisolone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- muromonab CD3
muromonab CD3 decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- mycophenolate
mycophenolate decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- ocrelizumab
ocrelizumab decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Vaccination with live-attenuated or live vaccines is not recommended during ocrelizumab treatment and until B-cell repletion.
- ofatumumab SC
ofatumumab SC decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Administer all immunizations according to immunization guidelines at least 2 weeks before initiating ofatumumab SC for inactivated vaccines, and whenever possible.
- prednisolone
prednisolone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- prednisone
prednisone decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- rilonacept
rilonacept decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- secukinumab
secukinumab decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.
- siponimod
siponimod decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Pause vaccinations beginning 1 week before initiating siponimod and for 4 weeks after stopping treatment. Coadministration with live attenuated vaccines may increase infection risk.
- sirolimus
sirolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- tacrolimus
tacrolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- temsirolimus
temsirolimus decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- tocilizumab
tocilizumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- ustekinumab
ustekinumab decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Contraindicated. Prior initiating therapy, patients should receive all age-appropriate immunizations as recommended by current guidelines. Immunosuppressants also increase risk of infection with concomitant live vaccines.
Monitor Closely (20)
- certolizumab pegol
certolizumab pegol decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Use Caution/Monitor.
- cyclosporine
cyclosporine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. If possible, complete all age-appropriate vaccinations at least 2 weeks before initiating immunosuppressant therapy. Patients vaccinated <14 days before starting immunosuppressive therapy or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued if immune competence has been restored. Longer waiting periods may be required for drugs that maintain their immunosuppressive effects for more than 3 months after discontinuation (eg, ocrelizumab). .
- dengue vaccine
dengue vaccine, influenza virus vaccine trivalent. unspecified interaction mechanism. Use Caution/Monitor. Data are not available to establish safety and immunogenicity of coadministration of dengue vaccine with recommended adolescent vaccines.
- ibrutinib
ibrutinib decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- ifosfamide
ifosfamide decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- lomustine
lomustine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- mechlorethamine
mechlorethamine decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- melphalan
melphalan decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- mercaptopurine
mercaptopurine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- methotrexate
methotrexate decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant administration of methotrexate can decrease the immunological response of vaccines.
- onasemnogene abeparvovec
onasemnogene abeparvovec decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Adjust vaccinations to accommodate concomitant corticosteroid administration prior to and following onasemnogene abeparvovec infusion. When initiating systemic corticosteriod therapy, wait 2 weeks after an inactivated vaccine.
- oseltamivir
oseltamivir decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Use Caution/Monitor. Avoid administration of live attenuated influenza vaccine intranasal within 2 weeks before or 48 hours after administration of oseltamivir, unless medically indicated.
- oxaliplatin
oxaliplatin decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- ponesimod
ponesimod decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.
- procarbazine
procarbazine decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- rituximab
rituximab, influenza virus vaccine trivalent. immunosuppressive effects; risk of infection. Use Caution/Monitor. When used for rheumatoid arthritis, follow current immunization guidelines and administer non-live vaccines at least 4 weeks prior to a course of rituximab.
- rituximab-hyaluronidase
rituximab-hyaluronidase, influenza virus vaccine trivalent. immunosuppressive effects; risk of infection. Use Caution/Monitor. When used for rheumatoid arthritis, follow current immunization guidelines and administer non-live vaccines at least 4 weeks prior to a course of rituximab.
- satralizumab
satralizumab decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Administer all immunizations according to immunization guidelines. At least 2 weeks before initiating for non-live vaccines. .
- tralokinumab
tralokinumab will decrease the level or effect of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Use Caution/Monitor. Limited data are available regarding coadministration with non-live vaccines.
- voclosporin
voclosporin decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment.
Minor (5)
- chloroquine
chloroquine decreases effects of influenza virus vaccine trivalent by pharmacodynamic antagonism. Minor/Significance Unknown.
- ethotoin
influenza virus vaccine trivalent, ethotoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.
- fosphenytoin
influenza virus vaccine trivalent, fosphenytoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.
- ozanimod
ozanimod decreases effects of influenza virus vaccine trivalent by immunosuppressive effects; risk of infection. Minor/Significance Unknown. No clinical data are available on the efficacy and safety of vaccinations in patients taking ozanimod. Vaccinations may be less effective if coadministered with ozanimod.
- phenytoin
influenza virus vaccine trivalent, phenytoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.
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
Shoulder injury (eg, tendinopathy or shoulder bursitis) may result from administration of the vaccine that is too high on the upper arm; symptoms may include reduced shoulder motion or shoulder pain; to reduce risk of injury, inject in the central, thickest part of the deltoid muscle
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
Oculorespiratory syndrome resulting from inactivated influenza vaccine reported; symptoms that may appear within 2 to 24 hours after administration may include cough, chest tightness, sore throat, wheezing, difficulty breathing, red eyes, or facial swelling; symptoms are self-limiting and may resolve within 48 hr of onset; cause of the syndrome has not been established
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: ~2 weeks
Duration: Several months
Effectiveness: Varies seasonally, depending on viral strain and mutations; lower antibody response in patients aged >65 yr or immunosuppressed individuals
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
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Formulary
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