diphtheria & tetanus toxoids (Rx)

Brand and Other Names:Decavac, Tenivac, more...TDVAX, Td, DT
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

Lf (flocculation units)

diphtheria/tetanus toxoid

injection, suspension (Td)

  • (2Lf/2Lf)/0.5mL (TDVAX)
  • (2Lf/5Lf)/0.5mL (Tenivac)

Primary Immunization

Adults who did not receive primary vaccination series

  • Give first dose as Tdap, THEN
  • Give second dose as Td 0.5 mL IM at least 4 weeks after the first dose, THEN
  • Give third dose as Td 0.5 mL IM 6-12 months later

Routine Booster Immunization

0.5 mL (Td or Tdap) every 10 years (patients that have completed primary immunization)

Diphtheria Prophylaxis for Case Contacts

Indicated for postexposure prophylaxis in persons who have not completed primary vaccination, whose vaccination status is unknown, or who have not been vaccinated with diphtheria toxoid within the previous 5 yr

Administer primary series using Td to catch up with vaccinations

Tetanus Prophylaxis in Wound Management

For active tetanus immunization in wound management, a preparation containing tetanus and diphtheria toxoids (Td) is preferred instead of single-antigen tetanus toxoid to enhance diphtheria protection

The need for active immunization with a tetanus toxoid-containing preparation, with or without passive immunization with tetanus immune globulin (TIG) depends on both the condition of the wound and the patient’s vaccination history

Clean minor wounds

  • Unknown or <3 tetanus doses: Administer Td
  • 3 or more tetanus doses (if <10 years since last dose): No dose needed
  • 3 or more tetanus doses (>10 years since last dose): Administer Td

All other wounds

  • Unknown or <3 tetanus doses: Administer Td and TIG
  • 3 or more tetanus doses (if <5 yr since last dose): No dose needed
  • 3 or more tetanus doses (>5 yr since last dose): Administer Td; if patient has history of Arhus-type reaction, administer only if at least 10 yr since last tetanus-containing immunization

Dosage Forms & Strengths

Lf (flocculation units)

diphtheria/tetanus toxoid

injection, suspension (Td)

  • (2Lf/2Lf)/0.5mL (TDVAX)
  • (2Lf/5Lf)/0.5mL (Tenivac)

injection, suspension (DT) for children younger than 7 years

  • (25Lf/5Lf)/0.5mL

Primary Immunization

For individuals who have not been immunized

<7 years

  • DT
    • 5-dose series
    • DT may be used if pertussis component contraindicated; DTaP preferred for primary immunization in children aged <7 years
    • Three doses: 0.5 mL IM at 2, 4, and 6 months of age; may administer as early as 6 weeks of age and repeated every 4-8 weeks
    • Fourth dose: At least 6 months must elapse after third dose; may give as early as 12 months of age if 6 months have passed since the third dose
    • Fifth dose: 4-6 years of age before starting school or kindergarten; may omit this dose if fourth dose given >4 years of age

≥7 years

  • Unimmunized individuals
    • Give first dose as Tdap, THEN
    • Give second dose as Td 0.5 mL IM at least 4 weeks after the first dose, THEN
    • Give third dose as Td 0.5 mL IM 6 months later

Routine Booster Immunization

0.5 mLIM every 10 years (patients that have completed primary immunization)

Diphtheria Prophylaxis for Case Contacts

Indicated for postexposure prophylaxis in persons aged ≥7 yr who have not completed primary vaccination, whose vaccination status is unknown, or who have not been vaccinated with diphtheria toxoid within the previous 5 yr

Administer primary series using Td to catch up with vaccinations

Tetanus Prophylaxis in Wound Management

For active tetanus immunization in wound management of patients aged ≥7 yr, a preparation containing tetanus and diphtheria toxoids (Td) is preferred instead of single-antigen tetanus toxoid to enhance diphtheria protection

The need for active immunization with a tetanus toxoid-containing preparation, with or without passive immunization with tetanus immune globulin (TIG) depends on both the condition of the wound and the patient’s vaccination history

Clean minor wounds

  • Unknown or <3 tetanus doses: Administer Td
  • 3 or more tetanus doses (if <10 years since last dose): No dose needed
  • 3 or more tetanus doses (>10 years since last dose): Administer Td

All other wounds

  • Unknown or <3 tetanus doses: Administer Td and TIG
  • 3 or more tetanus doses (if <5 years since last dose): No dose needed
  • 3 or more tetanus doses (>5 years since last dose): Administer Td
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Interactions

Interaction Checker

and diphtheria & tetanus toxoids

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (1)

            • belimumab

              belimumab decreases effects of diphtheria & tetanus toxoids by immunosuppressive effects; risk of infection. Contraindicated. Do not administer live vaccines 30 days before or concurrently with belimumab.

            Serious - Use Alternative (37)

            • adalimumab

              adalimumab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • alefacept

              alefacept decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • anakinra

              anakinra decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • antithymocyte globulin equine

              antithymocyte globulin equine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • antithymocyte globulin rabbit

              antithymocyte globulin rabbit decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • azathioprine

              azathioprine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • basiliximab

              basiliximab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • budesonide

              budesonide decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • canakinumab

              canakinumab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • cortisone

              cortisone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • cyclosporine

              cyclosporine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • deflazacort

              deflazacort decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • dexamethasone

              dexamethasone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • etanercept

              etanercept decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • everolimus

              everolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • fludrocortisone

              fludrocortisone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • glatiramer

              glatiramer decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • golimumab

              golimumab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • hydrocortisone

              hydrocortisone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • infliximab

              infliximab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • ixekizumab

              ixekizumab decreases effects of diphtheria & tetanus toxoids by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating ixekizumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with ixekizumab may not elicit an immune response sufficient to prevent disease.

            • leflunomide

              leflunomide decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • methylprednisolone

              methylprednisolone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • muromonab CD3

              muromonab CD3 decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • mycophenolate

              mycophenolate decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • prednisolone

              prednisolone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • prednisone

              prednisone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • rilonacept

              rilonacept decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • secukinumab

              secukinumab decreases effects of diphtheria & tetanus toxoids 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 diphtheria & tetanus toxoids 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 diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • tacrolimus

              tacrolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • temsirolimus

              temsirolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • tocilizumab

              tocilizumab decreases effects of diphtheria & tetanus toxoids 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 diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.

            • ustekinumab

              ustekinumab decreases effects of diphtheria & tetanus toxoids 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 (8)

            • belatacept

              belatacept decreases effects of diphtheria & tetanus toxoids by Other (see comment). Use Caution/Monitor. Comment: The use of live vaccines should be avoided during treatment with belatacept. Inform patients that vaccinations may be less effective while they are being treated with belatacept.

            • certolizumab pegol

              certolizumab pegol decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Use Caution/Monitor.

            • dengue vaccine

              dengue vaccine, diphtheria & tetanus toxoids. unspecified interaction mechanism. Use Caution/Monitor. Data are not available to establish safety and immunogenicity of coadministration of dengue vaccine with recommended adolescent vaccines.

            • ifosfamide

              ifosfamide decreases effects of diphtheria & tetanus toxoids 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 diphtheria & tetanus toxoids 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 diphtheria & tetanus toxoids by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressants also increase risk of infection with concomitant live vaccines.

            • methotrexate

              methotrexate decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant administration of methotrexate can decrease the immunological response of vaccines.

            • oxaliplatin

              oxaliplatin decreases effects of diphtheria & tetanus toxoids by passive renal tubular reabsorption due to increased pH. 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. .

            Minor (1)

            • chloroquine

              chloroquine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Minor/Significance Unknown.

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            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% (Age 7 yr or older)

            Injection site pain (35.3-80.1%)

            Muscle weakness (4.9-32.3%)

            Injection site redness (15.8-25.6%)

            Headache (11.7-24.1%)

            Injection site swelling (12.1-17%)

            Malaise (8.9-17%)

            Sore/swollen joints (8.5-15.7%)

            1-10% (Age 7 yr or older)

            Fever (2.5-5.7%)

            Postmarketing Reports (Age 7 yr or older)

            Blood and lymphatic system disorders: Lymphadenopathy

            Immune system disorders: Allergic reactions (eg, erythematous rash, maculopapular rash, urticaria, pruritus); anaphylactic reaction (bronchospasm, angioedema)

            Nervous system disorders: Paresthesia, dizziness, syncope, Guillain-Barre syndrome

            Gastrointestinal disorders: Vomiting

            Musculoskeletal, connective tissue and bone disorders: Myalgia, pain in extremities

            General disorders and administration site conditions: Injection site reactions (including inflammation, mass, edema, induration, warmth, pruritus, cellulitis, discomfort); fatigue, edema peripheral

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            Warnings

            Contraindications

            Hypersensitivity to toxoids or any component of the formulation

            Cautions

            Prior to the administration of the vaccine recipient’s current health status and health history should be reviewed; this includes a review of the immunization history of the patient, the presence of any contraindications to immunization, and any adverse events after previous immunizations to allow an assessment of the benefits and risks of vaccination

            Treatment (including epinephrine 1:1000) for anaphylactoid/hypersensitivity reactions should be immediately available when administering vaccine

            Check vaccine for latex content

            Do not exceed dosing frequency; more frequent doses may be associated with increased incidence and severity of adverse reactions

            Persons who experienced an Arthus-type hypersensitivity reaction following a prior dose of a tetanus toxoid-containing vaccine usually have high serum tetanus antitoxin levels and should not receive tetanus-containing vaccines more frequently than every 10 years, even for tetanus prophylaxis as part of wound management

            Evidence supports a causal relation between tetanus toxoid and both brachial neuritis and Guillain-Barré syndrome; if Guillain-Barré syndrome occurred within 6 weeks of receipt of prior vaccine containing tetanus toxoid, the decision to give any vaccine containing tetanus toxoid should be based on careful consideration of the potential benefits and possible risks

            Vaccination may not protect all individuals

            Administration to immunocompromised individuals may not obtain expected immune response

            Prior to administration of the vaccine, patients, parents, or guardians should be informed by the health care provider of the benefits and risks of immunization and of the importance of completing the primary immunization series or receiving recommended booster doses

            Drug interaction overview

            • Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs, and corticosteroids (used in greater than physiologic doses), may reduce the immune response
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            Pregnancy & Lactation

            Pregnancy

            There are insufficient human data from Td administered during pregnancy to establish the presence or absence of a vaccine-associated risk

            ACIP guidelines include immunizing pregnant women during every pregnancy with 1 dose of Tdap to convey immunity for pertussis to fetus during gestational weeks 27-36

            Animal studies

            • Female rabbits received a single human dose (0.5 mL) of Td IM 17 and 10 days before mating, and on gestation days 6 and 29; no adverse effects on preweaning development up to postnatal day 35 were observed
            • There were no vaccine-related fetal malformations or variations observed

            Lactation

            Unknown if excreted in human milk

            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.

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            Pharmacology

            Mechanism of Action

            Tetanus: Tetanus is an acute disease caused by an extremely potent neurotoxin produced by C tetani; protection against disease is imparted by the development of neutralizing antibodies to tetanus toxin; serum tetanus antitoxin level of at least 0.01 IU/mL, measured by neutralization assay is considered the minimum protective level

            Diphtheria: Diphtheria is an acute toxin-mediated disease caused by toxigenic strains of C diphtheriae; protection against disease is imparted by the development of neutralizing antibodies to diphtheria toxin; serum diphtheria antitoxin level of 0.01 IU/mL is the lowest level giving some degree of protection; antitoxin levels of at least 0.1 IU/mL are generally regarded as protective

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            Administration

            IM Preparation

            Just before use, shake the single-dose vial or syringe well until a uniform, white, cloudy suspension results

            Inspected visually for particulate matter and discoloration; if these conditions exist, do not administer.

            Do not combine through reconstitution or mix with any other vaccine

            IM Administration

            For IM administration only; do not administer IV, SC, or intradermally

            Adults and children aged 7 years or older

            • Administer IM in the deltoid muscle (preferred site)
            • Do not inject into the gluteal area or areas where there may be a major nerve trunk

            Children aged younger than 7 years

            • Infants aged <1 year: Inject IM in anterolateral aspect of the thigh provides the largest muscle and is the preferred site of injection
            • Older children: Administer IM in the deltoid muscle is usually large enough for injection; do not inject into the gluteal area or areas where there may be a major nerve trunk

            Storage

            Refrigerate at 2-8ºC (36-46ºF)

            Do not freeze; discard if exposed to freezing

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

            FormularyPatient Discounts

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