Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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 (39)
- 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.
- elivaldogene autotemcel
elivaldogene autotemcel, diphtheria & tetanus toxoids. Either decreases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: The safety and effectiveness of vaccination during or following elivaldogene autotemcel treatment have not been studied. Vaccination is not recommended during the 6 weeks preceding myeloablative conditioning, and until hematological recovery following elivaldogene autotemcel treatment. Where feasible, administer childhood vaccinations before myeloablative conditioning. .
- 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.
- teplizumab
teplizumab decreases effects of diphtheria & tetanus toxoids by Other (see comment). Avoid or Use Alternate Drug. Comment: Administer all age-appropriate vaccinations before starting teplizumab. Inactivated or mRNA vaccines are not recommended within 2 weeks before teplizumab treatment, during treatment, or 6 weeks after completion of treatment.
- 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 (10)
- 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.
- delandistrogene moxeparvovec
delandistrogene moxeparvovec, diphtheria & tetanus toxoids. Other (see comment). Use Caution/Monitor. Comment: Consider patient vaccination status before initiating corticosteroid regimen required before delandistrogene moxeparvovec administration. If possible, ensure patients are current with all immunizations according to immunization guidelines. Complete vaccinations at least 4 weeks before starting corticosteroid regimen. High-dose or long-term corticosteroids may decrease immungenicity of vaccines.
- 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. .
- ublituximab
ublituximab decreases effects of diphtheria & tetanus toxoids by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Administer all immunizations according to immunization guidelines at least 4 weeks before initiating ublituximab for live or live-attenuated vaccines and, whenever possible, at least 2 weeks before initiating for non-live vaccines. Vaccination with live virus vaccines is not recommended during treatment and until B-cell repletion. Do not administer live or live-attenuated vaccines to infants of mothers exposed to ublituximab during pregnancy, before confirming recovery of B-cell counts as measured by CD19+ B cells.
Minor (1)
- chloroquine
chloroquine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Minor/Significance Unknown.
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
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
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.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
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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Formulary
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