Dosing & Uses
Dosage Forms & Strengths
suspension reconstituted
- 50mg (Tice BCG)
- 81mg (TheraCys)
Tuberculosis Immunization
Used as TB immunization, primarily in developing countries
ACIP recommended use: TB exposed health care workers in high risk settings
0.2-0.3 mL percutaneous
Conduct tuberculin test 2-3 months after percutaneous administration; if test negative repeat vaccination
Immunotherapy for Bladder Cancer
Initiate treatment 7-14 days after biopsy
TheraCys: Instill one dose into bladder; retain for 2 hr; repeat dose once weekly for 6 weeks followed by 1 treatment at 3, 6, 12, 18, and 24 months after initial treatment
TICE BCG: Instill one dose into blatter; retain for 2 hr; repeat dose once weekly for 6 weeks (may repeat cycle once) followed by once monthly for 6-12 months
Administration
Okay to give Hib, DTP, OPV, IPV, MMR, influenza, and hepatitis B at same time
Dosage Forms & Strengths
suspension reconstituted
- 50mg (Tice BCG)
- 81mg (TheraCys)
Tuberculosis Immunization
Used as TB immunization, primarily in developing countries
ACIP recommended use: TB exposed TB skin test-negative infants and children
<1 month
- Half-strength (reconstitute with 2 mL instead of 1 mL sterile water)
- 0.2-0.3 mL percutaneous
- Conduct tuberculin test 2-3 months after percutaneous administration; if test negative repeat vaccination after 1 year
>1 month
- 0.2-0.3 mL percutaneous
- Conduct tuberculin test 2-3 months after percutaneous administration; if test negative repeat vaccination
Additional Information
Okay to give Hib, DTP, OPV, IPV, MMR, influenza, and hepatitis B at same time
Interactions
Interaction Checker
No Results

Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor

Contraindicated (11)
- belimumab
belimumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Do not administer live vaccines 30 days before or concurrently with belimumab.
- certolizumab pegol
certolizumab pegol decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Do not give live vaccines concurrently with certolizumab.
- ibrutinib
ibrutinib decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.
- ixekizumab
ixekizumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Ixekizumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating ixekizumab, complete all age appropriate immunizations.
- lomustine
lomustine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3mo after cessation of immunosuppressive therapy.
- mechlorethamine
mechlorethamine decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.
- melphalan
melphalan decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo. after cessation of immunosuppressive therapy.
- onasemnogene abeparvovec
onasemnogene abeparvovec decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Adjust vaccinations to accommodate concomitant corticosteroid administration prior to and following onasemnogene abeparvovec infusion. Avoid live vaccines for at least 1 month when initiating or after high-dose systemic corticosteroid therapy administered for =2 weeks.
- oxaliplatin
oxaliplatin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo. after cessation of immunosuppressive therapy.
- procarbazine
procarbazine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection). Live-attenuated vaccines should be avoided for at least 3 mo after cessation of immunosuppressive therapy.
- secukinumab
secukinumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Contraindicated. Secukinumab may interfere with immune response of live vaccines and increase risk for vaccine adverse effects; prior to initiating secukinumab, complete all age appropriate immunizations.
Serious - Use Alternative (141)
- abrocitinib
abrocitinib decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Administration of live vaccines is not recommended during abrocitinib treatment and immediately before or after treatment.
- adalimumab
adalimumab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- alefacept
alefacept decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- amikacin
amikacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- amoxicillin
amoxicillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- ampicillin
ampicillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- anakinra
anakinra decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- anifrolumab
anifrolumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Before initiation, update immunization according to current guidelines.
- antithymocyte globulin equine
antithymocyte globulin equine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- antithymocyte globulin rabbit
antithymocyte globulin rabbit decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- atoltivimab/maftivimab/odesivimab
atoltivimab/maftivimab/odesivimab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Ebola monoclonal antibodies may interfere with immune response of live vaccines. Refer to vaccine guidelines for vaccination timing during and following treatment. .
- azathioprine
azathioprine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- azithromycin
azithromycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- aztreonam
aztreonam decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- baricitinib
baricitinib decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live vaccines with baricitinib. Update immunizations in agreement with current immunization guidelines before initiating baricitinib.
- basiliximab
basiliximab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- beclomethasone, inhaled
beclomethasone, inhaled increases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. May interfere with generation of an adequate immune response to BCG vaccine.
- bedaquiline
BCG vaccine live decreases effects of bedaquiline by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid concomitant use of intravesical BCG and antibiotics, particulary those given via IV or oral routes and those with activity against mycobacteria.
- brodalumab
brodalumab, BCG vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating brodalumab, complete all age appropriate immunizations. No data are available on the ability of live or inactive vaccines to elicit an immune response in patients being treated with brodalumab.
- budesonide
budesonide decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- cabazitaxel
cabazitaxel decreases effects of BCG vaccine live by Mechanism: pharmacodynamic antagonism. Avoid or Use Alternate Drug. Live attenuated vaccines should not be used in patients receiving immunosuppressive therapy. Immunosuppressives may diminish therapeutic effects of vaccines and increase risk of adverse effects.
- canakinumab
canakinumab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- cefaclor
cefaclor decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefadroxil
cefadroxil decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefamandole
cefamandole decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefazolin
cefazolin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefdinir
cefdinir decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefditoren
cefditoren decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefepime
cefepime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefixime
cefixime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefotaxime
cefotaxime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefotetan
cefotetan decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefoxitin
cefoxitin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefpirome
cefpirome decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefpodoxime
cefpodoxime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefprozil
cefprozil decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- ceftazidime
ceftazidime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- ceftibuten
ceftibuten decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- ceftriaxone
ceftriaxone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cefuroxime
cefuroxime decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cephalexin
cephalexin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- chloramphenicol
chloramphenicol decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- chlorhexidine oral
chlorhexidine oral decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- ciprofloxacin
ciprofloxacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Antibiotics may diminish therapeutic effects of BCG. Wait until Abx Tx complete to administer live bacterial vaccine.
- clarithromycin
clarithromycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- clindamycin
clindamycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- cortisone
cortisone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- cyclosporine
cyclosporine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Avoid live vaccines in immunocompromised patients due to the risk of developing a clinical infection from the live vaccine. Inadequate immune response to the vaccine may also occur in the presence of immunosuppressants. Avoid live vaccines for at least 3 months after cessation of immunosuppressant therapy unless the benefit of vaccine administration outweighs the potential risk.
- dapsone
dapsone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- deflazacort
deflazacort decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
deflazacort decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Do not administer live or live attenuated vaccines to patients receiving immunosuppressive doses of corticosteroids. - demeclocycline
demeclocycline decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- dexamethasone
dexamethasone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- dicloxacillin
dicloxacillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- doxycycline
doxycycline decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- dupilumab
dupilumab, BCG vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating dupilumab, complete all age appropriate immunizations. Avoid use of live vaccines in patients treated with dupilumab.
- elivaldogene autotemcel
elivaldogene autotemcel, BCG vaccine live. 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. .
- ertapenem
ertapenem decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- erythromycin base
erythromycin base decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- erythromycin lactobionate
erythromycin lactobionate decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- erythromycin stearate
erythromycin stearate decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- etanercept
etanercept decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- ethambutol
ethambutol decreases effects of BCG vaccine live by pharmacodynamic antagonism. Avoid or Use Alternate Drug.
- everolimus
everolimus decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- fingolimod
fingolimod decreases effects of BCG vaccine live by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid live attenuated vaccines during and for 2 months after stopping fingolimod.
- fleroxacin
fleroxacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- fludrocortisone
fludrocortisone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- fosfomycin
fosfomycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- gemifloxacin
gemifloxacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- gentamicin
gentamicin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- glatiramer
glatiramer decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- golimumab
golimumab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- guselkumab
guselkumab, BCG vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating guselkumab, complete all age appropriate immunizations. No data available on the ability of live or inactive vaccine to elicit an immune response in patients treated with guselkumab.
- hydrocortisone
hydrocortisone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- hydroxyurea
hydroxyurea decreases effects of BCG vaccine live by Other (see comment). Avoid or Use Alternate Drug. Comment: Vaccination with live vaccines in a patient receiving hydroxyurea may diminish therapeutic effects of vaccines and increase risk of adverse effects (increased risk of infection).
- infliximab
infliximab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- leflunomide
leflunomide decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- levofloxacin
levofloxacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- linezolid
linezolid decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- mefloquine
mefloquine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated.
- mercaptopurine
mercaptopurine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- meropenem
meropenem decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- meropenem/vaborbactam
meropenem/vaborbactam decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- methylprednisolone
methylprednisolone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- metronidazole
metronidazole decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- minocycline
minocycline decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- moxifloxacin
moxifloxacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- muromonab CD3
muromonab CD3 decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- mycophenolate
mycophenolate decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- nafcillin
nafcillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- neomycin PO
neomycin PO decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- nitrofurantoin
nitrofurantoin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- ofatumumab SC
ofatumumab SC decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Administer all immunizations according to immunization guidelines at least 4 weeks prior to initiation of ofatumumab SC for live or live-attenuated vaccines, and whenever possible.
- ofloxacin
ofloxacin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- oxacillin
oxacillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- oxytetracycline
oxytetracycline decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- ozanimod
ozanimod decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live-attenuated vaccines with ozanimod during treatment and for up to 3 months after discontinuing ozanimod. .
- palifermin
palifermin increases toxicity of BCG vaccine live by Other (see comment). Avoid or Use Alternate Drug. Comment: Palifermin should not be administered within 24 hr before, during infusion of, or within 24 hr after administration of antineoplastic agents. Coadministration of palifermin within 24 hr of chemotherapy resulted in increased severity and duration of oral mucositis.
- paromomycin
paromomycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- penicillin G aqueous
penicillin G aqueous decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- penicillin VK
penicillin VK decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until antibiotic treatment complete to administer live bacterial vaccine.
- piperacillin
piperacillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until antibiotic treatment complete to administer live bacterial vaccine; antibiotics may diminish therapeutic effects of BCG.
- pivmecillinam
pivmecillinam decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- prednisolone
prednisolone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- prednisone
prednisone decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- quinupristin/dalfopristin
quinupristin/dalfopristin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- rifabutin
rifabutin decreases levels of BCG vaccine live by pharmacodynamic antagonism. Contraindicated.
- rifampin
rifampin decreases levels of BCG vaccine live by pharmacodynamic antagonism. Contraindicated.
- rifapentine
rifapentine decreases levels of BCG vaccine live by pharmacodynamic antagonism. Contraindicated.
- rilonacept
rilonacept decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- risankizumab
risankizumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live vaccines. Before starting risankizumab, complete age appropriate immunizations.
- ritlecitinib
ritlecitinib, BCG vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid live attenuated vaccines during or shortly before initiating ritlecitinib. No data are available on vaccination response in ritlecitinib treated patients. Before initiating, review patient immunization status (including herpes zoster) and immunize accordingly in agreement with current immunization guidelines.
- roxithromycin
roxithromycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- sarilumab
sarilumab, BCG vaccine live. immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid concurrent use of live virus vaccines, owing to potentially increased risk of infections. The interval between live vaccinations and initiation of sarilumab therapy should be in accordance with current vaccination guidelines regarding immunosuppressive agents.
- satralizumab
satralizumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. ive vaccines are not recommended during treatment. Administer all immunizations according to immunization guidelines. At least 4 weeks before initiating for live or live-attenuated vaccines.
- siponimod
siponimod decreases effects of BCG vaccine live 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 BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- streptomycin
streptomycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated.
- sulfadiazine
sulfadiazine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- sulfamethoxazole
sulfamethoxazole decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- sulfisoxazole
sulfisoxazole decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- tacrolimus
tacrolimus decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- teicoplanin
teicoplanin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- temocillin
temocillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- temsirolimus
temsirolimus decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- teplizumab
teplizumab decreases effects of BCG vaccine live by Other (see comment). Avoid or Use Alternate Drug. Comment: Administer all age-appropriate vaccinations before starting teplizumab. Live-attenuated vaccines are not recommended within 8 weeks before teplizumab treatment, during treatment, or up to 52 weeks after treatment.
- tetracycline
tetracycline decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- ticarcillin
ticarcillin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- tigecycline
tigecycline decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- tildrakizumab
tildrakizumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Before initiating tildrakizumab therapy, consider completion of all age appropriate immunizations according to current immunization guidelines. Avoid use of live vaccines in patients treated with tildrakizumab. No data are available on the response to live or inactive vaccines.
- tobramycin
tobramycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- tocilizumab
tocilizumab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.
- tralokinumab
tralokinumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live vaccines. Before starting tralokinumab, complete age appropriate immunizations.
- triamcinolone acetonide injectable suspension
triamcinolone acetonide injectable suspension decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.
- trimethoprim
trimethoprim decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- upadacitinib
upadacitinib decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug.
- ustekinumab
ustekinumab decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines. BCG vaccines should not be given during ustekinumab treatment, for one year prior to initiating treatment, or one year following discontinuation of treatment.
- vancomycin
vancomycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.
- vedolizumab
vedolizumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Avoid use of live virus vaccines while receiving vedolizumab; live vaccines may be administered concurrently with vedolizumab only if the benefits outweigh the risks.
- voclosporin
voclosporin decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Immunosuppressants also increase risk of infection with concomitant live vaccines. Avoid live vaccines for at least 3 months after immunosuppressants.
Monitor Closely (17)
- anthrax immune globulin
anthrax immune globulin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Immune globulin administration may impair the efficacy of live attenuated vaccines. Defer vaccination with live virus vaccines until ~3 months after administration of anthrax IG. Revaccinate people who received anthrax IG shortly after live virus vaccination following 3 months after the administration of anthrax IG.
- belatacept
belatacept decreases effects of BCG vaccine live 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.
- betibeglogene autotemcel
betibeglogene autotemcel, BCG vaccine live. Other (see comment). Use Caution/Monitor. Comment: Follow institutional guidelines for vaccine administration. Safety of live vaccines during or following treatment not studied. .
- cytomegalovirus immune globulin (CMV IG)
cytomegalovirus immune globulin (CMV IG) decreases effects of BCG vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.
- hepatitis B immune globulin (HBIG)
hepatitis B immune globulin (HBIG) decreases effects of BCG vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.
- imipenem/cilastatin
imipenem/cilastatin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. BCG vaccine prescribing information states that antimicrobial or immunosuppressive agents may interfere with the development of the immune response and should be used only under medical supervision.
- imipenem/cilastatin/relebactam
imipenem/cilastatin/relebactam decreases effects of BCG vaccine live by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. BCG vaccine prescribing information states that antimicrobial or immunosuppressive agents may interfere with the development of the immune response and should be used only under medical supervision.
- immune globulin IM (IGIM)
immune globulin IM (IGIM) decreases effects of BCG vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.
- immune globulin IV (IGIV)
immune globulin IV (IGIV) decreases effects of BCG vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.
- immune globulin SC
immune globulin SC decreases effects of BCG vaccine live by pharmacodynamic antagonism. Use Caution/Monitor.
- leniolisib
leniolisib decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Use Caution/Monitor. Live, attenuated vaccinations may be less effective if administered during leniolisib treatment.
- obinutuzumab
obinutuzumab decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Use Caution/Monitor. Immunization with live virus vaccines is not recommended during obinutuzumab treatment and until after B-cell recovery.
- ponesimod
ponesimod decreases effects of BCG vaccine live by immunosuppressive effects; risk of infection. Use Caution/Monitor. If possible, complete all age-appropriate vaccinations at least 4 weeks before initiating ponesimod.
- rabies immune globulin, human (RIG)
rabies immune globulin, human (RIG) decreases effects of BCG vaccine live by Other (see comment). Use Caution/Monitor. Comment: High dose rabies immunoglobulin may impair response to active immunization.
- tetanus immune globulin (TIG)
tetanus immune globulin (TIG) decreases effects of BCG vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Separate by 3 months.
- ublituximab
ublituximab decreases effects of BCG vaccine live 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.
- vaccinia immune globulin intravenous
vaccinia immune globulin intravenous decreases effects of BCG vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. Defer live vaccines for 3 months after immune globulin administration.
Minor (2)
- chloroquine
chloroquine decreases effects of BCG vaccine live by pharmacodynamic antagonism. Minor/Significance Unknown.
- Rho(D) immune globulin
Rho(D) immune globulin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Minor/Significance Unknown. Separate by 3 months.
Adverse Effects
>10%
Malaise (7-40%)
Fever (17-38%)
Pain (17%)
Chills (9-34%)
Nausea/vomiting (3-16%)
Dysuria (52-60%)
Hematutia (26-39%)
Urinary urgency (6-18%)
Infection (2-18%)
Anemia (21%)
Flu-lik syndrome (24-33%)
1-10%
Rash (2-3%)
Diarrhea (6%)
Abdominal pain (2-3%)
Headache (2%)
Leukopenia (6%)
Genital inflammation /abscess (2%)
Renal toxicity (10%)
Hemorrhagic cystitis (9%)
Nocturia (5%)
Urinary incontinence (2-6%)
Arthralgia/myalgia (3-7%)
Pulmonary infection (3%)
<1%
Urea nitrogen in blood increased
Creatinine increased
Disseminated sepsis
Hepatitis
Coagulopathy
Myoglobinuria
Nephritis
Uveitis
Warnings
Black Box Warning
Intravesical administration may cause disseminated infections
Contains live attenuated mycobacteria (handle with care and dispose properly)
Contraindications
Hypersensitivity, immunosuppression (corticosteroids)
Acquired immune deficiencies
Active tuberculosis
HIV infected patients
Bladder
- Febrile illness
- Urinary tract infection
- Gross hematuria
- Biopsy
- Transurethral resection
- Traumatic catherization
Cautions
Bacillus Calmette-Guérin strain of Mycobacterium bovis
Patient should have Mantoux skin test prior to vaccine administration
Following vaccination, Mantoux skin test usually positive; this is not a sensitive indicator of degree of protection
Immunity not permanent; duration unpredictable
Treat anaphylactoid reactions immediately
Intravesical administration may cause symptoms of bladder irritability 4-6 hr after instillation and increase in severity following each instillation; may last 24-72 hr
Use caution in patients with small bladder capacity
Postpone intravesical instillation during antibiotic therapy
Vaccination not recommended for patients with positive PPD reaction
Not for the treatment of active tuberculosis or prevention of cancer
May not result in effective immunity in all patients
Packaging may contain latex
Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967
Up-to-date vaccination schedules available at www.cdc.gov/nip/publications
Pregnancy & Lactation
Pregnancy Category: C
Lactation: Not known if excreted in breast milk, not recommended
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
M. bovis strain in the vaccine, immunologically similar to M. tuberculosis, produces cell-mediated immunity and simulates M. tuberculosis infection
May convey active immunity via stimulation of production of endogenously produced antibodies
The onset of protection from disease is relatively slow, but duration is long lasting (years)
In bladder cancer a local inflammatory reaction may lead to destruction of superficial tumor cells of the endothellium; stimulates the host's immune system to reject the tumor
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Formulary
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