zoster vaccine live (Rx)

Brand and Other Names:Zostavax
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injection solution

  • 19,400 PFU/0.65 mL

Shingles Prophylaxis

Live attenuated virus vaccine indicated for prevention of herpes zoster (shingles) in adults aged ≥50 years

0.65 mL (entire content of vial) injected SC into upper arm as single dose

ACIP recommendation

  • Although the vaccine is FDA-licensed for patients ≥50 years, the Advisory Committee on Immunization Practices (ACIP) recommends that vaccination with Zostavax begin at 60 years
  • For adults aged >60 yr, administer either recombinant zoster vaccine (Shingrix) or zoster vaccine live (Zostavax), although ACIP and CDC recommendations state that Shingrix is preferred owing to longer lasting immunity; additionally, Shingrix may be administered starting at age 50 years
  • Current immunization schedules available at http://www.cdc.gov/vaccines/schedules/hcp/index.html

Dosing Considerations

Limitations of use

  • Zostavax is not indicated for the treatment of zoster or postherpetic neuralgia (PHN)
  • Zostavax is not indicated for prevention of primary varicella infection (chickenpox)

Safety and efficacy not established

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Interactions

Interaction Checker

and zoster vaccine live

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Suspected adverse events after administration of vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS) at 1-800-822-7967

            >10%

            Injection-site erythema

            Pain or tenderness

            Pruritus

            Swelling

            Warmth

            1-10%

            Diarrhea (2%)

            Fever (2%)

            Flulike syndrome (2%)

            Upper respiratory tract infection (2%)

            Headache (1%)

            Rhinitis (1%)

            Skin disorder (1%)

            Weakness (1%)

            <1%

            Arthralgia

            Hypersensitivity

            Injection-site reactions

            Postmarketing Report

            Herpes zoster

            Necrotizing retinitis (patients on immunosuppressive therapy)

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            Warnings

            Contraindications

            Hypersensitivity to gelatin, neomycin

            Pregnancy

            Immunosuppressed or immunodeficient individuals (eg, those with a history of primary or acquired immunodeficiency states, leukemia, lymphoma, or other malignant neoplasms affecting bone marrow or lymphatic system; those with AIDS or other clinical manifestations of infection with HIV; those receiving immunosuppressive therapy; those with active tuberculosis)

            Cautions

            Serious adverse reactions (eg, anaphylaxis) have occurred with zoster live vaccine; adequate treatment provisions, including epinephrine injection (1:1,000), should be available for immediate use should an anaphylactic/anaphylactoid reaction occur

            Disseminated disease may occur in the zoster vaccine is given to immunosuppressed/immunodeficient patients (see Contraindications)

            Transmission of vaccine virus may occur between vaccinees and susceptible contacts

            Deferral should be considered in acute illness (for example, in the presence of fever) or in patients with active untreated tuberculosis

            Vaccination with zoster live vaccine does not result in protection of all vaccine recipients; duration of protection beyond 4 years after vaccination with zoster live vaccine is unknown; the need for revaccination has not been defined

            Drug interactions overview

            • Concomitant administration with other vaccines may reduce immune response; consider administering the vaccines separately by at least 4 weeks
            • Concurrent administration of zoster live vaccine and antiviral medications known to be effective against VZV has not been evaluated
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            Pregnancy & Lactation

            Pregnancy

            Contraindicated for use in pregnant women because the vaccine contains live, attenuated varicella-zoster virus, and it is known that wild-type varicella-zoster virus, if acquired during pregnancy, can cause congenital varicella syndrome (see Contraindications)

            Lactation

            Unknown whether varicella-zoster vaccine virus is excreted in human milk

            For preventive vaccines, the underlying maternal condition is susceptibility to disease prevented by the vaccine

            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

            Conveys active immunity by stimulating production of endogenously produced antibodies

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            Administration

            SC Administration

            Reconstitute vaccine by using diluent supplied, first withdrawing all contents of diluent vial into syringe, then injecting solution into vial of lyophilized vaccine, and finally agitating to mix

            Use separate needles and syringes for reconstituting and administration

            Administer immediately after reconstitution

            Inject total volume of reconstituted vaccine SC into upper arm

            Discard if not used within 30 minutes

            Storage

            During shipment: vaccine must be maintained at a temperature of 8°C (46°F) or colder, but not to exceed temperatures lower than -50°C (-58°F)

            Unused vials: Store in refrigerator at 2-8°C (36-46°F) or colder until it is reconstituted for injection; protect from light

            Diluent: Store separately at room temperature (20-25°C, 68-77°F) or in the refrigerator (2-8°C, 36-46°F

            Reconstituted vaccine: Store separately at room temperature 20-25°C (68-77°F) or in the refrigerator 2-8°C (36-46°F) for up to 30 minutes

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            Formulary

            FormularyPatient Discounts

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            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.
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            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
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            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.
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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.