Top 300 Pharmacy Drug Cards

ZOSTER VACCINE, LIVE: Zostavax

Class: Vaccine, Live, Viral

Dosage Forms. Suspension for Subcutaneous Injection: 0.65 mL after reconstitution

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Common FDA Label Indication, Dosing, and Titration.

1. Prevention of herpes zoster (zoster, shingles): Adults, single dose for adults aged 50 y and older

Off-Label Uses. None

Drug Characteristics: Zoster Vaccine, Live

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Medication Safety Issues: Zoster Vaccine, Live

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Drug Interactions: Zoster Vaccine, Live

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Adverse Reactions: Zoster Vaccine, Live

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Efficacy Monitoring Parameters. Prevention of herpes zoster (shingles).

Toxicity Monitoring Parameters. Monitor vital signs after administration.

Key Patient Counseling Points. About one in three individuals develops a rash at the injection site, which resolves after a few days with no treatment. The zoster vaccine is not 100% effective in preventing zoster. However, the disease and its consequences are less severe in immunized individuals who develop zoster.

Clinical Pearls. A history of chicken pox need not be obtained prior to zoster vaccine administration as birth before 1980 is considered evidence of varicella immunity. Consider administering the vaccine to 50- to 59-year-olds who are anticipating immunosuppressive therapy and those with HIV. Single dose recommended for all adults aged 60 y and older without regard to history of shingles; zoster vaccine may be administered to individuals on inhaled, topical or intra-articular steroids or low-dose oral steroids, treated with low-dose methotrexate (< 0.4 mg/kg/wk) or 6-mercaptopurine (<1.5 mg/kg/d), anticipating immunosuppressive therapy if vaccine can be administered at least 14 d prior or on antiviral therapy if it is stopped 1 d prior to vaccine administration and held for 14 d. Zoster vaccine can be administered to individuals with HIV if no manifestations of AIDS and CD4+ count >200 per mm3. Avoid in those taking corticosteroids, with HIV, with malignancy, who are immunocompromised, with a history of shingles, or who are pregnant. Not indicated for use in children.


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