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List of Medications Contraindicating Receipt of Smallpox
Vaccine
The ACIP recommends that individuals taking medications in certain pharmacologic categories not be vaccinated with the smallpox vaccine. There is concern that enhanced vaccinia virus replication due to medication-induced immunosuppression may occur, leading to the possibility of untoward effects of the virus in the person taking these medications.
General categories of medications that are considered immunosuppressive
- Alkylating agents
- Antimetabolites, or
- High-dose
corticosteroids (> 2 mg/kg body weight or 20 mg/day of prednisone for
> 2 weeks).
- Other immunosuppressive medications, immune suppressing antibodies
and interferons
The categories of medications include those used to directly treat cancers
and those that adversely affect the immune system (at recommended doses/duration
or greater). Corticosteroids used in greater than physiologic doses may
reduce the immune response to the vaccine. Persons being treated with or
taking high dose corticosteroids should not be vaccinated with the smallpox
vaccine within one month of completing corticosteroid therapy, and persons
being treated with other immunosuppressive drugs within the prior 3 months
should not be vaccinated.
The attached list is for general guidance about medications that if an
individual is taking may contraindicate them from receiving the smallpox
vaccine This list is not meant to be exhaustive but to serve as a guide
to clinicians seeking to assist patients decide if they should be vaccinated
with the smallpox vaccine. One should note that certain other medications
not listed, may idiosyncratically and in certain health conditions, be
immunosuppressive. Therefore clinical judgment is needed to decide the
impact of these medications for patients based on their health status.
The medications are listed in alphabetic order of their generic names.
Contributors to the development of this document
Charles C. Thomas, R. Ph., FAPhA
State Pharmacy Director
Alabama Department of Public Health
Seymour Williams, MD
Medical Epidemiologist
Smallpox Preparedness and Response Activity
National Immunization Program, MS E-05
Centers for Disease Control and Prevention
POSSIBLE
DRUG CONTRAINDICATIONS TO ADMINISTRATION OF SMALLPOX (Vaccinia)
VACCINE
(Alphabetically sorted by Generic name)
GENERIC
DRUG |
BRAND
NAME DRUG |
CATEGORY
|
*EQUIVALENCY
NUMBER TO PREDNISONE |
Abacavir |
Ziagen® |
T
|
|
Abciximab |
ReoPro® |
M
|
|
Adalimumab |
Humira |
DMARD
|
|
Aldesleukin |
Interleukin
2® |
A
|
|
Altretamine |
Hexalen |
A
|
|
Aminoglutethimide |
Cytadren |
A
|
|
Amprenivir |
Agenerase® |
T
|
|
Anakinra |
Kineret® |
D
|
|
Anastrozole |
Arimidex |
A
|
|
Asparaginase |
Elspar® |
A
|
|
Azathioprine |
Imuran® |
I
|
|
Basiliximab |
Simulect® |
M
|
|
Betamethasone |
Celestone® |
C
|
0.12 |
Betamethasone |
Valisone® |
C
|
0.12 |
Bleomycin |
Blenoxane® |
A
|
|
Busulfan |
Myleran® |
A
|
|
Capecitabine |
Xeloda |
A
|
|
Carboplatin |
Paraplatin® |
A
|
|
Carmustine |
BiCNU® (BCNU) |
A
|
|
Chlorambucil |
Leukeran® |
A
|
|
Cidofovir |
Vistide® |
T
|
|
Cisplatin |
cis-diamminedichloroplatinum
II [cDDP] |
A
|
|
Cisplatin |
Platinol® |
A
|
|
Cladribine |
Leustatin® |
A
|
|
Cortisone |
Cortone® |
C
|
5 |
Cyclophosphamide |
CTX |
A
|
|
Cyclophosphamide |
Cytoxan® |
A
|
|
Cyclophosphamide |
Neosar |
A
|
|
Cyclosporine |
Neoral® |
I
|
|
Cyclosporine |
Sandimmune® |
I
|
|
Cytarabine |
ara-C |
A
|
|
Cytarabine |
Cytosar-U® |
A
|
|
Cytarabine |
DepoCyt |
A
|
|
Dacarbazine |
DTIC-Dome® |
A
|
|
Dacarbazine |
Imidazole
Carboxamide |
A
|
|
Daclizumab |
Zenopax |
M
|
|
Dactinomycin |
Cosmegan® |
A
|
|
Daunorubicin |
Cerubidine® |
A
|
|
Daunorubicin |
Daunomycin |
A
|
|
Daunorubicin |
Daunoxome® |
A
|
|
Daunorubicin |
Rubidomycin |
A
|
|
Delavirdine |
Rescriptor® |
T
|
|
Denileukin
diftitox |
Ontak |
A
|
|
Dexamethasone |
Decadron® |
C
|
|
Didanosine |
Videx® |
T
|
|
Docetaxel |
Taxotere |
A
|
|
Doxorubicin |
Adriamycin |
A
|
|
Doxorubicin |
Doxil® |
A
|
|
Doxorubicin |
Hydroxydaunorubicin |
A
|
|
Doxorubicin |
Rubex |
A
|
|
Efavirenz |
Sustiva® |
T
|
|
Epirubicin |
Ellence |
A
|
|
Estramustine |
Emcyt |
A
|
|
Etanercept |
Enbrel® |
D
|
|
Etoposide |
Etopophos® |
A
|
|
Etoposide |
VePesid® |
A
|
|
Exemestane |
Aromasin |
A
|
|
Floxuridine |
Fluorodeoxyuridine |
A
|
|
Floxuridine |
FUDR® |
A
|
4 |
Fludarabine |
FAMP |
A
|
4 |
Fludarabine |
Fludara® |
A
|
4 |
Fluorouracil |
5-FU® |
A
|
|
Fluorouracil |
Adrucil |
A/Derm
|
4 |
Fluorouracil |
Efudex® |
A/Derm
|
|
Flutamide |
Eulexin® |
A
|
|
Gemcitabine |
Gemzar |
A
|
|
Gemtuzumab
ozogamicin |
Mylotarg |
AI
|
|
Hydrocortisone |
Cortef® |
C
|
|
Hydrocortisone |
Hydrocortone® |
C
|
|
Hydroxychloroquine |
Plaquenil® |
T
|
|
Hydroxyurea |
Hydrea® |
A
|
|
Idarubicin |
Idamycin |
A
|
|
Ifosphamide |
Ifex® |
A
|
|
Indinavir |
Crixivan® |
T
|
|
Infliximab |
Remicade® |
M
|
|
Interferon
alfa-2a |
Roferon-A® |
A
|
|
Interferon
alfa-2b |
Intron-A® |
A
|
|
Interferon
beta-1a |
Avonex® |
AV
|
|
Interferon
beta-1b |
Betaseron® |
AV
|
|
Interferon
gamma-1b |
Actimmune® |
A
|
|
Interleukin-2 |
Aldesleukin |
AI
|
|
Interleukin-2 |
Proleukin |
AI
|
|
Irinotecan |
Camptosar |
A
|
|
Isotretinoin |
Accutane |
Aderm
|
|
Lamivudine |
Epivir® |
T
|
|
Lamivudine & Zidovudine |
Combivir® |
T
|
|
Leflunomide |
Arava® |
D
|
|
Letrozole |
Femara |
A
|
|
Leuprolide |
Lupron® |
A
|
|
Lomustine |
CeeNu® (CCNU) |
A
|
|
Mechlorethamine
HCI |
Mustargen® |
A
|
|
Mechlorethamine
HCI |
Nitrogen
Mustard |
A
|
|
Megestrol |
Megace® |
A
|
|
Melphalan |
Alkeran® |
A
|
0.8 |
Melphalan |
L-Phenylalanine
Mustard |
A
|
|
Melphalan |
L-Sarcolysine |
A
|
|
Mercaptopurine |
Purinethol® |
A
|
|
Methotrexate |
Amethopterin |
A
|
|
Methotrexate |
Mexate |
A
|
|
Methotrexate |
Rheumatrex® |
D
|
|
Methotrexate |
Trexall™ |
D
|
|
Methylprednisolone |
Medrol® |
C
|
|
Mitomycin |
Mutamycin® |
A
|
|
Mitotane |
Lysodren® |
A
|
|
Mitoxantrone |
Dihydroxyanthracenedione |
A
|
|
Mitoxantrone |
Novantrone |
A
|
|
Muromonab-CD3 |
Orthoclone-OKT3 |
M
|
|
Mycophenolate |
Cellsept® |
I
|
|
Nelfinavir |
Viracept® |
T
|
|
Nevirapine |
Viramune® |
T
|
|
Paclitaxel |
Taxol® |
A
|
|
Pegaspargase |
Oncaspar® |
A
|
1 |
Penicillamine |
Cuprimine® |
D
|
1 |
Pentostatin |
Nipent® |
A
|
1 |
Pimecrolimus |
Elidel |
Derm
|
|
Pipobroman |
Vercyte® |
A
|
1 |
Plicamycin |
Mithracin® |
A
|
1 |
Prednisolone |
Pediapred® |
C
|
1 |
Prednisolone |
Prelone® |
C
|
|
Prednisone |
DeltaCortef® |
C
|
|
Prednisone |
Deltasone® |
C
|
|
Prednisone |
Meticorten® |
C
|
|
Prednisone |
Sterapred® |
C
|
|
Priliximab |
Centara |
M
|
|
Procarbazine |
Matulane® |
A
|
|
Procarbazine |
Natulanar |
A
|
|
Procarbazine |
N-Methylhydrazine |
A
|
|
Ritonavir |
Norvir® |
T
|
|
Rituximab |
Rituxan |
AI
|
|
Saquinavir |
Fortovase® |
T
|
|
Saquinavir |
Invirase® |
T
|
|
Sargramostim |
Leukine |
I
|
|
Sargramostim |
Leukomax |
I
|
|
Stavudine |
Zerit® |
T
|
|
Streptozocin |
Zanosar® |
A
|
|
Tacrolimus |
Prograf® |
I
|
|
Temozolomide |
Temodar |
A
|
|
Teniposide |
VM-26® |
A
|
|
Teniposide |
Vumon® |
A
|
|
Testolactone |
Teslac® |
A
|
|
Thioguanine |
6-TG® |
A
|
|
Thioguanine |
Aminopurine-6-Thiol-Hemihydrate |
A
|
|
Thioguanine |
Lavis |
A
|
0.8 |
Thioguanine |
Tabloid |
A
|
|
Thiotepa |
TESPA
(TSPA) |
A
|
|
Thiotepa |
Thioplex® |
A
|
|
Thiotepa |
Triethylenethiophosphoramide |
A
|
|
Trastuzumab |
Herceptin |
AI
|
|
Tretinoin |
All-Trans
Retinoic Acid |
A
|
|
Tretinoin |
Vesanoid |
A
|
|
Triamcinolone |
Kenalog® |
C
|
|
Uracil
mustard |
Uracil
Mustard |
A
|
|
Valrubicin |
Valstar® |
A
|
|
Vinblastine |
Velban® |
A
|
|
Vinblastine |
Velsar |
A
|
|
Vincristine |
Oncovin® |
A
|
|
Vinorelbine |
Navelbine® |
A
|
|
Zalcitabine |
Hivid® |
T
|
|
Zidovudine |
AZT® |
T
|
|
Zidovudine |
Retrovir® |
T
|
|
|
KEY
A = Antineoplastic Agent
AV = Antiviral Agent
C = Corticosteroid
D = DMARD
(Disease Modifying Anti-Rheumatic Drug)
I = Immunosuppressive
M = Monoclonal
Antibody Drug
T = treats immunosuppressive diseases or used for them prophylactically
Derm
= Dermatologic use
*Equivalency Number To Prednisone = represents a number
which when divided into the dose of a similar drug will yield a dose that
is approximately equal to the prednisone dosage.
Sources:
- American Hospital Formulary Service, 1996
- Pharmacist's Handbook of Drugs, ASHP 2001 Edition
- Package Insert, Dryvax Smallpox Vaccine, Wyeth Labs, published August
30, 2002
- CDC, Advisory Committee of Immunization Practices
- Drug Information Handbook, Lexicomp, 6th Edition
- Grabenstein JD. ImmunoFacts: Vaccine and Immunologic Drugs. St. Louis:
Facts and Comparisons, 2002
- Lippincott Williams & Wilkins:
LWW ONCOLOGY
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Page last reviewed August 5, 2004
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