individuals.satralizumabMonitor Closely (1)satralizumab decreases effects of influenza virus vaccine quadrivalent, recombinant by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Administer all immunizations according to immunization guidelines. At least 2 weeks before initiating for non-live vaccines. .secukinumabSerious - Use Alternative (1)secukinumab decreases effects of influenza virus vaccine quadrivalent, recombinant 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.siponimodSerious - Use Alternative (1)siponimod decreases effects of influenza virus vaccine quadrivalent, recombinant 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.sirolimusMonitor Closely (1)sirolimus decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.tacrolimusMonitor Closely (1)tacrolimus decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.temsirolimusMonitor Closely (1)temsirolimus decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.teplizumabSerious - Use Alternative (1)teplizumab decreases effects of influenza virus vaccine quadrivalent, recombinant 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.tocilizumabMonitor Closely (1)tocilizumab decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.tralokinumabMonitor Closely (1)tralokinumab will decrease the level or effect of influenza virus vaccine quadrivalent, recombinant by immunosuppressive effects; risk of infection. Use Caution/Monitor. Limited data are available regarding coadministration with non-live vaccines.triamcinolone acetonide injectable suspensionMonitor Closely (1)triamcinolone acetonide injectable suspension decreases effects of influenza virus vaccine quadrivalent, recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immune response to vaccine may be decreased in immunocompromised individuals.ublituximabMonitor Closely (1)ublituximab decreases effects of influenza virus vaccine quadrivalent, recombinant 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.ustekinumabContraindicated (1)ustekinumab decreases effects of influenza virus vaccine quadrivalent, recombinant 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.voclosporinMonitor Closely (1)voclosporin decreases effects of influenza virus vaccine quadrivalent, recombinant by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Inactivated vaccines noted to be safe for administration may not be sufficiently immunogenic during treatment. >10% Injection site tenderness (34-48%) Injection site pain (19-37%) Headache (13-20%) Fatigue (12-17%) Myalgia (13%) 1-10% Arthralgia (10%) Nausea (9%) Chills (7%) Injection site swelling/bruising (5%) Injection site redness (4%) Contraindications Severe hypersensitivity (eg, anaphylaxis) to any component of the vaccine Cautions Appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration of the vaccine Influenza vaccine may not protect all susceptible individuals If the rare occurrence of Guillain-Barré syndrome (GBS) has occurred within 6 weeks of receipt of a prior influenza vaccine, the decision to give the vaccine should be based on careful consideration of the potential benefits and risks Expected immune response may not be obtained in immunocompromised individuals, including those receiving immunosuppressive therapy Pregnancy Available data on the trivalent or quadrivalent formulations administered to pregnant women are insufficient to inform vaccine-associated risks in pregnant women Pregnancy outcomes in women who have been exposed to Flublok Quadrivalent during pregnancy are being monitored Contact: Protein Sciences Corporation 1-888-855-7871 Clinical considerations Pregnant women are at increased risk of complications associated with influenza infection compared with nonpregnant women Pregnant women with influenza may be at increased risk for adverse pregnancy outcomes, including preterm labor and delivery Lactation Unknown if distributed in human breast milk Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal conditionPregnancy 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. Mechanism of Action Contains recombinant hemagglutinin (HA) proteins of the 4 strains of influenza virus specified by health authorities for inclusion in the annual seasonal vaccine These proteins function as antigens, which induce a humoral immune response, measured by hemagglutination inhibition (HI) antibody IM Preparation Invert the prefilled syringe gently prior to affixing the appropriate size needle for IM administration Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit If either of these conditions exists, the vaccine should not be administered Do not mix in the same syringe with any other vaccine IM Administration Preferred IM injection site is the deltoid muscle Storage Refrigerate between 2-8°C (36-46°F) Do not freeze; discard if product has been frozen Protect syringes from light Do not use after expiration date No images available for this drug. No images available for this drug.A Patient Handout is not currently available for this monograph.Print FormularyPatient DiscountsAdding plans allows you to compare formulary status to other drugs in the same class.To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.Create Your List of PlansAdding plans allows you to:View the formulary and any restrictions for each plan.Manage and view all your plans together – even plans in different states.Compare formulary status to other drugs in the same class.Access your plan list on any device – mobile or desktop. The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. View explanations for tiers and restrictions 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. 3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs. 4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products. 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. QL Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered. ST Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription. OR Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription. 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