initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .rilonaceptMonitor Closely (1)rilonacept decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.rituximabMonitor Closely (1)rituximab, zoster vaccine recombinant. immunosuppressive effects; risk of infection. Use Caution/Monitor. When used for rheumatoid arthritis, follow current immunization guidelines and administer non-live vaccines at least 4 weeks prior to a course of rituximab.rituximab-hyaluronidaseMonitor Closely (1)rituximab-hyaluronidase, zoster vaccine recombinant. immunosuppressive effects; risk of infection. Use Caution/Monitor. When used for rheumatoid arthritis, follow current immunization guidelines and administer non-live vaccines at least 4 weeks prior to a course of rituximab.sarilumabMonitor Closely (1)sarilumab decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.satralizumabMonitor Closely (1)satralizumab decreases effects of zoster vaccine 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. .secukinumabMonitor Closely (1)secukinumab decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.siponimodSerious - Use Alternative (1)siponimod decreases effects of zoster vaccine 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 zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.tacrolimusMonitor Closely (1)tacrolimus decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.temsirolimusMonitor Closely (1)temsirolimus decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.teplizumabSerious - Use Alternative (1)teplizumab decreases effects of zoster vaccine 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 zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.tralokinumabMonitor Closely (1)tralokinumab will decrease the level or effect of zoster vaccine 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 zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.ublituximabMonitor Closely (1)ublituximab decreases effects of zoster vaccine 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.ustekinumabMonitor Closely (1)ustekinumab decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.vedolizumabMonitor Closely (1)vedolizumab decreases effects of zoster vaccine recombinant by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressive therapies may reduce the effectiveness of zoster vaccine recombinant.voclosporinMonitor Closely (1)voclosporin decreases effects of zoster vaccine 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% 50-59 years Pain (88.4%) Fatigue (57%) Myalgia (56.9%) Headache (50.6%) Redness (38.7%) Shivering (35.8%) Swelling (30.5%) Fever (27.8%) Gastrointestinal [GI] symptoms (24.3%) Pain, Grade 3 (10.3%) Redness >100 mm (2.8%) Swelling >100 mm (1.1%) 60-69 years Pain (82.8%) Myalgia (49%) Fatigue (45.7%) Headache (39.6%) Redness (38.4%) Shivering (30.3%) Swelling (26.5%) Fever (23.9%) GI symptoms (16.7%) 70-79 years Pain (69.2%) Myalgia (35.1%) Fatigue (36.6%) Redness (37.7%) Swelling (23%) Headache (29%) Shivering (19.5%) Fever (14.3%) GI symptoms (13.5%) Immunocompromised adults ≥50 years Pain (74-75%) Fatigue (37-46%) Myalgia (37-43%) Redness (21-28%) Headache (15-25%) Shivering (11-21%) GI symptoms (18%) Swelling (10-15%) Fever (6-15%) 18-49 years Pain (81-82%) Fatigue (49-51%) Myalgia (41-51%) Fever (9-28%) Headache (23-38%) Shivering (20-26%) Redness (20-25%) Swelling (14-17%) GI symptoms (13-14%) Pain, Grade 3 (11%) 1-10% 50-59 years Myalgia, Grade 3 (8.9%) Fatigue, Grade 3 (8.5%) Shivering, Grade 3 (6.8%) Headache (6%) Redness >100 mm (2.8%) GI symptoms, Grade 3 (2.1%) Swelling >100 mm (1.1%) 60-69 years Pain, Grade 3 (6.9%) Shivering, Grade 3 (4.5%) Redness, >100 mm (2.6%) Swelling (1%) 70-79 years Pain, Grade 3 (4%) Fatigue, Grade 3 (3.5%) Redness >100 mm (3.1%) Myalgia, Grade 3 (2.8%) Shivering, Grade 3 (2.2%) Headache, Grade 3 (1.5%) Swelling >100 mm (1.3%) GI symptoms, Grade 3 (1.2%) Immunocompromised adults ≥50 years Pain, Grade 3 (5-7%) Fatigue, Grade 3 (3-4%) Myalgia, Grade 3 (2-4%) Shivering, Grade 3 (1-3%) Headache, Grade 3 (0.1-2%) Swelling, >100 mm (2%) Redness, >100 mm (1-2%) GI symptoms, Grade 3 (1%) 18-49 years Fatigue, Grade 3 (6-10%) Myalgia, Grade 3 (4-8%) Shivering, Grade 3 (1-6%) Headache, Grade 3 (1-5%) Redness, >100 mm (1-2%) Fever, Grade 3 (>39.5°C/103 .1°F) (1%) GI symptoms, Grade 3 (1%) Swelling, >100 mm (0.1-1%) <1% 50-59 years Fever, Grade 3 (0.4%) 60-69 years GI symptoms, Grade 3 (0.9%) Pain, Grade 3 (0.5%) Fever, Grade 3 (0.5%) 70-79 years Fever, grade 3 (0.1%) Immunocompromised adults ≥50 years Fever, Grade 3 (0.1-02%) Postmarketing Reports General disorders and administration site conditions: Decreased mobility of injected arm which may persist for >1 week Immune system disorders: Hypersensitivity reactions, including angioedema, rash, and urticaria Nervous system disorders: Guillain-Barre syndrome Contraindications Hypersensitivity (eg, anaphylaxis) to any component of the vaccine Cautions Review immunization history for possible vaccine sensitivity and previous vaccination-related adverse reactions; appropriate medical treatment and supervision must be available to manage possible anaphylactic reactions following administration (see Contraindications) In a postmarketing observational study, an increased risk of Guillain-Barre syndrome was observed during the 42 days following vaccination Syncope can be associated with injectable vaccine administration; may be accompanied by transient neurological signs (visual disturbance, paresthesia, tonic-clonic limb movements); procedures should be in place to avoid falling injury and to restore cerebral perfusion following syncope Drug interactions overview Use caution with concomitant use of vaccine administration of zoster recombinant with inactivated influenza Immunosuppressive therapies may reduce effectiveness of the zoster vaccine Pregnancy There is no available human data to establish vaccine-associated risks with the vaccine in pregnant women Lactation Unknown whether zoster vaccine is excreted in human milk Data are not available to assess effects of the zoster vaccine on the breastfed infant or on milk production/excretionPregnancy 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 Conveys active immunity by stimulating production of endogenously produced antibodies Vaccine boosts VZV-specific immune response, which is thought to be the mechanism by which it protects against zoster disease IM Preparation Reconstitute lyophilized varicella zoster virus glycoprotein E (gE) antigen with the AS01B adjuvant suspension Reconstituted vaccine should be an opalescent, colorless to pale brownish liquid Visually inspect for particulate matter and discoloration prior to administration, whenever solution and container permit IM administration IM use only Withdraw 0.5 mL from reconstituted vial Administer IM immediately Store in refrigerator at 2-8°C (36-46°F) for up to 6 hr if unable to administer immediately Preferred site for IM injection is the deltoid region of the upper arm Storage Before reconstitution Vials of adjuvant suspension and antigen component Refrigerate at 2-8°C (36-46°F) Protect from light Do not freeze; discard if adjuvant suspension or antigen component have been frozen Reconstituted vials If not administered immediately, refrigerate at 2-8°C (36-46°F) for up to 6 hr Discard reconstituted vaccine if not used within 6 hr Do not freeze; discard if the vaccine has been frozen BRAND FORM. UNIT PRICE PILL IMAGE Shingrix (PF) intramuscular- 50 mcg/0.5 mL kitShingrix (PF) intramuscular- 50 mcg/0.5 mL kitCopyright © 2010 First DataBank, Inc.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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