vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .ublituximabublituximab decreases effects of diphtheria & tetanus toxoids 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.Minor (1)chloroquinechloroquine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Minor/Significance Unknown.adalimumabSerious - Use Alternative (1)adalimumab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.alefaceptSerious - Use Alternative (1)alefacept decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.anakinraSerious - Use Alternative (1)anakinra decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.antithymocyte globulin equineSerious - Use Alternative (1)antithymocyte globulin equine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.antithymocyte globulin rabbitSerious - Use Alternative (1)antithymocyte globulin rabbit decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.azathioprineSerious - Use Alternative (1)azathioprine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.basiliximabSerious - Use Alternative (1)basiliximab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.belataceptMonitor Closely (1)belatacept decreases effects of diphtheria & tetanus toxoids by Other (see comment). Use Caution/Monitor. Comment: The use of live vaccines should be avoided during treatment with belatacept. Inform patients that vaccinations may be less effective while they are being treated with belatacept.belimumabContraindicated (1)belimumab decreases effects of diphtheria & tetanus toxoids by immunosuppressive effects; risk of infection. Contraindicated. Do not administer live vaccines 30 days before or concurrently with belimumab.budesonideSerious - Use Alternative (1)budesonide decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.canakinumabSerious - Use Alternative (1)canakinumab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.certolizumab pegolMonitor Closely (1)certolizumab pegol decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Use Caution/Monitor.chloroquineMinor (1)chloroquine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Minor/Significance Unknown.cortisoneSerious - Use Alternative (1)cortisone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.cyclosporineSerious - Use Alternative (1)cyclosporine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.deflazacortSerious - Use Alternative (1)deflazacort decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.delandistrogene moxeparvovecMonitor Closely (1)delandistrogene moxeparvovec, diphtheria & tetanus toxoids. Other (see comment). Use Caution/Monitor. Comment: Consider patient vaccination status before initiating corticosteroid regimen required before delandistrogene moxeparvovec administration. If possible, ensure patients are current with all immunizations according to immunization guidelines. Complete vaccinations at least 4 weeks before starting corticosteroid regimen. High-dose or long-term corticosteroids may decrease immungenicity of vaccines.dengue vaccineMonitor Closely (1)dengue vaccine, diphtheria & tetanus toxoids. unspecified interaction mechanism. Use Caution/Monitor. Data are not available to establish safety and immunogenicity of coadministration of dengue vaccine with recommended adolescent vaccines.dexamethasoneSerious - Use Alternative (1)dexamethasone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.elivaldogene autotemcelSerious - Use Alternative (1)elivaldogene autotemcel, diphtheria & tetanus toxoids. Either decreases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: The safety and effectiveness of vaccination during or following elivaldogene autotemcel treatment have not been studied. Vaccination is not recommended during the 6 weeks preceding myeloablative conditioning, and until hematological recovery following elivaldogene autotemcel treatment. Where feasible, administer childhood vaccinations before myeloablative conditioning. .etanerceptSerious - Use Alternative (1)etanercept decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.everolimusSerious - Use Alternative (1)everolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.fludrocortisoneSerious - Use Alternative (1)fludrocortisone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.glatiramerSerious - Use Alternative (1)glatiramer decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.golimumabSerious - Use Alternative (1)golimumab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.hydrocortisoneSerious - Use Alternative (1)hydrocortisone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.hydroxychloroquine sulfateSerious - Use Alternative (1)hydroxychloroquine sulfate decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.ifosfamideMonitor Closely (1)ifosfamide decreases effects of diphtheria & tetanus toxoids by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .infliximabSerious - Use Alternative (1)infliximab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.ixekizumabSerious - Use Alternative (1)ixekizumab decreases effects of diphtheria & tetanus toxoids by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating ixekizumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with ixekizumab may not elicit an immune response sufficient to prevent disease.leflunomideSerious - Use Alternative (1)leflunomide decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.melphalanMonitor Closely (1)melphalan decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .mercaptopurineMonitor Closely (1)mercaptopurine decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Use Caution/Monitor. Immunosuppressants also increase risk of infection with concomitant live vaccines.methotrexateMonitor Closely (1)methotrexate decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Use Caution/Monitor. Concomitant administration of methotrexate can decrease the immunological response of vaccines.methylprednisoloneSerious - Use Alternative (1)methylprednisolone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.muromonab CD3Serious - Use Alternative (1)muromonab CD3 decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.mycophenolateSerious - Use Alternative (1)mycophenolate decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.oxaliplatinMonitor Closely (1)oxaliplatin decreases effects of diphtheria & tetanus toxoids by passive renal tubular reabsorption due to increased pH. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .prednisoloneSerious - Use Alternative (1)prednisolone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.prednisoneSerious - Use Alternative (1)prednisone decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.rilonaceptSerious - Use Alternative (1)rilonacept decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.secukinumabSerious - Use Alternative (1)secukinumab decreases effects of diphtheria & tetanus toxoids 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 diphtheria & tetanus toxoids 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.sirolimusSerious - Use Alternative (1)sirolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.tacrolimusSerious - Use Alternative (1)tacrolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.temsirolimusSerious - Use Alternative (1)temsirolimus decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.teplizumabSerious - Use Alternative (1)teplizumab decreases effects of diphtheria & tetanus toxoids 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.tocilizumabSerious - Use Alternative (1)tocilizumab decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Immunosuppressants also increase risk of infection with concomitant live vaccines.triamcinolone acetonide injectable suspensionSerious - Use Alternative (1)triamcinolone acetonide injectable suspension decreases effects of diphtheria & tetanus toxoids by pharmacodynamic antagonism. Contraindicated. Corticosteroids also increase risk of infection with concomitant live vaccines.ublituximabMonitor Closely (1)ublituximab decreases effects of diphtheria & tetanus toxoids 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.ustekinumabSerious - Use Alternative (1)ustekinumab decreases effects of diphtheria & tetanus toxoids 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. Suspected adverse events after administration of any vaccine may be reported to Vaccine Adverse Events Reporting System (VAERS), 1-800-822-7967 >10% (Age 7 yr or older) Injection site pain (35.3-80.1%) Muscle weakness (4.9-32.3%) Injection site redness (15.8-25.6%) Headache (11.7-24.1%) Injection site swelling (12.1-17%) Malaise (8.9-17%) Sore/swollen joints (8.5-15.7%) 1-10% (Age 7 yr or older) Fever (2.5-5.7%) Postmarketing Reports (Age 7 yr or older) Blood and lymphatic system disorders: Lymphadenopathy Immune system disorders: Allergic reactions (eg, erythematous rash, maculopapular rash, urticaria, pruritus); anaphylactic reaction (bronchospasm, angioedema) Nervous system disorders: Paresthesia, dizziness, syncope, Guillain-Barre syndrome Gastrointestinal disorders: Vomiting Musculoskeletal, connective tissue and bone disorders: Myalgia, pain in extremities General disorders and administration site conditions: Injection site reactions (including inflammation, mass, edema, induration, warmth, pruritus, cellulitis, discomfort); fatigue, edema peripheral Contraindications Hypersensitivity to toxoids or any component of the formulation Cautions Prior to the administration of the vaccine recipient’s current health status and health history should be reviewed; this includes a review of the immunization history of the patient, the presence of any contraindications to immunization, and any adverse events after previous immunizations to allow an assessment of the benefits and risks of vaccination Treatment (including epinephrine 1:1000) for anaphylactoid/hypersensitivity reactions should be immediately available when administering vaccine Check vaccine for latex content Do not exceed dosing frequency; more frequent doses may be associated with increased incidence and severity of adverse reactions Persons who experienced