Immunosuppressive therapy Safe dose to vaccinate Dose at which vaccine is contraindicated  Acceptable timing of Zostavax if dose is contraindicated
Corticosteroid monotherapy ≤20 mg per day of prednisolone or equivalenta ≥20 mg/day of prednisolone or equivalent for less than 14 days
  • At least 1 month before treatment starts, or
  • Any time after treatment stops
≥20 mg per day of prednisolone or equivalent for 14 days or longer
  • At least 1 month before treatment starts, or
  • Any time after treatment stops
csDMARD — azathioprine ≤3.0 mg per kg per day (if used as a single agent, with or without low-dose corticosteroids) >3.0 mg per kg per day
  • At least 1 month before treatment starts, or
  • Any least 3 months after treatment stops
csDMARD — 6-mercaptopurine ≤1.5 mg per kg per day (if used as a single agent, with or without low-dose corticosteroids) >1.5 mg per kg per day
  • At least 1 month before treatment starts, or
  • Any least 3 months after treatment stops
csDMARD — methotrexate ≤0.4 mg per kg per week (if used as a single agent, with or without low-dose corticosteroids) >0.4 mg per kg per week
  • At least 1 month before treatment starts, or
  • Any least 3 months after treatment stops
csDMARDs — sulfasalazine or hydroxychloroquine Any dose None Not applicable
csDMARD — mycophenolate None All regimens
  • At least 1 month before treatment starts, or
  • Any least 12 months after treatment stops
Other csDMARDs None All regimens
  • At least 1 month before treatment starts, or
  • Any least 3 months after treatment stops
T-cell inhibitors or activators (eg tacrolimus, cyclosporine; except denosumab, for which there is no evidence of significant immunosuppression) None All regimens
  • At least 1 month before treatment starts, or
  • Any least 3 months after treatment stops
Other unspecified immunosuppressants (eg chemotherapy, radiotherapy) None All regimens
  • At least 1 month before treatment starts, or
  • At least 3 months after treatment stops, and at least 6 months for people who have received chemotherapy or radiotherapy (based on an individual patient risk assessment)
Anti-TNF agents (eg etanercept, infliximab, adalimumab) None All regimens
  • At least 1 month before treatment starts, or
  • At least 12 months after treatment stops
tsDMARDs — Janus kinase inhibitors (eg tofacitinib), phosphodiesterase-4 inhibitors (eg apremilast), or bDMARDs — monoclonal antibodies, IL inhibitors (eg anakinra, tocilizumab), costimulation blockers (eg abatacept), B-cell depleting agents (eg rituximab) None All regimens
  • At least 1 month before treatment starts, or
  • At least 12 months after treatment stops
Haematopoietic stem cell transplant None All regimens
  • At least 1 month before transplant, or
  • At least 24 months after transplant

b = biologic; cs = conventional synthetic; DMARD = disease-modifying anti-rheumatic drug; IL = interleukin; TNF = tumour necrosis factor; ts - target synthetic

a If person is on long-term corticosteroid monotherapy or corticosteroid therapy combined with other disease-modulating or immunosuppressive therapy, consider delaying Zostavax and consulting with both the treating doctor and an immunisation specialist.

For more information, please refer to the Zostavax screening tool.

Last updated: 
13 January 2021
Last reviewed: 
13 January 2021