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Table. Recommendations for use of Zostavax in people aged ≥50 years on immunosuppressive therapy

Immunosuppressive therapy	Safe dose to vaccinate	Dose at which Zostavax is contraindicated	Acceptable timing of Zostavax if dose is contraindicated
Corticosteroid monotherapy	≤20 mg per day of prednisolone or equivalent^a	≥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
Corticosteroid monotherapy	≤20 mg per day of prednisolone or equivalent^a	≥20 mg per day of prednisolone or equivalent for 14 days or longer	At least 1 month before treatment starts, or At least 1 month 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 At 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 At 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 At 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 At least 12 months after treatment stops
Other csDMARDs	None	All regimens	At least 1 month before treatment starts, or At 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 At 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	1 month before treatment starts, or At least 12 months after treatment stops — this must be discussed with the treating physician
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.

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Last updated

1 November 2023

Last reviewed

1 November 2023

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