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List of Medications Contraindicating Receipt of Smallpox Vaccine

The ACIP recommends that individuals taking medications in certain pharmacologic categories not be vaccinated with the smallpox vaccine. There is concern that enhanced vaccinia virus replication due to medication-induced immunosuppression may occur, leading to the possibility of untoward effects of the virus in the person taking these medications.

General categories of medications that are considered immunosuppressive

  • Alkylating agents
  • Antimetabolites, or
  • High-dose corticosteroids (> 2 mg/kg body weight or 20 mg/day of prednisone for > 2 weeks).
  • Other immunosuppressive medications, immune suppressing antibodies and interferons

The categories of medications include those used to directly treat cancers and those that adversely affect the immune system (at recommended doses/duration or greater). Corticosteroids used in greater than physiologic doses may reduce the immune response to the vaccine. Persons being treated with or taking high dose corticosteroids should not be vaccinated with the smallpox vaccine within one month of completing corticosteroid therapy, and persons being treated with other immunosuppressive drugs within the prior 3 months should not be vaccinated.

The attached list is for general guidance about medications that if an individual is taking may contraindicate them from receiving the smallpox vaccine This list is not meant to be exhaustive but to serve as a guide to clinicians seeking to assist patients decide if they should be vaccinated with the smallpox vaccine. One should note that certain other medications not listed, may idiosyncratically and in certain health conditions, be immunosuppressive. Therefore clinical judgment is needed to decide the impact of these medications for patients based on their health status.

The medications are listed in alphabetic order of their generic names.

Contributors to the development of this document

Charles C. Thomas, R. Ph., FAPhA
State Pharmacy Director
Alabama Department of Public Health

Seymour Williams, MD
Medical Epidemiologist
Smallpox Preparedness and Response Activity
National Immunization Program, MS E-05
Centers for Disease Control and Prevention

POSSIBLE DRUG CONTRAINDICATIONS TO ADMINISTRATION OF SMALLPOX (Vaccinia) VACCINE
(Alphabetically sorted by Generic name)
GENERIC DRUG BRAND NAME DRUG
CATEGORY
 *EQUIVALENCY NUMBER TO PREDNISONE
Abacavir Ziagen®
T
  
Abciximab ReoPro®
M
  
Adalimumab Humira
DMARD
  
Aldesleukin Interleukin 2®
A
  
Altretamine Hexalen
A
  
Aminoglutethimide Cytadren
A
  
Amprenivir Agenerase®
T
  
Anakinra Kineret®
D
  
Anastrozole Arimidex
A
  
Asparaginase Elspar®
A
  
Azathioprine Imuran®
I
  
Basiliximab Simulect®
M
  
Betamethasone Celestone®
C
 0.12
Betamethasone Valisone®
C
 0.12
Bleomycin Blenoxane®
A
  
Busulfan Myleran®
A
  
Capecitabine Xeloda
A
  
Carboplatin Paraplatin®
A
  
Carmustine BiCNU® (BCNU)
A
  
Chlorambucil Leukeran®
A
  
Cidofovir Vistide®
T
  
Cisplatin cis-diamminedichloroplatinum II [cDDP]
A
  
Cisplatin Platinol®
A
  
Cladribine Leustatin®
A
  
Cortisone Cortone®
C
 5
Cyclophosphamide CTX
A
  
Cyclophosphamide Cytoxan®
A
  
Cyclophosphamide Neosar
A
  
Cyclosporine Neoral®
I
  
Cyclosporine Sandimmune®
I
  
Cytarabine ara-C
A
  
Cytarabine Cytosar-U®
A
  
Cytarabine DepoCyt
A
  
Dacarbazine DTIC-Dome®
A
  
Dacarbazine Imidazole Carboxamide
A
  
Daclizumab Zenopax
M
  
Dactinomycin Cosmegan®
A
  
Daunorubicin Cerubidine®
A
  
Daunorubicin Daunomycin
A
  
Daunorubicin Daunoxome®
A
  
Daunorubicin Rubidomycin
A
  
Delavirdine Rescriptor®
T
  
Denileukin diftitox Ontak
A
  
Dexamethasone Decadron®
C
  
Didanosine Videx®
T
  
Docetaxel Taxotere
A
  
Doxorubicin Adriamycin
A
  
Doxorubicin Doxil®
A
  
Doxorubicin Hydroxydaunorubicin
A
  
Doxorubicin Rubex
A
  
Efavirenz Sustiva®
T
  
Epirubicin Ellence
A
  
Estramustine Emcyt
A
  
Etanercept Enbrel®
D
  
Etoposide Etopophos®
A
  
Etoposide VePesid®
A
  
Exemestane Aromasin
A
  
Floxuridine Fluorodeoxyuridine
A
  
Floxuridine FUDR®
A
 4
Fludarabine FAMP
A
 4
Fludarabine Fludara®
A
 4
Fluorouracil 5-FU®
A
  
Fluorouracil Adrucil
A/Derm
 4
Fluorouracil Efudex®
A/Derm
  
Flutamide Eulexin®
A
  
Gemcitabine Gemzar
A
  
Gemtuzumab ozogamicin Mylotarg
AI
  
Hydrocortisone Cortef®
C
  
Hydrocortisone Hydrocortone®
C
  
Hydroxychloroquine Plaquenil®
T
  
Hydroxyurea Hydrea®
A
  
Idarubicin Idamycin
A
  
Ifosphamide Ifex®
A
  
Indinavir Crixivan®
T
  
Infliximab Remicade®
M
  
Interferon alfa-2a Roferon-A®
A
  
Interferon alfa-2b Intron-A®
A
  
Interferon beta-1a Avonex®
AV
  
Interferon beta-1b Betaseron®
AV
  
Interferon gamma-1b Actimmune®
A
  
Interleukin-2 Aldesleukin
AI
  
Interleukin-2 Proleukin
AI
  
Irinotecan Camptosar
A
  
Isotretinoin Accutane
Aderm
  
Lamivudine Epivir®
T
  
Lamivudine & Zidovudine Combivir®
T
  
Leflunomide Arava®
D
  
Letrozole Femara
A
  
Leuprolide Lupron®
A
  
Lomustine CeeNu® (CCNU)
A
  
Mechlorethamine HCI Mustargen®
A
  
Mechlorethamine HCI Nitrogen Mustard
A
  
Megestrol Megace®
A
  
Melphalan Alkeran® 
A
 0.8
Melphalan L-Phenylalanine Mustard 
A
  
Melphalan  L-Sarcolysine 
A
  
Mercaptopurine  Purinethol® 
A
  
Methotrexate  Amethopterin 
A
  
Methotrexate  Mexate 
A
  
Methotrexate  Rheumatrex® 
D
  
Methotrexate  Trexall™ 
D
  
Methylprednisolone  Medrol® 
C
  
Mitomycin  Mutamycin® 
A
  
Mitotane  Lysodren® 
A
  
Mitoxantrone   Dihydroxyanthracenedione 
A
  
Mitoxantrone   Novantrone 
A
  
Muromonab-CD3  Orthoclone-OKT3
M
  
Mycophenolate  Cellsept® 
I
  
Nelfinavir Viracept®
T
  
Nevirapine Viramune®
T
  
Paclitaxel Taxol®
A
  
Pegaspargase Oncaspar®
A
 1
Penicillamine Cuprimine®
D
 1
Pentostatin Nipent®
A
 1
Pimecrolimus Elidel
Derm
  
Pipobroman Vercyte®
A
 1
Plicamycin  Mithracin® 
A
 1
Prednisolone Pediapred®
C
 1
Prednisolone Prelone®
C
  
Prednisone DeltaCortef®
C
  
Prednisone Deltasone®
C
  
Prednisone Meticorten®
C
  
Prednisone Sterapred®
C
  
Priliximab Centara
M
  
Procarbazine Matulane®
A
  
Procarbazine Natulanar
A
  
Procarbazine N-Methylhydrazine
A
  
Ritonavir Norvir®
T
  
Rituximab Rituxan
AI
  
Saquinavir Fortovase®
T
  
Saquinavir Invirase®
T
  
Sargramostim Leukine
I
  
Sargramostim Leukomax
I
  
Stavudine Zerit®
T
  
Streptozocin Zanosar®
A
  
Tacrolimus Prograf®
I
  
Temozolomide Temodar
A
  
Teniposide VM-26®
A
  
Teniposide Vumon®
A
  
Testolactone Teslac®
A
  
Thioguanine  6-TG®
A
  
Thioguanine Aminopurine-6-Thiol-Hemihydrate
A
  
Thioguanine Lavis
A
 0.8 
Thioguanine Tabloid
A
  
Thiotepa TESPA (TSPA)
A
  
Thiotepa Thioplex®
A
  
Thiotepa Triethylenethiophosphoramide
A
  
Trastuzumab  Herceptin
AI
  
Tretinoin  All-Trans Retinoic Acid
A
  
Tretinoin Vesanoid
A
  
Triamcinolone Kenalog®
C
  
Uracil mustard Uracil Mustard
A
  
Valrubicin Valstar®
A
  
Vinblastine Velban®
A
  
Vinblastine Velsar
A
  
Vincristine Oncovin®
A
  
Vinorelbine Navelbine®
A
  
Zalcitabine Hivid®
T
  
Zidovudine AZT®
T
  
Zidovudine Retrovir®
T
  

 

KEY

A = Antineoplastic Agent
AV = Antiviral Agent
C = Corticosteroid
D = DMARD (Disease Modifying Anti-Rheumatic Drug)
I = Immunosuppressive
M = Monoclonal Antibody Drug
T = treats immunosuppressive diseases or used for them prophylactically
Derm = Dermatologic use
*Equivalency Number To Prednisone = represents a number which when divided into the dose of a similar drug will yield a dose that is approximately equal to the prednisone dosage.

Sources:

  • American Hospital Formulary Service, 1996
  • Pharmacist's Handbook of Drugs, ASHP 2001 Edition
  • Package Insert, Dryvax Smallpox Vaccine, Wyeth Labs, published August 30, 2002
  • CDC, Advisory Committee of Immunization Practices
  • Drug Information Handbook, Lexicomp, 6th Edition
  • Grabenstein JD. ImmunoFacts: Vaccine and Immunologic Drugs. St. Louis: Facts and Comparisons, 2002
  • Lippincott Williams & Wilkins: LWW ONCOLOGY
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  • cdcinfo@cdc.gov
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