General

Pronunciation:
zoe-ster vak-seen

Trade Name(s)

• Zostavax

Ther. Class.

vaccines/immunizing agents

Pharm. Class.

active immunizer

Indications

Reduces the risk of shingles in patients ≥50 yr.

Action

Boosts immunity by actively immunizing against the varicella-zoster virus.

Therapeutic Effect(s):

Reduced risk of shingles and its sequelae.

Pharmacokinetics

Absorption: Well absorbed following subcut administration.

Distribution: Unknown.

Metabolism and Excretion: Unknown.

Half-life: Unknown.

TIME/ACTION PROFILE

Contraindication/Precautions

Contraindicated in:

• History of anaphylactic/anaphylactoid reactions to gelatin, neomycin, or other vaccine components
• Primary/acquired immunodeficiency states (including leukemia, lymphoma, AIDS)
• Concurrent immunosupressive medications (including high dose corticosteroids)
• Acute febrile illness (>38.5° C or 101.3° F
• Active untreated tuberculosis
• OB:  Pregnancy
• Pedi:  Children.

Use Cautiously in:

• OB:  Child-bearing potential (pregnancy should be avoided for 3 mo following vaccination)
• OB:  Lactation.

Adverse Reactions/Side Effects

Local: swelling, redness, pain, swelling

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Concurrent  immunosupressants   including  antineoplastics  and high dose  corticosteroids  may ↓ response to and ↑ risk of adverse reactions.
•  Pneumococcal vaccine  (Pneumovax 23) may ↓ response; do not administer concomitantly.

Route/Dosage

SUBQ (Adults  ≥50 yr): 0.65 mL (contents of 1 vial).

Availability

Lyophylized powder for injection (with diluent): at least 19,400 PFU/0.65 mL

Assessment

• Assess patient for immunosuppressant medications or reactions to previous vaccines. Administration may result in a more extensive vaccine-associated rash or disseminated disease in immunocompromised patients.

Potential Diagnoses

• Risk for infection (Indications) 

Implementation

• SUBQ Reconstitute using only diluent supplied. Use a separate sterile needle for reconstitution and administration. Vaccine is stored frozen; reconstitute immediately upon removing from freezer. Store diluent at room temperature. Withdraw entire contents of diluent into syringe and inject into vaccine vial. Agitate gently to mix. Solution should be semi-hazy to translucent, off-white to pale yellow. Do not administer solutions that are discolored or contain particulate matter. Administer only subcut, preferably in the upper arm. Have epinephrine injection available in case of anaphylactic reactions.
  • Discard vaccine if not used within 30 min of reconstitution. Do not freeze reconstituted solution.

Patient/Family Teaching

• Explain purpose of vaccine to patient. Provide patient with a copy of the  Patient Information Sheet.
• Advise patient to notify health care professional if pregnancy is planned or expected. Pregnancy should be avoided for 3 mo after administration of vaccine.

Evaluation/Desired Outcomes

Reduced risk of shingles and its sequelae.