Drug Interaction Report

Consumer information for this interaction is not currently available.

MONITOR: The administration of SARS-CoV-2 (COVID-19) vaccines to immunosuppressed patients is generally safe, but may be associated with a diminished or suboptimal immunologic response due to antibody inhibition. Observational studies in adults who completed a 1 or 2 dose COVID-19 vaccine series revealed lower efficacy against SARS-CoV-2 infection and COVID-19 disease in immunocompromised adults when compared with the general population. Such patients may include those who have recently received or are receiving immunosuppressive agents, antilymphocyte globulins, alkylating agents, antimetabolites, radiation, some antirheumatic agents, high dosages of corticosteroids or adrenocorticotropic agents (e.g., greater than or equal to 2 mg/kg/day or 20 mg/day of prednisone or equivalent for 14 consecutive days or more), or long-term topical or inhaled corticosteroids.

MANAGEMENT: In general, the U.S. Advisory Committee on Immunization Practices (ACIP) recommends administering SARS-CoV-2 (COVID-19) vaccines to moderately or severely immunosuppressed patients. However, depending on the patient's age, concurrent medical condition(s), medication(s), and prior receipt of a COVID-19 vaccine, additional doses, boosters, or revaccination may be appropriate to improve the patient's immune response and the vaccine's efficacy. Whenever possible, COVID-19 vaccine administration should be completed at least 2 weeks before initiation or resumption of immunosuppressive therapies. Revaccination is often recommended in patients who received 1 or more doses of a COVID-19 vaccine prior to or during hematopoietic cell transplantation (HCT) or chimeric antigen receptor (CAR) T-cell therapy and may be considered in patients who were treated with B-cell-depleting therapy over a limited period (e.g., as part of a treatment regimen for certain malignancies). The ACIP recommends that patients who receive B-cell-depleting therapies on a continuing basis receive their COVID-19 vaccine(s) approximately 4 weeks before the next scheduled therapy. COVID-19 vaccines may generally be administered to patients receiving corticosteroids as replacement therapy (e.g., for Addison's disease). Decisions to alter the schedule or frequency of immunosuppressive therapy in order to complete COVID-19 vaccination should consider the individual's risks relative to their underlying condition. Prescribing information and relevant guidelines should be consulted for the most up to date information.

Products containing folic acid may increase the effects of fluorouracil. You may be more likely to develop serious side effects such as anemia, bleeding problems, infections, and nerve damage when these medications are used together. Contact your doctor if you experience severe nausea and vomiting, diarrhea, paleness of skin, fatigue, dizziness, fainting, unusual bleeding or bruising, blood in the stools, fever, chills, body aches, flu-like symptoms, skin reactions, mouth ulcers or sores, and/or numbness, burning or tingling in your hands and feet. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.