Drug Interaction Report

GENERALLY AVOID: The administration of inactivated, killed, or otherwise noninfectious vaccines to patients with congenital athymia who have received an allogenic thymocyte-depleted thymus tissue implant but have not yet developed sufficient immune function may be associated with diminished or suboptimal immunological response and the potential triggering of cytopenias within the first year after implantation. Immunizations in patients with congenital athymia have not been shown to be effective prior to the development of immune function post-implantation. The time to development of sufficient immune function is generally 6 to 12 months after treatment with the allogenic thymocyte-depleted thymus tissue implant but may take up to 2 years in some patients.

MANAGEMENT: The manufacturer recommends that inactivated, killed, or otherwise noninfectious vaccines should not be administered to patients who have received allogenic thymocyte-depleted thymus tissue-implant until specific immune function criteria are met, including that the total CD4+ T cell count is greater than 200 cells/mm3, that there are more CD4+ T cells than CD8+ T cells, as well as the discontinuation of immunosuppressive therapies and immunoglobulin (IgG) replacement therapy. A limit of 2 inactivated vaccines should be administered per month. In addition, the manufacturer advises that no other vaccine (live or inactivated), apart from the inactivated influenza vaccine, should be administered within 6 months after administration of a measles-containing vaccine, or within a 2-month period after administration of varicella vaccines. The product labeling should be consulted for further recommendations.

ADJUST DOSING INTERVAL: Coadministration of oral cholera vaccine with food or an oral beverage may impair its efficacy. The formulations of both the inactivated and live, attenuated oral cholera vaccines (Dukoral and Vaxchora, respectively) are acid-labile, and must be administered with a buffer. According to the manufacturer, eating and drinking may interfere with the protective effect of the buffer. However, clinical data are not available.

MANAGEMENT: It is recommended that patients avoid eating or drinking for 60 minutes before and after administration of either Dukoral or Vaxchora oral cholera vaccines.