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Shingles (herpes zoster) vaccine live


Powder and solvent to produce a suspension for injection of live attenuated varicella-zoster (Oka/Merck strain) virus.

Varicella zoster vaccine contains varicella-zoster virus (Oka/Merck strain) produced on human diploid cells (MRC-5) containing not less than 19400 plaque-forming units per dose.

Drugs List

  • shingles (herpes zoster) live vaccine
  • ZOSTAVAX live vaccine
  • Therapeutic Indications


    Herpes zoster (shingles): prevention
    Herpes zoster related post herpatic neuralgia: prevention

    Prevention of herpes zoster ("zoster" or shingles) and herpes zoster-related post-herpetic neuralgia (PHN) in individuals aged 50 years or older.



    Adults aged 50 years or over
    One single (0.65 ml) dose


    One single (0.65 ml) dose.


    To be injected subcutaneously or intramuscularly, preferably in the deltoid region.


    Febrile disorder
    Patients under 50 years
    Acute untreated tuberculosis
    Immunodeficiency syndromes

    Precautions and Warnings

    Females of childbearing potential

    Live vaccine must not be given during/within 6 months of chemotherapy
    Live vaccine must not be given during/within 6 months of radiotherapy
    Postpone immunisation if there is active or suspected infection
    Vaccine may not be effective in 100% of patients
    May contain trace amounts of neomycin
    Do not mix with other vaccines in the same syringe
    Do not use if any signs of precipitate or particulate matter apparent
    Inject other vaccines at different sites
    Resuscitation facilities must be immediately available
    Exclude pregnancy prior to initiation of treatment
    Theoretical risk of transmission of live virus to susceptible contacts
    Follow national immunisation guidelines
    Female: Contraception required during and for 1 month after treatment

    Although this vaccine is contraindicated in immunosuppressed patients including those receiving high dose corticosteroids, it may be used with caution in patients who are receiving topical/inhaled corticosteroids or low-dose systemic corticosteroids, or in patients who are receiving corticosteroids as replacement drugs.

    Administration of the vaccine may result in disseminated disease in individuals who are immunosuppressed or immunodeficient. Patients who previously received immune suppressive therapy should be carefully evaluated for the reconstitution of the immune system prior to receiving the vaccine.

    The vaccine should be administered subcutaneously in patients with severe thrombocytopenia or any coagulation disorder because these individuals may bleed following intramuscular injection.

    Pregnancy and Lactation


    The vaccine is contraindicated in pregnancy.

    It is not known whether the vaccine can cause foetal harm or can affect reproductive toxicity. Naturally-occurring varicella-zoster virus infection is known to sometimes cause foetal harm.

    Pregnancy should be avoided for one month following vaccination.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    It is not known whether varicella-zoster virus is excreted in human milk. Caution should be exercised when administering the vaccine to breastfeeding women.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Anaphylactic reaction
    Hypersensitivity reactions
    Induration (injection site)
    Necrotising retinitis
    Pain / soreness (injection site)
    Painful extremities
    Sensation of warmth
    Swelling (injection site)


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: March 2013

    Reference Sources

    British National Formulary, 64th Edition (2012) Pharmaceutical Press, London.

    Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

    Summary of Product Characteristics: Zostavax shingles (herpes zoster) vaccine (live). Sanofi Pasteur MSD Limited. Revised February 2016.

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