Can a patient taking Renflexis (Infliximab) receive the shingles vaccine?

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Shingles Vaccination for Patients on Renflexis (Infliximab)

Patients taking Renflexis (infliximab) should not receive the live shingles vaccine (Zostavax), but can safely receive the recombinant shingles vaccine (Shingrix). 1, 2

Types of Shingles Vaccines

  • There are two types of herpes zoster (shingles) vaccines:
    • Recombinant zoster vaccine (RZV, Shingrix) - a non-live vaccine 1
    • Live zoster vaccine (ZVL, Zostavax) - a live attenuated vaccine (no longer marketed in the US but still used in some countries) 1

Vaccination Recommendations for Patients on Infliximab

Contraindication for Live Vaccines

  • The FDA label for Renflexis (infliximab) explicitly states: "It is recommended that live vaccines not be given concurrently with REMICADE" 2
  • Live vaccines, including the live zoster vaccine (Zostavax), are contraindicated in patients on biological therapy such as infliximab due to the theoretical risk of infection from vaccination 1
  • TNF inhibitors like infliximab cause immunosuppression that may lead to serious infections if live vaccines are administered 1

Safe Alternative: Recombinant Shingles Vaccine

  • The recombinant zoster vaccine (Shingrix) is not live and is considered safe for immunocompromised patients 1
  • Shingrix is more effective than the live vaccine, with approximately 90% efficacy in preventing shingles, even in older age groups 3
  • The recombinant vaccine requires two doses administered 2-6 months apart 3

Clinical Considerations

Timing of Vaccination

  • Ideally, patients should receive vaccination before starting immunosuppressive therapy like infliximab 1
  • For patients already on infliximab, the recombinant vaccine (Shingrix) can be administered at any time 1

Risk of Herpes Zoster in Immunosuppressed Patients

  • Patients on TNF inhibitors like infliximab have an increased risk of developing herpes zoster 1, 4
  • The risk of herpes zoster and postherpetic neuralgia increases rapidly after age 50 3, 4
  • Approximately one in three people will develop shingles during their lifetime without vaccination 5, 4

Efficacy of Shingrix in Immunocompromised Patients

  • While specific data on Shingrix in patients taking infliximab is limited, studies show that the recombinant vaccine produces significant T-cell responses even in patients with hematologic malignancies on anti-CD20 therapies 1
  • The vaccine remains effective for at least 8 years after administration, though effectiveness gradually wanes over time 6

Potential Concerns

  • There has been theoretical concern that the adjuvant in Shingrix may cause a flare of underlying inflammatory disease, but retrospective studies show variable results (7-16% incidence of disease flare) 1
  • Common side effects of Shingrix include local injection site reactions 3
  • Recent research suggests that the recombinant shingles vaccine may have additional benefits beyond preventing shingles, including a potentially lower risk of dementia 7

Summary of Key Points

  • DO NOT administer the live zoster vaccine (Zostavax) to patients on infliximab 1, 2
  • DO consider the recombinant zoster vaccine (Shingrix) for patients on infliximab 1
  • Vaccination against shingles is particularly important for immunosuppressed patients due to their increased risk of developing herpes zoster 1, 4

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Research

[Shingles, a vaccine-preventable disease: time to realize it].

Geriatrie et psychologie neuropsychiatrie du vieillissement, 2024

5
Research

Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP).

MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports, 2008

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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