What is the proper procedure for writing a prescription for the Shingrix (zoster vaccine recombinant) vaccine?

How to Write a Shingrix Vaccine Prescription

Shingrix is administered as a two-dose intramuscular series (0.5 mL per dose) with the second dose given 2-6 months after the first dose for immunocompetent adults aged ≥50 years, or 1-2 months apart for immunocompromised adults aged ≥18 years. 1

Prescription Components

Basic Prescription Information

• Medication name: Shingrix (Recombinant Zoster Vaccine, RZV) 1
• Route: Intramuscular injection only 1
• Dose: 0.5 mL per injection 1
• Site: Deltoid region of the upper arm (preferred) 1
• Number of doses: Two-dose series 1

Dosing Schedule Based on Patient Population

For immunocompetent adults aged ≥50 years:

• First dose at Month 0, second dose at 2-6 months later 2, 3, 1
• Minimum interval between doses is 4 weeks (if given earlier, the dose must be repeated) 3

For immunocompromised adults aged ≥18 years:

• First dose at Month 0, second dose at 1-2 months later 2, 1
• This shorter schedule is recommended for those who would benefit from more rapid protection 1

Special Considerations for Prescription Writing

Reconstitution Requirements

The prescription should note that Shingrix requires reconstitution before administration:

• Supplied as two vials (lyophilized antigen powder and AS01B adjuvant liquid) that must be combined 1
• Must be reconstituted immediately before use 1
• After reconstitution, must be used immediately or stored refrigerated at 2-8°C (36-46°F) and used within 6 hours 1

Patient-Specific Indications

Standard indication (age ≥50 years):

• Prevention of herpes zoster (shingles) in adults aged 50 years and older 1

Expanded indication (age ≥18 years):

• Prevention of herpes zoster in adults aged 18 years and older who are or will be at increased risk due to immunodeficiency or immunosuppression caused by known disease or therapy 1, 4

Prior Vaccination History

If the patient previously received Zostavax (live zoster vaccine):

• Shingrix should be given at least 2 months after the last Zostavax dose 2, 3
• No maximum interval exists between Zostavax and Shingrix 3

Post-Shingles Outbreak Timing

For patients with recent herpes zoster:

• Wait at least 2 months after acute symptoms resolve before administering Shingrix 3
• Prior shingles history does not contraindicate vaccination 3

Contraindications to Document

Absolute contraindication:

• History of severe allergic reaction (e.g., anaphylaxis) to any vaccine component or after a previous dose of Shingrix 1

Important Safety Warnings for Prescription Notes

Guillain-Barré Syndrome Risk

• Postmarketing data showed increased risk of GBS during 42 days following vaccination 1
• Consider this risk when prescribing, particularly in patients with prior GBS history 1

Syncope Prevention

• Procedures should be in place to prevent falling injury, as syncope can occur with any injectable vaccine 1

Common Expected Reactions

Inform patients that reactogenicity is common but transient:

• 85% of recipients experience local or systemic reactions 5
• Approximately 17% experience grade 3 reactions (symptoms interfering with normal activity) 5
• Most common: injection site pain (22.5%), fever (23.6%), injection site erythema (20.1%) 5

Series Completion Rates

Real-world data shows 70% complete the two-dose series within 6 months and 80% within 12 months 6, so emphasize the importance of returning for the second dose when writing the prescription.

Clinical Efficacy to Support Prescription Decision

• Vaccine effectiveness is 70.1% for two doses versus 56.9% for one dose 7
• Two-dose effectiveness against postherpetic neuralgia is 76.0% 7
• Efficacy remains high (>83%) for at least 8 years 3
• Second doses given beyond 6 months (even at ≥180 days) do not impair effectiveness 7