High-Dose Flu Vaccine with Eligard: Safe and Recommended
Yes, patients can safely receive the high-dose influenza vaccine while taking Eligard (leuprolide acetate), and there are no contraindications or drug interactions between these medications. 1
Key Points on Safety and Administration
No Contraindications Exist
- Eligard (leuprolide acetate) is a GnRH agonist used primarily for prostate cancer treatment and does not cause immunosuppression that would contraindicate influenza vaccination 1
- The contraindications for inactivated influenza vaccines are limited to severe allergic reactions to vaccine components or previous doses—not hormonal therapies 1
- High-dose influenza vaccine (Fluzone High-Dose Quadrivalent) is specifically approved for adults aged ≥65 years and contains 60 μg of hemagglutinin per strain (240 μg total) in a 0.7 mL dose 1
Age-Appropriate Vaccine Selection
For patients ≥65 years on Eligard:
- High-dose or adjuvanted influenza vaccines are the preferred options over standard-dose vaccines 1
- High-dose vaccine demonstrates superior efficacy, with 24% relative vaccine effectiveness compared to standard-dose in preventing laboratory-confirmed influenza (95% CI 10-37) 2
- The vaccine also reduces influenza-related hospitalizations by 11.8% (95% CI 6.4-17.0) compared to standard-dose 3
For patients <65 years on Eligard:
- Standard-dose quadrivalent influenza vaccine (0.5 mL) is appropriate 1
- Recent evidence suggests high-dose vaccine benefits are most consistent in those aged ≥75 years, with limited advantage in the 65-74 age group 4, 5
Administration Guidelines
Timing and Route
- Administer intramuscularly in the deltoid muscle for adults 1
- The vaccine can be given at any point during Eligard treatment without timing restrictions 1
- Annual vaccination is recommended regardless of when Eligard therapy was initiated 1
Important Caveats
- Never delay vaccination if high-dose vaccine is unavailable—standard-dose vaccine should be administered immediately rather than waiting 1
- Insurance restrictions may limit high-dose vaccine access for patients <65 years; in such cases, standard-dose provides substantial protection 1, 4
- High-dose vaccine is associated with higher rates of local reactions (pain, swelling, redness) and systemic effects (fever, malaise) compared to standard-dose, but these are mild and self-limited 6, 3
Common Pitfalls to Avoid
- Do not use live attenuated intranasal influenza vaccine (LAIV) in any patient you consider potentially immunocompromised, though Eligard alone does not cause immunosuppression 1
- Do not withhold vaccination due to concerns about drug interactions—none exist between Eligard and influenza vaccines 1
- Do not delay vaccination waiting for "optimal timing" within the influenza season; vaccinate as soon as vaccine becomes available starting in September 1