Shingrix Dosing Recommendations
Shingrix is administered as a two-dose intramuscular series, with the second dose given 2 to 6 months after the first dose for immunocompetent adults aged 50 years and older, or 1 to 2 months apart for immunocompromised adults aged 18 years and older. 1
Standard Dosing Schedule
- Each dose is 0.5 mL administered intramuscularly into the deltoid region of the upper arm 1
- For immunocompetent adults ≥50 years: First dose at Month 0, second dose at 2-6 months 2, 1
- The minimum interval between doses is 4 weeks; if administered earlier than this minimum interval, the dose should be repeated 2
- If the second dose is administered beyond 6 months, effectiveness is not impaired—real-world data shows second doses given at ≥180 days maintain full effectiveness 2, 3
Immunocompromised Adults
- For adults aged ≥18 years who are or will be immunodeficient or immunosuppressed, use a shortened schedule: first dose at Month 0, second dose at 1-2 months 4, 1
- This includes patients on chronic high-dose glucocorticoids (≥20 mg/day prednisone equivalent), those with hematologic malignancies, solid organ transplant recipients, HIV infection, and autoimmune diseases requiring immunosuppressive therapy 4
Vaccine Preparation and Storage
- After reconstitution, administer immediately or store refrigerated between 2°C and 8°C (36°F and 46°F) and use within 6 hours 1
- Discard reconstituted vaccine if not used within 6 hours 1
- Use a separate sterile needle and sterile syringe for each individual 1
Efficacy by Dosing Completion
- Two-dose vaccine effectiveness is 70.1% (95% CI: 68.6-71.5) compared to 56.9% (95% CI: 55.0-58.8) for a single dose, demonstrating the critical importance of completing the full series 3
- Clinical trials showed >90% efficacy against herpes zoster when the two-dose series is completed 5, 6
- Two-dose vaccine effectiveness against postherpetic neuralgia is 76.0% (95% CI: 68.4-81.8) 3
Alternative Dosing Intervals
- Non-inferiority was demonstrated for a 0,6-month schedule compared to the standard 0,2-month schedule 7
- A 0,12-month schedule did not meet non-inferiority criteria for antibody concentrations, though vaccine response rates remained high at 94.5% 7
- Despite these findings, the FDA-approved and guideline-recommended interval remains 2-6 months for standard patients 2, 1
Common Pitfalls to Avoid
- Do not delay the second dose unnecessarily—while effectiveness is maintained beyond 6 months, completing the series promptly ensures optimal protection 2, 3
- Do not confuse Shingrix with the older live-attenuated Zostavax vaccine, which had different dosing (single dose) and is no longer preferred 2
- Do not use Shingrix for prevention of primary varicella (chickenpox)—it is only indicated for herpes zoster prevention in those with prior VZV immunity 4
- Concerns about tolerability are a leading reason for non-completion of the series; counsel patients that most side effects (injection site pain, myalgia, fatigue) resolve within 4 days 2, 8