Drug interactions
Cladribine + Dengue vaccine
Severity: Major
Cladribine and Dengue vaccine: major interaction.
Last updated Sources: UK SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Dengue vaccine is a live attenuated vaccine, and cladribine causes prolonged lymphopenia. Vaccination may produce a reduced immune response and carries a risk of vaccine-related infection.
What this interaction means in plain words
Cladribine and Dengue vaccine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Cladribine-induced lymphocyte depletion impairs vaccine response and permits replication of live attenuated virus.
What to do
Avoid live vaccines during cladribine treatment and until lymphocyte counts have recovered. Vaccinate at least several weeks before starting cladribine where feasible.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
- Cladribine Merck 10 mg tablets - SmPC sections 4.3/4.5 (class statement: live or attenuated live vaccines; "Vaccination with live or attenuated live vaccines should be avoided during and after cladribine treatment as long as the patient's white blood cell counts are n") — electronic medicines compendium (UK SmPC)
Other interactions of Cladribine
- Adenovirus types 4 and 7 live + Cladribine Contraindicated
- Cladribine + Siponimod Contraindicated
- Cladribine + Tofacitinib Contraindicated
- Axicabtagene ciloleucel + Cladribine Major
- Belatacept + Cladribine Major
- Brexucabtagene autoleucel + Cladribine Major
Frequently asked questions
Can I take Cladribine with Dengue vaccine?
MediHelp rates the interaction as major. Cladribine and Dengue vaccine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Dengue vaccine is a live attenuated vaccine, and cladribine causes prolonged lymphopenia. Vaccination may produce a reduced immune response and carries a risk of vaccine-related infection.
How serious is the interaction between Cladribine and Dengue vaccine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid live vaccines during cladribine treatment and until lymphocyte counts have recovered. Vaccinate at least several weeks before starting cladribine where feasible.
What other medicines interact with Cladribine?
MediHelp also lists interactions of Cladribine with, for example, Adenovirus types 4 and 7 live, Siponimod, Tofacitinib. The full list is on the Cladribine page.
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