Drug interactions
Influenza virus vaccine quadrivalent intranasal + Rituximab
Severity: Major
Influenza virus vaccine quadrivalent intranasal and Rituximab: major interaction.
Last updated
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
The intranasal influenza vaccine contains live attenuated virus, which may replicate excessively in patients whose immunity is suppressed by rituximab. Vaccine response is also likely to be poor.
What this interaction means in plain words
Influenza virus vaccine quadrivalent intranasal and Rituximab 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
Rituximab-induced B-cell depletion impairs immune control of live attenuated virus.
What to do
Use an inactivated injectable influenza vaccine instead of the live intranasal product. Ideally vaccinate at least 2 to 4 weeks before rituximab, though the inactivated vaccine may still be given during therapy.
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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Other interactions of Rituximab
Frequently asked questions
Can I take Influenza virus vaccine quadrivalent intranasal with Rituximab?
MediHelp rates the interaction as major. Influenza virus vaccine quadrivalent intranasal and Rituximab 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. The intranasal influenza vaccine contains live attenuated virus, which may replicate excessively in patients whose immunity is suppressed by rituximab. Vaccine response is also likely to be poor.
How serious is the interaction between Influenza virus vaccine quadrivalent intranasal and Rituximab?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use an inactivated injectable influenza vaccine instead of the live intranasal product. Ideally vaccinate at least 2 to 4 weeks before rituximab, though the inactivated vaccine may still be given during therapy.
What other medicines interact with Rituximab?
MediHelp also lists interactions of Rituximab with, for example, Adenovirus types 4 and 7 live, Baricitinib, Certolizumab pegol. The full list is on the Rituximab page.
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