Identification
- Brand Names
- Proquad, Varivax, Zostavax
- Generic Name
- Varicella zoster vaccine (live/attenuated)
- DrugBank Accession Number
- DB10318
- Background
Live attenuated zoster vaccine is available as two products: Zostavax for the prevention of shingles in immunocompetent people over the age of 50, and Varivax for the prevention of chickenpox in individuals 12 months of age and older. While the two vaccines contain the same immunological components and provide protection against the same virus, Zostavax contains a higher dose and is used in older adults to prevent the development of shingles and post-herpetic neuralgia.
First approved in May 2006 by the Food and Drug Administration, Zostavax was the first vaccine available for the prevention of shingles. Since October 2017, however, it has been replaced as first line therapy by Shingrix (Varicella zoster vaccine (recombinant)), a more effective and longer lasting vaccine3. Both Varivax and Zostavax are composed of a lyophilized preparation of live, attenuated Oka/Merck strain of varicella-zoster virus.
Varicella Zoster Virus (VZV) is the virus that commonly causes Chickenpox (also known as Varicella) in childhood 4. Following initial infection of VZV and resolution of Chickenpox as a child, VZV then lies dormant within the dorsal root ganglion of the central nervous sytem. Decades later, when the body's immune system weakens with age, VZV is able to reactivate and descend through the nerve cells to the surface of the skin where it causes a painful blistering rash, known as shingles (or Herpes Zoster). Risk factors for developing shingles include old age, with rates increasing substantially in person's over the age of 50, low immune function or immunosuppression, psychological stress, and diabetes. Person's living with HIV or cancer, those taking immunosuppressants, and transplant recipients are particularly at risk 2.
One of the most common complications associated with shingles is the development of Post-Herpetic Neuralgia (PHN), a persistant severe nerve pain that develops as a result of chronic pain from shingles lesions. PHN can last for days, months, or even years following resolution of shingles. Other complications also include bacterial infection, spread of the shingles rash to the eye (herpes zoster ophthalmicus) or ear, nerve palsies, or spread of VZV to non-immune persons via contact with varicella lesions.
There are numerous advantages to using Shingrix over Zostavax. Clinical trials for Shingrix have shown greater than 90% efficacy in adults aged 50 and older, with 89% efficacy in preventing postherpetic neuralgia in patients 70 years and older and 91% efficacy in patients 50-70 years of age. This is a significant improvement over its predecessor, Zostavax, which reduces the risk of shingles by only 51% and the risk of post-herpetic neuralgia by 67% 1. Efficacy of Zostavax also wanes over time, with protection against shingles and PHN lasting only around 5 years. Efficacy for prevention of shingles is highest in patients 60-69 years old and decreases with increasing age. Furthermore, because Shingrix is an inactivated vaccine it can also be used to prevent shingles and PHN in individuals with suppressed immune systems, who are already at increased risk of developing shingles, while Zostavax, a live attenuated vaccine, is contraindicated.
- Type
- Biotech
- Groups
- Approved
- Biologic Classification
- Vaccines
Attenuated - Synonyms
- Chickenpox vaccine
- Human herpesvirus 3 live (attenuated) antigen
- Varicella vaccine
- Varicella virus vaccine live (oka-merck) strain
- Varicella zoster live (attenuated) antigen
- Varicella zoster live(attenuated) antigen
- Varicella-zoster virus (live, attenuated)
- Varicella-zoster virus strain oka/merck live (attenuated) antigen
- Varicella-zoster virus strain oka/merck live antigen
- Varicella-zoster virus vaccine live attenuated (oka/merck strain)
Pharmacology
- Indication
Zostavax vaccine is indicated for the prevention of herpes zoster (shingles) in immunocompetent adults aged 50 years and older.
Varivax vaccine is indicated for active immunization for the prevention of varicella in individuals 12 months of age and older.
Reduce drug development failure ratesBuild, train, & validate machine-learning modelswith evidence-based and structured datasets.Build, train, & validate predictive machine-learning models with structured datasets.- Associated Conditions
Indication Type Indication Combined Product Details Approval Level Age Group Patient Characteristics Dose Form Used in combination to prevent Chickenpox •••••••••••• ••••••••• Prevention of Chickenpox •••••••••••• Prevention of Herpes zoster •••••••••••• - Contraindications & Blackbox Warnings
Prevent Adverse Drug Events TodayTap into our Clinical API for life-saving information on contraindications & blackbox warnings, population restrictions, harmful risks, & more.Avoid life-threatening adverse drug events with our Clinical API- Pharmacodynamics
Not Available
- Mechanism of action
Zostavax provides protection against Herpes Zoster reactivation by eliciting an immune response to Varicella Zoster Virus (VZV).
Varivax provides protection against chickenpox by eliciting both cell-mediated and humoral immune responses to varicella-zoster virus.
- Absorption
Not Available
- Volume of distribution
Not Available
- Protein binding
Not Available
- Metabolism
- Not Available
- Route of elimination
Not Available
- Half-life
Not Available
- Clearance
Not Available
- Adverse Effects
Improve decision support & research outcomesWith structured adverse effects data, including: blackbox warnings, adverse reactions, warning & precautions, & incidence rates. View sample adverse effects data in our new Data Library!Improve decision support & research outcomes with our structured adverse effects data.- Toxicity
Not Available
- Pathways
- Not Available
- Pharmacogenomic Effects/ADRs
- Not Available
Interactions
- Drug Interactions
- This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
Drug Interaction Integrate drug-drug
interactions in your softwareAbacavir The therapeutic efficacy of Varicella zoster vaccine (live/attenuated) can be decreased when used in combination with Abacavir. Abatacept The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Abatacept. Acetylsalicylic acid The risk or severity of adverse effects can be increased when Acetylsalicylic acid is combined with Varicella zoster vaccine (live/attenuated). Acyclovir The therapeutic efficacy of Varicella zoster vaccine (live/attenuated) can be decreased when used in combination with Acyclovir. Adalimumab The risk or severity of adverse effects can be increased when Adalimumab is combined with Varicella zoster vaccine (live/attenuated). - Food Interactions
- Not Available
Products
Drug product information from 10+ global regionsOur datasets provide approved product information including:dosage, form, labeller, route of administration, and marketing period.Access drug product information from over 10 global regions.- Brand Name Prescription Products
Name Dosage Strength Route Labeller Marketing Start Marketing End Region Image Varivax Powder, for solution 1350 unit / vial Subcutaneous Merck Frosst Canada & Cie, Merck Frosst Canada & Co. 1999-01-21 2001-08-01 Canada 
Varivax Injection, powder, lyophilized, for suspension 1350 [PFU]/0.5mL Subcutaneous Merck Sharp & Dohme Llc 1995-03-17 2016-03-31 US 
Varivax Injection, powder, lyophilized, for suspension 1350 [PFU]/0.5mL Subcutaneous Merck Sharp & Dohme Llc 1995-03-17 Not applicable US Varivax II Powder, for solution 1350 unit / dose Subcutaneous Merck Frosst Canada & Cie, Merck Frosst Canada & Co. 2000-06-27 2004-08-27 Canada Varivax III Powder, for solution 1350 PFU/0.5mL Subcutaneous Merck Ltd. 2002-12-02 Not applicable Canada - Mixture Products
Name Ingredients Dosage Route Labeller Marketing Start Marketing End Region Image Priorix - Tetra Pulver in einer Durchstechflasche und Lösungsmittel in einer Fertigspritze zur Herstellung einer Injektionslösung Varicella zoster vaccine (live/attenuated) (1995 PFU) + Measles virus vaccine live attenuated (1000 CCID) + Mumps virus strain B level jeryl lynn live antigen (25119 CCID) + Rubella virus vaccine (1000 CCID) Injection, solution Intramuscular; Subcutaneous Glaxo Smith Kline Pharma Gmb H 2007-11-09 Not applicable Austria 
Priorix - Tetra Pulver und Lösungsmittel zur Herstellung einer Injektionslösung Varicella zoster vaccine (live/attenuated) (1995 PFU) + Measles virus vaccine live attenuated (1000 CCID) + Mumps virus strain B level jeryl lynn live antigen (25119 CCID) + Rubella virus vaccine (1000 CCID) Injection, powder, for solution Intramuscular; Subcutaneous Glaxo Smith Kline Pharma Gmb H 2007-11-09 Not applicable Austria PRIORIX TETRA Varicella zoster vaccine (live/attenuated) (10 PFU) + Measles virus vaccine live attenuated (10 CCID) + Mumps virus strain B level jeryl lynn live antigen (10 CCID) + Rubella virus vaccine (10 CCID) Injection, powder, for solution Subcutaneous Glaxosmithkline S.P.A. 2014-07-08 Not applicable Italy 
PRIORIX TETRA Varicella zoster vaccine (live/attenuated) (10 PFU) + Measles virus vaccine live attenuated (10 CCID) + Mumps virus strain B level jeryl lynn live antigen (10 CCID) + Rubella virus vaccine (10 CCID) Injection, powder, for solution Subcutaneous Glaxosmithkline S.P.A. 2014-07-08 Not applicable Italy PRIORIX TETRA Varicella zoster vaccine (live/attenuated) (10 PFU) + Measles virus vaccine live attenuated (10 CCID) + Mumps virus strain B level jeryl lynn live antigen (10 CCID) + Rubella virus vaccine (10 CCID) Injection, powder, for solution Subcutaneous Glaxosmithkline S.P.A. 2014-07-08 Not applicable Italy - Unapproved/Other Products
Name Ingredients Dosage Route Labeller Marketing Start Marketing End Region Image VARILRIX SC ENJEKSIYON ICIN LIYOFILIZE TOZ ICEREN FLAKON Varicella zoster vaccine (live/attenuated) (103 PFU) Injection, powder, lyophilized, for solution Intramuscular GLAXOSMİTHKLİNE İLAÇLARI SAN. VE TİC. A.Ş. 2019-11-26 Not applicable Turkey 
Categories
- Drug Categories
- Classification
- Not classified
- Affected organisms
- Not Available
Chemical Identifiers
- UNII
- GPV39ZGD8C
- CAS number
- Not Available
References
- General References
- Bharucha T, Ming D, Breuer J: A critical appraisal of 'Shingrix', a novel herpes zoster subunit vaccine (HZ/Su or GSK1437173A) for varicella zoster virus. Hum Vaccin Immunother. 2017 Aug 3;13(8):1789-1797. doi: 10.1080/21645515.2017.1317410. Epub 2017 Apr 20. [Article]
- CDC - Clinical Overview of Shingles (Herpes Zoster) [Link]
- CDC - What Everyone Should Know about Shingles Vaccine [Link]
- CDC - About Chickenpox [Link]
- External Links
- PubChem Substance
- 347910497
- 1292422
- RxList
- RxList Drug Page
- Drugs.com
- Drugs.com Drug Page
- Wikipedia
- Zoster_vaccine
- FDA label
- Download (408 KB)
Clinical Trials
- Clinical Trials
Phase Status Purpose Conditions Count 4 Active Not Recruiting Prevention Varicella 1 4 Completed Not Available Measles / Mumps / Rubella / Varicella 1 4 Completed Basic Science Herpes Zoster (Shingles) 1 4 Completed Prevention Acute Respiratory Infections (ARIs) / Flu caused by Influenza 1 4 Completed Prevention Fibrosis / Herpes Zoster 1
Pharmacoeconomics
- Manufacturers
- Not Available
- Packagers
- Not Available
- Dosage Forms
Form Route Strength Injection, solution Intramuscular; Subcutaneous Injection, powder, for solution Intramuscular; Subcutaneous Injection, powder, for solution Subcutaneous Injection Injection, powder, lyophilized, for solution Intramuscular; Subcutaneous Powder, for solution Intramuscular; Subcutaneous Injection, powder, for suspension Intramuscular; Subcutaneous Injection, powder, lyophilized, for suspension Intramuscular; Subcutaneous Injection, powder, lyophilized, for suspension Subcutaneous Injection, powder, lyophilized, for solution Subcutaneous Injection, powder, for suspension 27400 PFU/0.5mL Powder Subcutaneous 1400 PFU/0.7mL Injection Subcutaneous 2000 PFU/0.5mL Injection, powder, for solution Subcutaneous 2000 unit Powder, for solution Subcutaneous Injection, powder, for suspension Subcutaneous 103.3 PFU Injection, powder, lyophilized, for solution Intramuscular 103 PFU Injection, powder, for solution Subcutaneous 2000 PFU Injection, powder, lyophilized, for suspension Subcutaneous Injection, powder, for suspension Intramuscular; Subcutaneous Injection, powder, lyophilized, for suspension Subcutaneous 1350 [PFU]/0.5mL Powder, for solution Subcutaneous 1350 unit / vial Injection Subcutaneous 2700 PFU/mL Suspension Subcutaneous 1350 PFU Powder, for solution Subcutaneous 1350 unit / dose Powder, for solution Subcutaneous 1350 PFU/0.5mL Injection, powder, for suspension Intramuscular; Subcutaneous 1350 PFU Powder Subcutaneous 1.35 CFU Injection Subcutaneous 194000 PFU/0.65ml Injection, powder, for suspension Subcutaneous 19400 PFU/0.65mL Injection, powder, for suspension Subcutaneous 194000 PFU/0.65ml Injection, powder, lyophilized, for suspension Subcutaneous 19400 [PFU]/0.65mL Injection, suspension Subcutaneous 19400 PFU/0.65mL Injection, powder, lyophilized, for suspension Subcutaneous 19400 PFU/0.65mL Powder, for suspension Subcutaneous 19400 pfu / 0.65 mL Injection, powder, for suspension Subcutaneous 19400 PFU Powder Subcutaneous 1350 PFU/0.5mL Powder Subcutaneous 19400 PFU/0.7mL Injection, powder, lyophilized, for suspension - Prices
- Not Available
- Patents
- Not Available
Properties
- State
- Not Available
- Experimental Properties
- Not Available
Drug created at December 01, 2015 20:03 / Updated at April 19, 2024 20:55