Varicella zoster vaccine (live/attenuated)

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.

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Associated Conditions

• Chickenpox
• Herpes Zoster

Contraindications & Blackbox Warnings

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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

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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.

• Approved
• Vet approved
• Nutraceutical
• Illicit
• Withdrawn
• Investigational
• Experimental
• All Drugs

Drug	Interaction
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Abacavir	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).
Adefovir dipivoxil	The therapeutic efficacy of Varicella zoster vaccine (live/attenuated) can be decreased when used in combination with Adefovir dipivoxil.
Aldesleukin	The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Aldesleukin.
Alefacept	The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Alefacept.
Alemtuzumab	The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Alemtuzumab.
Altretamine	The risk or severity of infection can be increased when Varicella zoster vaccine (live/attenuated) is combined with Altretamine.

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Food Interactions

Not Available

Products

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Brand Name Prescription Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End	Region	Image
Varivax	Injection, powder, lyophilized, for suspension	1350 [PFU]/0.5mL	Subcutaneous	Merck Sharp & Dohme Llc	1995-03-17	Not applicable
Varivax	Injection, powder, lyophilized, for suspension	1350 [PFU]/0.5mL	Subcutaneous	Merck Sharp & Dohme Llc	1995-03-17	Not applicable
Varivax	Powder, for solution	1350 unit / vial	Subcutaneous	Merck Frosst Canada & Cie, Merck Frosst Canada & Co.	1999-01-21	2001-08-01
Varivax II	Powder, for solution	1350 unit / dose	Subcutaneous	Merck Frosst Canada & Cie, Merck Frosst Canada & Co.	2000-06-27	2004-08-27
Varivax III	Powder, for solution	1350 PFU/0.5mL	Subcutaneous	Merck Ltd.	2002-12-02	Not applicable
Zostavax	Injection	194000 PFU/0.65ml	Subcutaneous	Merck Sharp & Dohme B.V.	2016-09-08	Not applicable
Zostavax	Injection, powder, for suspension	194000 PFU/0.65ml	Subcutaneous	Merck Sharp & Dohme B.V.	2016-09-08	Not applicable
Zostavax	Powder, for suspension	19400 pfu / 0.65 mL	Subcutaneous	Merck Ltd.	2009-09-16	2015-05-06
Zostavax	Injection	194000 PFU/0.65ml	Subcutaneous	Merck Sharp & Dohme B.V.	2016-09-08	Not applicable
Zostavax	Injection	194000 PFU/0.65ml	Subcutaneous	Merck Sharp & Dohme B.V.	2016-09-08	Not applicable

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
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
Priorix-Tetra	Varicella zoster vaccine (live/attenuated) (1995 PFU) + Measles virus vaccine live attenuated (1000 CCID50) + Mumps virus strain B level jeryl lynn live antigen (25119 CCID50) + Rubella virus vaccine (1000 CCID50)	Injection, powder, lyophilized, for solution	Intramuscular; Subcutaneous	GLAXOSMITHKLINE PTE LTD	2009-03-04	Not applicable
PRIORIX-TETRA	Varicella zoster vaccine (live/attenuated) (1995 PFU/0.5ml) + Measles virus vaccine live attenuated (1000 CCID_50/0.5ml) + Mumps virus strain B level jeryl lynn live antigen (25119 CCID_50/0.5ml) + Rubella virus vaccine (1000 CCID_50/0.5ml)	Injection		บริษัท แกล็กโซสมิทไคล์น (ประเทศไทย) จำกัด	2014-02-27	Not applicable
Priorix-tetra	Varicella zoster vaccine (live/attenuated) (1995.2623 CCID50 / 0.5 mL) + Measles virus vaccine live attenuated (1000 CCID50 / 0.5 mL) + Mumps virus strain B level jeryl lynn live antigen (25118.9 CCID50 / 0.5 mL) + Rubella virus vaccine (1000 CCID50 / 0.5 mL)	Powder, for solution	Intramuscular; Subcutaneous	Glaxosmithkline Inc	2008-06-04	Not applicable
PRIORIX-TETRA 0.5 ML SC ENJEKSIYON IÇIN LIYOFILIZE TOZ IÇEREN FLAKON VE ÇÖZÜCÜ IÇEREN KULLANIMA HAZIR ENJEKTÖR, 1 DOZ İĞNELİ	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, lyophilized, for solution	Subcutaneous	GLAXOSMİTHKLİNE İLAÇLARI SAN. VE TİC. A.Ş.	2020-08-14	2021-10-12
PRIORIX-TETRA 0.5 ML SC ENJEKSIYON IÇIN LIYOFILIZE TOZ IÇEREN FLAKON VE ÇÖZÜCÜ IÇEREN KULLANIMA HAZIR ENJEKTÖR, 1 DOZ İĞNESİZ	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, lyophilized, for solution	Subcutaneous	GLAXOSMİTHKLİNE İLAÇLARI SAN. VE TİC. A.Ş.	2020-08-14	2021-10-12
PRIORIX-TETRA 0.5 ML SC ENJEKSIYON IÇIN LIYOFILIZE TOZ IÇEREN FLAKON VE ÇÖZÜCÜ IÇEREN KULLANIMA HAZIR ENJEKTÖR, 10X1 DOZ İĞNELİ	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, lyophilized, for solution	Subcutaneous	GLAXOSMİTHKLİNE İLAÇLARI SAN. VE TİC. A.Ş.	2020-08-14	2021-10-12
PRIORIX-TETRA 0.5 ML SC ENJEKSIYON IÇIN LIYOFILIZE TOZ IÇEREN FLAKON VE ÇÖZÜCÜ IÇEREN KULLANIMA HAZIR ENJEKTÖR, 10X1 DOZ İĞNESİZ	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, lyophilized, for solution	Subcutaneous	GLAXOSMİTHKLİNE İLAÇLARI SAN. VE TİC. A.Ş.	2020-08-14	2021-10-12
PRIORIX-TETRA 0.5 ML SC ENJEKSIYON IÇIN LIYOFILIZE TOZ IÇEREN FLAKON VE ÇÖZÜCÜ IÇEREN KULLANIMA HAZIR ENJEKTÖR, 20X1 DOZ İĞNESİZ	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, lyophilized, for solution	Subcutaneous	GLAXOSMİTHKLİNE İLAÇLARI SAN. VE TİC. A.Ş.	2020-08-14	2021-10-12

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.	2020-08-14	Not applicable

Categories

Drug Categories

• Actively Acquired Immunity
• Antiinfectives for Systemic Use
• Biological Products
• Complex Mixtures
• Herpesvirus Vaccines
• Live Attenuated Herpes Zoster Virus Vaccine
• Live Attenuated Varicella Zoster Virus Vaccine
• Live vaccines
• Vaccines
• Varicella Zoster Vaccines
• Viral Vaccines

Classification

Not classified

Affected organisms

Not Available

Chemical Identifiers

UNII

GPV39ZGD8C

CAS number

Not Available

References

General References

1. 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]
2. CDC - Clinical Overview of Shingles (Herpes Zoster) [Link]
3. CDC - What Everyone Should Know about Shingles Vaccine [Link]
4. CDC - About Chickenpox [Link]

External Links

PubChem Substance

347910497

RxNav

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	Chickenpox	1
4	Completed	Prevention	Chickenpox / Hepatitis A / Measles / Mumps / Rubella	1
4	Completed	Prevention	Chickenpox / Japanese Encephalitis	1
4	Completed	Prevention	Fibrosis / Herpes Zoster	1
4	Completed	Prevention	Hepatitis A Virus	1
4	Completed	Prevention	Herpes Zoster	2

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

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Drug created at December 01, 2015 20:03 / Updated at March 24, 2023 20:20