Yes, unless the person is allergic to any of the vaccine components. HepA vaccination is safe and effective and is recommended for any person who wishes to obtain immunity.
Which children should be routinely vaccinated against HAV infection? All children should receive 2 doses of HepA vaccine beginning at age 1 year i. The 2 doses in the series should be administered at least 6 months apart. Any child age 2 through 18 years not previously vaccinated should be vaccinated.
For hepatitis A vaccination, the minimum interval between the 2-dose series is at least 6 months. Is this the same as 24 weeks?
The minimum interval between dose 1 and 2 of HepA vaccine is 6 calendar months, not 24 weeks. I have a child who was given her second dose of hepatitis A vaccine 4 months after the first dose.
Does it need to be repeated, and if so, when? The second dose was given more than 4 days before the minimum interval of 6 calendar months, so it is considered invalid and should be repeated. The repeat dose should be administered the proper minimum interval 6 months after the invalid dose. If this repeat dose is inadvertently given less than 6 months after the invalid dose, it does not need to be repeated again as long as the interval between the initial HepA vaccine and the most recent dose is at least 6 calendar months.
What are the recommendations for postexposure prophylaxis PEP for hepatitis A? Please see the complete PEP recommendations at www. People who have recently been exposed to HAV and who have not received HepA vaccine previously should receive PEP as soon as possible, within 2 weeks of exposure.
People age 12 months and older exposed to HAV within the past 14 days and who have not previously completed the HepA vaccine series should receive a single dose of HepA vaccine as soon as possible. In addition to vaccine, immune globulin IG; 0. For long-term immunity, the HepA vaccine series should be completed with a second dose at least 6 months after the first dose. However, the second dose is not necessary for PEP.
A second dose should not be administered sooner than 6 calendar months after the first dose, regardless of HAV exposure risk. People age 12 months or older who are immunocompromised or have chronic liver disease, and who have been exposed to HAV within the past 14 days and have not previously completed the HepA vaccination series, should receive both IG 0.
For long-term immunity, the HepA vaccination series should be completed with a second dose at least 6 months after the first dose. Protection following vaccination of a person with HIV may wane over time. Vaccine should be administered if the exposed individual is not fully vaccinated; however, CDC also advises clinicians to consider administering IG PEP to an individual with HIV after a high-risk exposure such as a household or sexual contact even if the individual has been fully vaccinated.
Twinrix contains half the amount of hepatitis A antigen as a standard single-dose adult HepA vaccine. Twinrix should not be used for PEP, but may be used to confer protection to at-risk but not yet exposed persons during an outbreak. Infants younger than age 12 months and persons for whom vaccine is contraindicated should receive IG 0. MMR and varicella vaccines should not be administered sooner than 6 months after IG administration in order to avoid possible IG interference with the effectiveness of MMR and varicella vaccines.
When should prevaccination anti-HAV testing for susceptibility be performed? It also is not routinely recommended for adults, but may be considered in some settings to reduce costs associated with vaccinating people who are already immune. Prevaccination testing should not be used if it poses a barrier to vaccinating susceptible people, especially people who are difficult to access. Prevaccination testing is most likely to be cost-effective for adults who were either born in or lived for long periods of time in areas of the world with high or intermediate hepatitis A endemicity.
When evaluating people from populations with high rates of previous HAV infection, vaccination history also should be obtained, if feasible. If testing or vaccination history is not available, do not postpone vaccinating. There is no harm in vaccinating a person who has had natural infection or previous doses of vaccine. When should postvaccination testing be performed? Serologic testing for immunity is not necessary after routine vaccination of infants, children or adults.
Testing for the presence of anti-HAV antibody one month or more after completing the HepA vaccination series is recommended only for people whose future clinical management depends on knowing their immune status and for whom revaccination might be indicated, such as people living with HIV and other immunocompromised persons such as transplant recipients and people vaccinated while receiving chemotherapy.
If that second test remains negative, no additional vaccination is recommended; however, the patient should be counseled on strategies to avoid exposure to HAV and the need for IG if an exposure occurs.
If vaccination results in seroconversion, insufficient data are available to make recommendations concerning repeat testing, booster doses or revaccination. For Special Groups Back to top Explain the details regarding the recommendation for giving HepA vaccine to people who will be in contact with recently adopted children.
ACIP recommends vaccination against HAV infection for all previously unvaccinated people who anticipate having close personal contact with an international adoptee from a country of high or intermediate endemicity during the first 60 days following the adoptee's arrival in the U. In addition to the adoptee's new parents and siblings, this group might include grandparents, other household members, regular babysitters and other caregivers.
The first dose of HepA should be given to close contacts as soon as adoption is planned, ideally at least 2 weeks before the arrival of the adoptee. A second dose should be given no sooner than 6 months after the first dose. ACIP now recommends routine hepatitis A vaccination for people experiencing homelessness. Can you provide a definition of "experiencing homelessness"? The ACIP recommendations for the prevention of hepatitis A define a person experiencing homelessness as 1 a person who lacks housing regardless of whether the person is a member of a family , including a person whose primary residence during the night is a supervised public or private facility e.
In addition, previously homeless persons who are to be released from a prison or a hospital might be considered homeless if they do not have a stable housing situation to which they can return. The instability of a person's living arrangements is critical to the definition of homelessness. Some people on my team are worried about initiating the HepA vaccine series in people who are homeless because we may not be able to complete the series or keep up with their records over time.
How much of a concern is this? While a complete series of HepA is recommended for long-term protection, even a single dose of HepA vaccine has been demonstrated to provide protection against hepatitis A for more than 10 years and can prevent or control outbreaks of hepatitis A. People who are experiencing homelessness may have difficulty protecting themselves from exposure to HAV in other ways because of their living conditions. They should be vaccinated when possible and provided a record of immunization.
Reporting the HepA vaccination to a state immunization information system also can facilitate immunization assessment at future healthcare encounters. Should healthcare providers HCP be vaccinated routinely against hepatitis A?
A number of studies have shown that HCP are not at significantly increased risk of HAV infection because of their occupation.
However, if HCPs are going to work or vacation in a country with a high or intermediate endemic rate of HAV infection, they are at risk of HAV infection and should be vaccinated. The only occupational indications for routine HepA vaccination are work with non-human primates or live HAV in a laboratory setting.
Should daycare workers be routinely vaccinated against hepatitis A? In the past, outbreaks of hepatitis A occurred among children in child care centers, infecting employees of those centers, especially those caring for infants and toddlers. Following widespread adoption of early childhood vaccination against hepatitis A, outbreaks in child care centers are now rare. Why is hepatitis A vaccination recommended for people with chronic liver disease?
Although not at increased risk for HAV infection, people with chronic liver disease are at increased risk for fulminant hepatitis A, hospitalization and death if they become infected with HAV. For this reason, hepatitis A vaccination is recommended for them. Why isn't hepatitis A vaccination recommended for sewage and solid waste disposal workers?
In published reports of three serologic surveys conducted among United States wastewater workers and appropriate comparison populations, no substantial or consistent increase in the prevalence of anti-HAV was identified among wastewater workers. No work-related instances of HAV transmission have been reported among wastewater workers in the United States. In addition, in the United States, outbreaks of hepatitis A caused by flooding, which can carry raw sewage, have not been reported.
Why is hepatitis A vaccination no longer recommended for people with clotting factor disorders? Why is hepatitis A vaccination recommended and IG not recommended for infant travelers age 6 through 11 months at risk of exposure to HAV? Because of measles.
Measles is highly communicable and poses a serious threat to the health of unvaccinated infants. For this reason, all infants age 6 through 11 months who travel internationally are recommended to receive a dose of measles, mumps, and rubella vaccine MMR to reduce the risk of measles infection during travel. The antibodies in immune globulin IG typically used to prevent HAV infection in infants before the first birthday can interfere with the effectiveness of MMR vaccine.
The HepA and MMR doses administered before the first birthday do not count toward the routine vaccination series of either vaccine: these infant travelers will still need two doses of HepA and two doses of MMR when age appropriate.
Can pregnant women receive hepatitis A vaccine? The ACIP recommends that pregnant women at risk for HAV infection during pregnancy or at risk for a severe outcome from HAV infection should be vaccinated during pregnancy if not previously vaccinated. Pregnant women should be vaccinated for the same indications as non-pregnant women. For additional information, see page 20 of the recommendations: www. Administering Vaccines Back to top By what method should hepatitis A vaccine be administered?
Hepatitis A vaccine HepA should be administered intramuscularly IM , using the appropriate injection site and needle size as determined by the patient's age and body mass. Can HepA vaccine be given concurrently with other vaccines?
If given in the same muscle, separate the injections by a minimum distance of 1 inch. What happens if dose 2 of HepA vaccine is delayed? You do not need to start the series over again.
To ensure optimal long-term protection it is important to administer the second dose. To complete a year-old patient's HepA vaccine series, how many adult doses should I give if the patient received a single dose of pediatric HepA vaccine 5 years ago?
A person should receive the dosage of HepA vaccine appropriate for their age at the time of administration. You should give the patient one adult dose of HepA to complete the 2-dose series. It is not necessary to restart the vaccine series. One of our staff gave a dose of pediatric HepA vaccine to an adult patient by mistake. How do we remedy this error? In general, if the error is discovered on the same clinic day, you can administer the other "half" of the dose on that same day.
If the error is discovered later, the dose should not be counted, and then the person should be recalled to the office and given a full age-appropriate repeat dose. There may be an increased risk of a local adverse reaction when more than the recommended dose is given. If the error occurred with the first dose of the series the child should still receive the second dose on schedule. Giving a "double" dose for the first dose does not negate the need for a second dose.
Avoid such errors by checking the vaccine vial label 3 times. Why does a year old who weighs pounds receive a pediatric dose of HepA while his pound mother receives an adult dose twice the pediatric dose?
The efficacy data from the clinical trials were based on age at time of vaccination, and not on the weight of the individual. Hence, the dosage recommendations reflect this age-based efficacy data. The same holds true for HepB vaccine. In addition, higher response rates are expected in younger people, even if their weights are above the norm.
Twinrix Back to top Could you please provide more information about Twinrix the combination hepatitis A and B vaccine and the two schedules for its use? The vaccine contains EL. In the U.
Generally speaking, no. A person with laboratory evidence of resolved hepatitis B infection is considered immune.
Vaccination of such individuals is not harmful but is not necessary. How stable is HBV in the environment? What types of equipment cleaners are effective against HBV? HBV is stable in the environment and remains viable for 7 or more days on environmental surfaces at room temperature.
HBV can be transmitted despite the absence of visible blood. Any high level disinfectant that is tuberculocidal will inactivate HBV. Its presence indicates either acute or chronic HBV infection. Its presence indicates an immune response to HBV infection, an immune response to vaccination, or the presence of passively acquired antibody.
It is also known as HBsAb, but this abbreviation is best avoided since it is often confused with abbreviations such as HBsAg. It is not a marker of vaccine-induced immunity. It may be used in prevaccination testing to determine previous exposure to HBV infection. It is also known as HBcAb , but this abbreviation is best avoided since it is often confused with other abbreviations. Its presence indicates acute infection. It is primarily used to help determine the clinical management of patients with chronic HBV infection.
Anti-HBe: Antibody to hepatitis B "e" antigen may be present in an infected or immune person. In persons with chronic HBV infection, its presence suggests a low viral titer and a low degree of infectivity. It correlates well with infectivity. It is used to assess and monitor the treatment of patients with chronic HBV infection. How do I interpret some of the common hepatitis B panel results?
Table 2 Tests Results Interpretation Vaccinate? Infants born to HBsAg-positive mothers should be tested for HBsAg and anti-HBs after completion of at least 3 doses of a licensed hepatitis B vaccination series, at age months generally at the next well child visit. May be distantly immune, but the test may not be sensitive enough to detect a very low level of anti-HBs in serum 2.
May be susceptible with a false positive anti-HBc 3. May be chronically infected and have an undetectable level of HBsAg present in the serum 4. Serologic testing for immunity is not necessary or recommended after routine vaccination of infants, children, or adults. I have a patient who is positive for anti-HBc hepatitis B core antibody but negative for all other hepatitis B serologic markers. Should he receive hepatitis B vaccine? Some isolated positive anti-HBc results are false positives it is the most common false positive HBV marker.
If that can be established, the individual can and likely should be vaccinated, assuming there is an indication or desire to be protected. If the positive anti-HBc is believed to be a true positive, the individual would not require vaccination since they have already presumably had HBV infection.
Isolated positive anti-HBc could indicate low-level chronic infection. In an infant isolated anti-HBc could indicate passive transfer of antibody from a mother who is HBsAg positive. HBsAg testing may be performed on the same specimen collected for anti-HBc testing. If the HBsAg test result is positive, the person is infected and should receive appropriate management. I work in a dialysis unit. Our lab reports anti-HBs results as adequate or inadequate, rather than providing a quantitative result.
Is this acceptable? Reporting of adequate and inadequate is acceptable only if your lab is using mIUs as the measurement for anti-HBs and the cutoff is below 10 mIU for reporting inadequate anti-HBs and 10 mIU or higher for reporting adequate anti-HBs.
You should check with your lab to be certain this is being done. We did a hepatitis B panel for a new hospital employee from Gambia. She had no documentation of having been vaccinated. We don't know how to interpret these results. Should she be immunized? Most likely this person has a resolved hepatitis B infection and is immune. However, it would be preferable to test her again for all these serologic markers, and also quantify the anti-HBs result.
No further action is needed other than to document the results. The most recent comprehensive recommendations for hepatitis B vaccination were published in January The document is available at www. Recommendations for the use of adjuvanted hepatitis B vaccine Heplisav-B, Dynavax were published in April and are available at www. Please describe the currently available hepatitis B vaccines. Hepatitis B vaccines are available as a single-antigen formulation and in combination with other vaccines.
Heplisav-B Dynavax is approved only for people 18 years of age and older. Engerix-B and Recombivax HB are available in both pediatric and adult formulations.
For the 3-dose series of both vaccines, people 0 through 19 years of age receive a 0. People 20 years of age and older receive a 1. Three combination vaccines that contain HepB are, or soon will be, available in the United States. Twinrix GlaxoSmithKline is approved for persons 18 years of age and older and contains HepB and inactivated hepatitis A virus. Comvax Merck , a combination vaccine that contained HepB and Haemophilus influenzae type b, was discontinued in in the United States.
The adult formulation of Engerix-B contains twice as much antigen per dose as the adult formulations of Recombivax HB. If a patient received 10 mcg 1 mL of Recombivax for the first dose, and I stock only Engerix-B, should I give a 10 mcg 0. It is the volume of the dose, not the antigen content, that is important. Persons 20 years and older should always receive a 1. Likewise, persons younger than 20 years should always receive a 0. Please provide information about Heplisav-B. Heplisav-B was approved by the Food and Drug Administration in November for persons 18 years of age and older.
It is provided in a single dose 0. Local reactions were most commonly reported injection site pain, redness, and swelling and were similar in frequency to those following Engerix-B. What is the schedule for hepatitis B vaccine? Heplisav-B is administered intramuscularly on a 2-dose schedule with doses separated by 1 month.
Primary vaccination with Engerix-B, Recombivax HB, or Twinrix consists of three intramuscular doses administered on a 0-, 1-, and 6-month schedule. Alternative vaccination schedules for Engerix-B and Recombivax HB for example, 0, 1, and 4 months or 0, 2, and 4 months have been demonstrated to elicit dose-specific and final rates of seroprotection similar to those obtained on a 0-, 1-, and 6-month schedule. Increasing the interval between the first 2 doses has little effect on immunogenicity or the final antibody concentration.
The third dose confers the maximum level of seroprotection and provides long-term protection. Pediarix is administered at ages 2, 4, and 6 months; it is not used for the birth dose.
The Heplisav-B schedule for hemodialysis patients is the same as for other adults, two 0. If the vaccination series is interrupted does the series need to be restarted? For all ages, when the HepB schedule is interrupted, the vaccine series does not need to be restarted. If the Heplisav-B series is interrupted, the second final dose should be given as soon as possible.
For Engerix-B and Recombivax HB, if the series is interrupted after the first dose, the second dose should be administered as soon as possible, and the second and third doses should be separated by at least 8 weeks. If only the third dose has been delayed, it should be administered as soon as possible. What are the minimum intervals between doses in the hepatitis B vaccine series?
The minimum interval between the two doses of Heplisav-B is 4 weeks. For the 3-dose series vaccines, Engerix-B and Recombivax HB, the minimum interval between the first and second doses is 4 weeks. The final dose of vaccine must be administered at least 8 weeks after the second dose and should follow the first dose by at least 16 weeks.
Vaccine doses administered 4 or fewer days before the minimum interval or age are considered valid. Doses received 5 or more days before the minimum interval or age should be repeated using the correct schedule.
We inadvertently gave a year-old a pediatric 0. Can we just give her another pediatric dose or should she receive a repeat adult dose? What you do depends on when the error is identified. If the error is discovered while the person is still in the office, you can administer the other "half" of the Engerix-B dose. If the error is discovered later, the dose should not be counted.
The person should be recalled to the office and given a full age-appropriate 1. The same recommendation would apply if the error was with Recombivax HB. However, data are limited on the safety and immunogenicity effects when Heplisav-B is interchanged with hepatitis B vaccines from other manufacturers.
When feasible, the same manufacturer's vaccines should be used to complete the series. However, vaccination should not be deferred when the manufacturer of the previously administered vaccine is unknown or when the vaccine from the same manufacturer is unavailable. The 2-dose HepB series for adults only applies when both doses in the series consist of Heplisav-B. Series consisting of a combination of 1 dose of Heplisav-B and a vaccine from a different manufacturer should consist of 3 total vaccine doses and should adhere to the 3-dose schedule minimum intervals of 4 weeks between dose 1 and 2, 8 weeks between dose 2 and 3, and 16 weeks between dose 1 and 3.
Doses administered at less than the minimum interval should be repeated. However, a series containing 2 doses of Heplisav-B administered at least 4 weeks apart is valid, even if the patient received a single earlier dose from another manufacturer.
How long is hepatitis B vaccine protective? Studies indicate that immunologic memory remains intact for at least 30 years and confers protection against clinical illness and chronic HBV infection, even though anti-HBs levels that once measured adequate might become low or decline below detectable levels.
If exposed to HBV, people whose immune systems are competent will mount an anamnestic response and develop protective anti-HBs. Studies are on-going to assess whether booster doses of HepB will be needed in the future. I tested positive for chronic HBV infection about 5 months ago. I know there is a vaccine to prevent transmission, however, I would like to know how long my partner should wait after taking this vaccine, before having sex with me without any risk of transmission?
You should use condoms until a postvaccination blood test hepatitis B surface antibody, or anti-HBs shows that your partner is protected from HBV infection. The efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce the risk of transmission. Your sexual partner should have the 2- or 3-dose series of hepatitis B vaccine depending on brand and postvaccination blood testing 1 to 2 months after the last dose of vaccine.
Where can I find out about vaccine shortages? My adult patient is traveling to Nigeria in three days. She is already immune to hepatitis A, but we want to provide protection for hepatitis B.
She received Twinrix two weeks ago and then a dose of single-component hepatitis B vaccine one week ago. How can we best provide protection in this circumstance? Even though ACIP does not recommend an accelerated HepB schedule in routine circumstances, a 4-dose series at 0, 7, 14 days, and 6 months is acceptable see www. Although this schedule deviates from the routine recommendation it can be used if travel is imminent. Give a dose of HepB now which will complete 3 of the 4-dose accelerated schedule.
She will need a fourth and final dose at least 6 months after the first dose in the accelerated schedule. An adolescent received the first dose of HepB at age 11 years but did not return for subsequent doses. If the patient comes back at age 16 years, is it necessary to repeat the first dose of the series? It is not necessary to restart or add doses to the HepB series or any other routine vaccine series because of a prolonged interval between doses. Just continue the series from the point where it was interrupted.
Note that the 2-dose Recombivax HB series using the adult formulation is approved only for adolescents 11 through 15 years of age. At age 16 years, the schedule reverts to the standard pediatric formulation 3-dose schedule rather than 2 adult doses.
If you want to test and vaccinate your patient for hepatitis B on the same day, does it matter if you test or vaccinate first? You should draw the blood first and then administer the first dose of vaccine, as transient HBsAg-positivity has been detected after a dose of HepB see next question. How long should a person wait to donate blood or have an HBsAg blood test after a dose of hepatitis B vaccine?
It is advisable to wait at least 3 weeks. Published studies have found that transient HBsAg-positivity can be detected for up to 18 days after HepB vaccination up to 52 days among hemodialysis patients. This does not mean the person is infected with HBV. However, donating too close to receipt of HepB could cause a person to be permanently deferred from blood donation if that person tests transiently HBsAg positive after the vaccine dose. The January recommendations are available at www.
Should pregnant women be vaccinated against hepatitis B during pregnancy? Yes; women who are identified as being at risk for HBV infection during pregnancy should be vaccinated. They also should be counseled concerning other methods to prevent HBV infection. Until safety data are available for Heplisav-B administration during pregnancy, ACIP recommends providers vaccinate pregnant women needing HepB vaccination with a vaccine from a different manufacturer.
What if Heplisav-B is inadvertently administered to a pregnant woman? There are insufficient data available to inform assessment of Heplisav-B vaccine-associated risks during pregnancy. The manufacturer, Dynavax, does not consider pregnancy to be a contraindication to the use of Heplisav-B. Dynavax has established a Vaccination in Pregnancy Registry in order to understand the effect if any of Heplisav-B vaccination during pregnancy.
Women who receive Heplisav-B within 28 days before pregnancy or at any time during pregnancy are encouraged to participate in the registry by calling What is the schedule for hepatitis B vaccine administration for infants who weigh less than grams? Decreased seroconversion rates might occur among preterm infants with birth weights less than 2, grams after administration of HepB at birth.
However, by the chronological age of 1 month, all preterm infants, regardless of initial birth weight, are likely to respond as adequately as larger infants. The initial vaccine dose should not be counted toward completion of the hepatitis B series, and 3 additional doses of HepB should be administered, beginning when the infant is age 1 month.
Infants weighing less than 2, grams born to HBsAg-negative mothers should receive the first dose of the HepB series at hospital discharge or at chronological age 1 month even if weight is still less than 2, grams , whichever comes first. What blood test should be used to screen a pregnant woman to prevent perinatal HBV infection? Screening should be done with the hepatitis B surface antigen HBsAg test only. This blood test will tell whether a woman has current HBV infection that can be transmitted to her infant.
An infant born to a woman for whom HBsAg screening test results during pregnancy are not available but other evidence suggesting maternal HBV infection exists e. The woman should also be referred to her jurisdiction's Perinatal Hepatitis B Prevention Program for case management to ensure that their infants receive timely prophylaxis and follow-up. Do women who have been vaccinated previously against HBV infection still need to be screened during pregnancy?
Just because a woman has been vaccinated does not mean she is HBsAg negative. Since postvaccination testing is not performed for most vaccinated people, she could have been vaccinated even though she was already actively infected. I've identified a patient in my obstetrical practice who is HBsAg positive.
Should she be evaluated for liver disease during her pregnancy, or should the evaluation wait until the postpartum period? What should I recommend for her husband and her children? How urgent is the time frame? The earlier the evaluation is done, the better. Consultation with or referral to a liver disease specialist such as a hepatologist, gastroenterologist, or infectious disease specialist should be done. In addition, the patient's sex partner and children or other household contacts should be tested for HBV infection total anti-HBc and HBsAg as soon as possible.
If any are HBsAg positive, they should be referred to or have consultation with a liver disease specialist. If a mother's HBsAg test result is not available at the time of birth, how should the infant be managed?
Only single antigen HepB vaccine should be used for the birth dose. For preterm infants, see the next question.
Measles, mumps and rubella vaccines Meningococcal vaccines Other Pneumococcal vaccines Polio 1. Pregnancy 7. Rotavirus Vaccines Shingles vaccines TB skin test Travel vaccines Vaccine eligibility 4.
Vaccine ingredients Vaccine safety Vaccine Schedules Vaccine Status Reporting Regulation 8. Where to get immunized How soon after a Heb B booster shot will immunity show up in bloodwork? I've missed my hepatitis b 3rd shot for a month now. Can I still go for it? Can someone receive his or her hepatitis b vaccine before the next dosage date????? Protection from hepatitis A and hepatitis B: As with any vaccine, this vaccine may not result in total protection from hepatitis A and hepatitis B and may not prevent hepatitis A or hepatitis B for people who are infected with the virus at the time of vaccination.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while receiving this medication, contact your doctor immediately. Breast-feeding: It is not known if this vaccine passes into breast milk.
If you are a breast-feeding mother, this medication may affect your baby. Talk to your doctor about whether you should continue breast-feeding. Immunosuppressant medications e. If you are taking any of these medications, speak with your doctor or pharmacist.
Depending on your specific circumstances, your doctor may want you to:. An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed. Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter non-prescription , and herbal medications that you are taking.
Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them. All material copyright MediResource Inc. Terms and conditions of use.
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