Dosing & Uses
Dosage Forms & Strengths
Lf = limits of flocculation
pertussis/diphtheria/tetanus
injection for suspension
- (15.5mcg/2Lf/5Lf)/0.5mL (Adacel)
- (18.5mcg/2.5Lf/5Lf)/0.5mL (Boostrix)
Immunization
Boostrix
- Indicated as active booster immunization against tetanus, diphtheria, and pertussis for individuals aged ≥10 yr
- 0.5 mL IM
-
Routine booster vaccination
- First dose: Administer ≥5 yr after the last dose of diphtheria and tetanus toxoids and acellular pertussis (DTaP) series or after a dose of tetanus and diphtheria toxoids adsorbed (Td)
- May administer an additional dose ≥9 yr after initial Tdap dose
Adacel
- Indicated for active booster immunization against tetanus, diphtheria and pertussis in individuals aged 10 through 64 years
- 0.5 mL IM
-
Routine booster vaccination
- First dose: Administer ≥5 yr after last DTaP or Td dose
- May administer a second dose ≥8 yr after initial Tdap dose
-
Wound management
- May administer for tetanus prophylaxis for wound management
- Booster dose may be administered if >5 yr have elapsed since previous receipt of a tetanus toxoid containing vaccine
CDC ACIP Recommendations
Regardless of the interval since their last tetanus or diphtheria toxoid-containing vaccine, persons aged ≥19 yr who have never received a dose of Tdap should receive 1 dose of Tdap
To ensure continued protection against tetanus and diphtheria, booster doses of either Td or Tdap should be administered every 10 yr throughout life (MMWR January 24, 2020 / 69(3);77-83)
Immunization During Pregnancy
Adacel or Boostrix
Indicated to prevent pertussis in infants younger than 2 months by immunizing pregnant females during third trimester of pregnancy
Administer a single 0.5-mL dose regardless of vaccination history and time since prior Td or Tdap
Dosage Forms & Strengths
Lf = limits of flocculation
pertussis/diphtheria/tetanus
injection for suspension
- (15.5mcg/2Lf/5Lf)/0.5mL (Adacel)
- (18.5mcg/2.5Lf/5Lf)/0.5mL (Boostrix)
Routine Vaccination
Indicated as active booster immunization for prevention of tetanus, diphtheria (not indicated for primary immunization series)
Boostrix: 0.5 mL IM; approved for individuals aged ≥10 yr
Adacel
- 0.5 mL IM; approved for individuals aged ≥10 yr
-
Routine booster vaccination
- First dose: Administer ≥5 yr after the last dose of diphtheria and tetanus toxoids and acellular pertussis (DTaP) series or after a dose of tetanus and diphtheria toxoids adsorbed (Td)
- May administer a second dose ≥8 yr after the first dose of Tdap
-
Wound management
- May administer for tetanus prophylaxis for wound management
- Booster dose may be administered if >5 yr have elapsed since previous receipt of a tetanus toxoid containing vaccine
CDC ACIP general recommendations
- 11-18 years: A single dose of Tdap, preferably at a preventive care visit at age 11-12 years
- To ensure continued protection against tetanus and diphtheria, 1 booster dose of either Td or Tdap should be administered every 10 yr throughout life (MMWR January 24, 2020 / 69(3);77-83)
Catch-up Vaccination
≥7 years who are not fully immunized with DTaP vaccine: Administer a single-dose Tdap vaccine (preferably the first) dose in the catch-up series; if additional doses are needed, use either Td or Tdap vaccine
Children 7-10 years who receive a dose of Tdap as part of the catch-up series: Administer an adolescent Tdap vaccine dose at age 11-12 years
11-18 years: Administer booster of Td or Tdap every 10 years
≥19 years who did previously receive dose of Tdap: Administer 1 dose of Tdap; to ensure continued protection against tetanus and diphtheria, booster doses of either Td or Tdap should be administered every 10 yr throughout life
Immunization During Pregnancy
Administer Tdap vaccine to pregnant adolescents to reduce morbidity and mortality associated with pertussis in infants <2 months
The CDC's Advisory Committee on Immunization Practices (ACIP) recommends all pregnant females receive 1 dose of Tdap during each pregnancy ideally between 27 and 36 weeks of gestation regardless of vaccination history and time since prior Td or Tdap
Dosing Considerations
Inadvertent doses of Tdap vaccine
-
Age 2 months to 6 years
- If Tdap is administered inadvertently instead of DTaP as any one of the first 3 doses of the tetanus-diphtheria-pertussis vaccination series, do not count Tdap dose and administer replacement dose of DTaP
- If Tdap is administered inadvertently as fourth or fifth dose in tetanus-diphtheria-pertussis vaccination series, count Tdap dose as valid and do not replace; administer adolescent Tdap dose as recommended when this child is aged 11-12 years
-
Age 7-10 years
- Children aged 7-10 years who are fully vaccinated: If Tdap is administered inadvertently, do not count Tdap dose as valid
- Administer adolescent Tdap dose as recommended when child is 11-12 years; however, if Tdap is administered at age 10 years, the Tdap dose may count as the adolescent Tdap dose
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (0)
Serious - Use Alternative (5)
- elivaldogene autotemcel
elivaldogene autotemcel, tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine. Either decreases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: The safety and effectiveness of vaccination during or following elivaldogene autotemcel treatment have not been studied. Vaccination is not recommended during the 6 weeks preceding myeloablative conditioning, and until hematological recovery following elivaldogene autotemcel treatment. Where feasible, administer childhood vaccinations before myeloablative conditioning. .
- ixekizumab
ixekizumab decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating ixekizumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with ixekizumab may not elicit an immune response sufficient to prevent disease.
- secukinumab
secukinumab decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Prior to initiating secukinumab, complete all age appropriate immunizations; non-live vaccinations received during treatment with secukinumab may not elicit an immune response sufficient to prevent disease.
- siponimod
siponimod decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by immunosuppressive effects; risk of infection. Avoid or Use Alternate Drug. Pause vaccinations beginning 1 week before initiating siponimod and for 4 weeks after stopping treatment. Coadministration with live attenuated vaccines may increase infection risk.
- teplizumab
teplizumab decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by Other (see comment). Avoid or Use Alternate Drug. Comment: Administer all age-appropriate vaccinations before starting teplizumab. Inactivated or mRNA vaccines are not recommended within 2 weeks before teplizumab treatment, during treatment, or 6 weeks after completion of treatment.
Monitor Closely (6)
- certolizumab pegol
certolizumab pegol decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Use Caution/Monitor.
- delandistrogene moxeparvovec
delandistrogene moxeparvovec, tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine. Other (see comment). Use Caution/Monitor. Comment: Consider patient vaccination status before initiating corticosteroid regimen required before delandistrogene moxeparvovec administration. If possible, ensure patients are current with all immunizations according to immunization guidelines. Complete vaccinations at least 4 weeks before starting corticosteroid regimen. High-dose or long-term corticosteroids may decrease immungenicity of vaccines.
- ifosfamide
ifosfamide decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- melphalan
melphalan decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- oxaliplatin
oxaliplatin decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by passive renal tubular reabsorption due to increased pH. Modify Therapy/Monitor Closely. Coadministration with immunosuppressant therapy reduced efficacy of the vaccine may occur. If possible, complete all age-appropriate vaccinations at least 2 weeks prior to initiation of immunosuppressant therapy. Patients vaccinated <14 days before initiation or during immunosuppressive therapy should be revaccinated at least 3 months after therapy is discontinued. .
- ublituximab
ublituximab decreases effects of tetanus & reduced diphtheria toxoids/ acellular pertussis vaccine by immunosuppressive effects; risk of infection. Modify Therapy/Monitor Closely. Administer all immunizations according to immunization guidelines at least 4 weeks before initiating ublituximab for live or live-attenuated vaccines and, whenever possible, at least 2 weeks before initiating for non-live vaccines. Vaccination with live virus vaccines is not recommended during treatment and until B-cell repletion. Do not administer live or live-attenuated vaccines to infants of mothers exposed to ublituximab during pregnancy, before confirming recovery of B-cell counts as measured by CD19+ B cells.
Minor (0)
Adverse Effects
>10% (Boostrix)
Pain (21.5%)
Fatigue (12.5%)
Headache (11.5%)
Redness (10.8%)
Swelling (7.5%)
>10% (Adacel)
Any injection site pain (65.7-77.8%)
Malaise (30.8-33.3%)
Headache (33.9-43.7%)
Body ache or muscle weakness (21.9-30.4%)
Tiredness (24.3-30.2%)
Any injection site erythema (20.8-24.7%)
Any injection site swelling (20.9-21%)
Moderate injection site pain (15.1-18%)
Chills (8.1-15.1%)
Nausea (9.2-13.3%)
Sore and swollen joints (9.1-11.3%)
Diarrhea (10.3%)
1-10% (Boostrix)
Gastrointestinal symptoms (7.6%)
Swelling (7.5%)
Fever (≥99.5°F [37.5°C])
1-10% (Adacel)
Body aches/muscle weakness (1.2-8.5%)
Injection site erythema (2.7-8.4%)
Lymph node swelling (6.5-6.6%)
Injection site swelling (2.8-6.4%)
Fever (1.4-5%)
Vomiting (3-4.6%)
Chills, moderate (1.3-3.2%)
Nausea (1-3.2%)
Rash (2-2.7%)
Joint pain, moderate (2.5%)
Severe injection site reactions (1.1-1.5%)
Lymphadenopathy (1%)
Warnings
Contraindications
Hypersensitivity
Encephalopathy with 7 days of previously administered pertussis antigen
History of Arthus reaction to prior tetanus vaccination (unless 10 yr have elapsed)
Cautions
Epinephrine and other emergency equipment should be available to respond to hypersensitivity reactions
Not indicated for primary vaccination series; for children aged 6 months-7 yr, see DTaP
Caution if Guillain-Barré syndrome and brachial neuritis has occurred with previously administered tetanus toxoid
Caution with neurologic disorders (eg, epilepsy, CVA, encephalopathic condition)
Defer vaccine if moderate or severe illness present
Syncope has been associated with administration of injectable vaccine
Attenuated immune response may occur with immunosuppressed conditions (eg, high-dose corticosteroids, use of antineoplastic agents, immunosuppressive illness)
Prefilled syringes contain natural latex rubber
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies of administration in pregnant women
Available data suggest the rates of major birth defects and miscarriage in women who receive Tdap within 30 days prior to pregnancy or during pregnancy are consistent with estimated background rates
Animal studies
- Adacel: Two developmental toxicity studies were performed in female rabbits given 0.5 mL (a single human dose) of Adacel twice prior and during gestation
- Boostrix: Developmental toxicity studies were performed in female rats and New Zealand White rabbits did not observe fetal abnormalities following vaccine administration before mating and during gestation
Pregnancy registries
- Clinicians are encouraged to call and register women in the following pregnancy exposure registries
- Adacel: 1-800-822- 2463 (1-800-VACCINE)
- Boostrix: 1-888-452-9622
Lactation
Unknown if distributed in human breast milk
Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for the drug, and any potential adverse effects on the breastfed infant from the drug or from the underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Active immunization resulting in development of neutralizing antibodies to tetanus, diphtheria, and pertussis toxins
These products convey active immunity via stimulation of production of endogenously produced antibodies
Pharmacokinetics
The onset of protection from disease is relatively slow, but duration is long lasting (years)
Duration: Variable, possibly >10 yr; Tdap maternal pertussis antibodies appear to wane greatly between subsequent pregnancies
Administration
IM Preparation
Shake vigorously to obtain a homogeneous, turbid, white suspension before administration; do not use if resuspension does not occur with vigorous shaking
Visually inspected for particulate matter and discoloration prior to administration, whenever solution and container permit
Adacel or Boostrix vial: Withdraw 0.5 mL dose from vial using a sterile needle and syringe
IM Administration
IM administration only
Do not administer IV, intradermally, or SC
Storage
All formulations: Refrigerate between 2-8°C (36-46°F); do not freeze
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Adacel (Tdap Adolescent/Adult)(PF) intramuscular - | 2 Lf-(2.5-5-3-5 mcg)-5Lf/0.5 mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
diphtheria,pertussis(acel)tetanus vaccine (PF) intramuscular
DIPHTHERIA/TETANUS/ACELLULAR PERTUSSIS VACCINE - INJECTION
(dip-THEER-ee-uh/TET-un-us/per-TUSS-iss)
COMMON BRAND NAME(S): Adacel, Boostrix
USES: This vaccine is used to keep up protection (immunity) against diphtheria, tetanus (lockjaw) and pertussis (whooping cough) in children and adults who have been vaccinated for these diseases in the past. It may also be given during the third trimester of pregnancy to help prevent pertussis in the newborn baby. Vaccination is the best way to protect against these life-threatening diseases. Vaccines work by causing the body to produce its own protection (antibodies). Booster doses are needed to keep up immunity because antibody levels may become too low over time to provide the needed protection.
HOW TO USE: Read all vaccine information available from your health care professional before receiving the vaccine. If you have any questions, ask your health care professional.This medication is given by injection into a muscle by a health care professional. It is usually given in the upper arm.This vaccine may be given at the same time as other vaccines (such as hepatitis B) using a separate needle and injection site.
SIDE EFFECTS: Pain, swelling, or redness at the injection site may occur. Headache, tiredness, body aches, nausea, diarrhea, fever, chills, vomiting, or sore/swollen joints may also occur. Acetaminophen or ibuprofen (non-aspirin) may be used to reduce soreness. If any of these effects last or get worse, tell your health care professional promptly.Rarely, some people have symptoms such as fainting, dizziness, vision changes, or ringing in the ears just after getting a vaccine injection. Tell your health care professional right away if you have any of these symptoms. Sitting or lying down may help, since these symptoms usually don't last long.Remember that this medication has been prescribed because your health care professional has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your health care professional right away if you have any serious side effects, including: high fever (higher than 104 degrees F/40 degrees C), seizures, numbness/tingling, muscle weakness, difficulty breathing.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your health care professional.Contact the health care professional for medical advice about side effects. The following numbers do not provide medical advice, but in the US you may report side effects to the Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967. In Canada, you may call the Vaccine Safety Section at Public Health Agency of Canada at 1-866-844-0018.
PRECAUTIONS: Before receiving this vaccination, tell your health care professional if you are allergic to it; or to any other vaccines; or if you have any other allergies. This product may contain inactive ingredients (such as latex found in some brands), which can cause allergic reactions or other problems. Talk to your health care professional for more details.Before receiving this vaccine, tell your health care professional your medical history, especially of: nervous system disorders (such as seizures, encephalopathy, Guillain-Barre syndrome), current illness/infection, immune system disorders (such as due to HIV infection, certain cancers such as leukemia/lymphoma, cancer or radiation treatment), vaccination history including previous reactions to any vaccines.During pregnancy, this vaccine is usually recommended. Discuss the risks and benefits with your health care professional.It is unknown if this vaccine passes into breast milk. Consult your health care professional before breastfeeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your health care professional. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this vaccine include: drugs that weaken the immune system (including cyclosporine, tacrolimus, cancer chemotherapy, corticosteroids such as prednisone), other vaccines (such as diphtheria/tetanus toxoids).
OVERDOSE: Not applicable.
NOTES: There are various combinations of vaccines available. Based on your age, vaccination history, and previous reaction to vaccines, your health care professional will determine the most appropriate one for you. Discuss the risks and benefits of vaccination with your health care professional.History of infection with tetanus or diphtheria does not always protect against future infections with these bacteria. You should still receive this vaccine if your health care professional orders it for you.
MISSED DOSE: It is important to receive each vaccination as scheduled. Be sure to make a note of when the vaccination was last given for your medical record.
STORAGE: Store in the refrigerator. Do not freeze. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised March 2024. Copyright(c) 2024 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
