Interaction between COVID-19 Vaccine and Paracetamol, Chlorpheniramine and Prednisolone

Interaction between COVID-19 Vaccine and:	Paracetamol	Chlorpheniramine	Prednisolone
Lexicomp Interaction Category	D: Consider therapy modification	D: Consider therapy modification	C: Monitor therapy
Summary	Paracetamol may diminish the therapeutic effect of vaccines. This interaction only applies to prophylactic use of acetaminophen before or during vaccine administration.	Antihistamines may enhance the adverse / toxic effect of COVID-19 Vaccine.  Specifically, the prophylactic use of antihistamines may mask symptoms and delay diagnosis and management of anaphylaxis.	Immunosuppressants may diminish the therapeutic effect of COVID-19 Vaccine
Patient Management	Consider avoiding routine prophylactic use of paracetamol before or during vaccine administration when possible. Paracetamol is still recommended to treat fevers and/or pain that occur after vaccination.	Do not administer antihistamines to COVID-19 vaccine recipients prior to vaccination to prevent allergic reactions. Antihistamines do not prevent anaphylaxis, and their use may mask cutaneous symptoms, which could lead to a delay in the diagnosis and management of anaphylaxis.	·   The COVID-19 vaccine (mRNA) has not been systematically studied in individuals receiving immunosuppressant therapy. While this combination is expected to be safe, reduced efficacy of the vaccine (eg, reduced immune response) may occur if administered to patients on immunosuppressant therapy. ·   If possible, based on recommendations for the timing of inactivated vaccines, administer the COVID-19 (mRNA) vaccine series at least 2 weeks prior to initiation of immunosuppressant therapy. ·   Decisions to delay immunosuppressive therapy to complete COVID-19 vaccination should consider the person’s risks related to their underlying condition. ·   Patients vaccinated less than 14 days before starting immunosuppressant therapy or while receiving immunosuppressant therapy may get less than full protection from the vaccine; hence advised to continue to carefully adhere to current public health recommendations regarding social distancing, wearing a mask, avoiding large gatherings, and other guidance regarding minimizing possible exposure to the virus.
Proposed Mechanisms	Paracetamol suppression of the inflammatory response, which is an important component of the host response to vaccine administration.		Likely decreased immune response to inactivated vaccines due to immunosuppression.
Remark(s)		Only found for mRNA and adenovirus vector.

 *COVID-19 vaccines placed in the search include mRNA, inactivated virus and adenovirus vector.

However, pre-med may be suggested by physician / allergist / immunologist in specific individual cases.

Reference:   Lexicomp Drug Interaction: Online [Accessed on 28 March 2021]     by J. Ho

Sugammadex Administration Guide

SUGAMMADEX 200 MG / 2 ML INJECTION
Route	Dilution	Infusion Rate
Reconstitution	Not required  1
INTRAVENOUS INJECTION	Single bolus injection into an existing IV line 1 ü   Adult: Pure ü   Paediatrics: May dilute (refer ‘to Diluent’ section)	Rapidly within 10 seconds 1,3,4   However, some experts suggest administering slow IV push to reduce incidence of serious adverse events (e.g. bradycardia or asystole), e.g. in older patients 3,4
DILUENT	·       May be injected into the intravenous line of a running infusion with NS / D5 / Ringer’s Lactate / Ringer’s Solution / NSD5 / NaCl 0.45% + Glucose 2.5% 1,4 ·       The infusion line should be adequately flushed with NS (NaCl 0.9%) between administration of Sugammadex and other drugs. 1,4 ·       For paediatric patients, to increase accuracy of dosing, may dilute with NS to: ü  10 mg/mL concentration for 2 years old and above 1 ü  25 mg/mL concentration for below 2 years old 3
Stability	Original Intact Product Store in the original package to protect from light 1 The vials may be stored outside the carton for up to 5 days 1,4   Diluted Product §   Under aseptic condition: Diluted product: 48 hrs at 2-25°C 1 §   NOT under aseptic condition: Diluted product: 24 hrs at 2-8°C 1
RECOMMENDED DOSE	Dosing in geriatrics: Same as adult dose 1,3 Dosing in obesity: Use actual body weight 1,4   Indication 1,2 Adult Dose Paeds Dose (For 2 years old & above) Spontaneous recovery has occurred up to at least the reappearance of second twitch tension of the train-of-four (T2) 2 mg/kg 1-4 2 mg/kg 1,3 Recovery has reached at least 1- 2 post-tetanic counts (PTC) 4 mg/kg 1-4 Not recommended as no data 1 Immediate reversal following administration of rocuronium 16 mg/kg 1-4   Recommended waiting times for readministration with neumomuscular blocking agents (NMBA) after reversal with Sugammadex: Dose of Sugammadex Administered Minimum Waiting Time NMDA and Dose to be Administered After routine reversal with up to 4 mg/kg sugammadex 5 mins 1.2 mg/kg rocuronium 4 hrs 0.6 mg/kg rocuronium  OR  0.1 mg/kg vecuronium After immediate reversal with 16 mg/kg sugammadex 24 hrs -
Remarks	·       Physical incompatibility reported with ranitidine, verapamil & ondansetron.1 ·       Very common side effects include hypotension, headache, nausea, vomiting and procedural pain / pain at injection site. 3,4
References	1.     Product Leaflet (BRIDION ; Revised Jan 2017) 2.     FUKKM online: Sugammadex [Accessed 18 March 2021] 3.     Uptodate [online]: Sugammadex [Accessed on 18 March 2021] 4.     Micromedex Version v3.0b856 [Accessed 18 March 2021]

 

Prepared by J. Ho [18.03.2021]