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Immunosuppressants and COVID Vaccine: Fundamentals in the new guidelines

Immunosuppressants and COVID vaccine: which you should stop and not stop

Immunosuppressants and COVID vaccine ACR guidelines and recommendations
Immunosuppressants and COVID vaccine ACR guidelines and recommendations
American College of Rheumatology Clinical Guidance Summary UPDATED AUG 2021
The above come from the ACR published guidelines. You can find the entire article here
Revised with new drugs to stop for vaccines 9/12/21. However, they were again updated in August 2021. The above photo

Bottom Line:
Now it is recommended to stop immunosuppressants after the booster shot. 
These recommendations are quite puzzling to me. Note how they recommend stopping immunosuppressants for two weeks after getting the COVID-19 booster shot. However, they state that immunosuppressants such as azathioprine do not need to be stopped for the initial shots. The committee that formed these has a meeting after this August publication and I hope that they change the recommendations to be more uniform. After seeing these recommendations, I am recommending that my patients stop their immunosuppressants for all vaccines to help them work better (if they are not at high risk of flaring).

How about having a sulfa drug allergy and COVID vaccine? I hope the reader is aware that everyone with systemic lupus should avoid sulfa (sulfonamide) drugs. They can flare lupus. However, it is completely safe to get your COVID-19 vaccines.

Please check with your doctor and ask before implementing these. Your medical condition may dictate otherwise

Resource: American College of Rheumatology ACR COVID-19 Vaccine Clinical Guidance Task Force (2/8/21). COVID-19 Vaccine Clinical Guidance Summary for Patients with Rheumatic and Musculoskeletal Diseases. Retrieved on 2/25/21 from ​https:///


Don Thomas, MD, author of “The Lupus Encyclopedia” and “The Lupus Secrets


  1. What does this mean? If one had the vaccine and didn’t reduce cellcept are they at risk for lupus flares? Does this reduce efficacy of vaccine? Can you please elaborate? TIA!

  2. I’m confused. We are concerned about blood clots with the vaccine but you want me to hold my aspirin (I take 2 baby aspirin) 24 hours before? Why?

    • Dear Celia: Good question.

      1. The reported blood clots from the J&J/Jannsen COVID vaccine were incredibly rare. If it is a personal concern, I’d recommend Moderna or the Pfizer RNA vaccines.
      2. The Advisory Committee on Immunization Practices recommends not taking aspirin, acetaminophen, or NSAIDs prior to vaccines just in case they may blunt the effect of the vaccine. However, this has not been proven to be a problem, but they just want to ensure everyone can have the best response possible.
      3. … A little known secret… the blood thinning properties of aspirin last the entire life span of the platelets that they affect. Platelets are the blood cell fragments that help us clot and aspirin ingestion affects the action of platelet’s abilities to work. When you stop aspirin, enough platelets affected by the previous doses of aspirin last for around 10 – 14 days. Therefore, there is no worry of missing a day’s worth. The Advisory Committee on Immunization Practices says it is OK to take it after your vaccine.

      thanks for the great question… Donald Thomas, MD

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