
Do i need to stop plaquenil before getting shingles shot?
Do i need to stop plaquenil before getting shingles shot?
Linda: Thanks for asking. The good news is that HCQ does not need to be stopped. It doesn’t interfere with how well vaccines work. Thanks for reading my post and asking… Donald Thomas, MD
Linda: not at all. Studies show that Plaquenil does not reduce vaccination antibody responses. … Donald Thomas, MD
It’s safe to get my 1st dose vaccine since I have lupus & I have medication intake
I assume the COVID vaccine? The answer is “yes” unless you are allergic to any components of the vaccine. Also, some would recommend not getting it if your lupus is severely active, or if you are on prednisone 20 mg a day or more. It is important to stop some immunosuppressants after getting the vaccine to ensure it works better. Make sure to ask your doctor (hopefully a rheumatologist if you have one)…. Donald Thomas, MD
I got a shingles vaccine in 2016 after having had shingles and been free of any break out for 6 months. It was one that required a prescription and did not require a booster shot. Should I get a new vaccination or a booster to the previous one?
Cynthia: It sounds like you probably received the live vaccine, Zostavax, which was around in 2016; Shingrix the newer, better one was FDA approved in 2017. The problems with Zostavax: it is only 65% effective and it wears off over time. The CDC (and I) recommend getting the Shingrix even if you have had the Zostavax before and if you have had shingles before. Get one now, then a booster in 2-6 months. It is FDA approved for 18+ year olds who are immunosuppressed, and for all 50 year old adults… Donald Thomas, MD
I had a Shingrix vaccine in January and went off my methotrexate two weeks following.
I had a horrible lupus flare that lingered for weeks.
I had no flares going off of methotrexate two weeks after each of my 4 covid vaccines.
I’m hesitant to get the second Shingrix vaccine not knowing if my flare
was that or two weeks off of methotrexate.
Dr how would you advise your patient if this was the case with him/her?
Thank you for your time and valued advise. Cathy
Cathy: So sorry to hear that.
1. I’m glad you got your Shingrix. I just saw a lupus patient today who kept putting her Shingrix off (though I constantly asked her to get it) … today she was in tears from horrible pain on her left face and shoulder from shingles wishing she had gotten it. Another RA patient… her arm is paralyzed from shingles attacking her muscle nerves (she regrets not getting it). A male RA patient of mine was in tears from horrible leg pain (also a Shingrix procrastinator). I am mentioning all this just to put things into perspective for you.
2. The following is not to be used in replacement of your doctors’ advice (who know your medical history completely) … but from what you tell me, I would most likely recommend you still get Shingrix #2 go get some extra immunity, but take Tylenol Arthritis 2 tabs three times daily around the clock for a week afterward (to minimize side effects) if no contraindications (such as advanced liver disease or excess alcohol use) but keep taking MTX to lower the risk of a lupus flare afterward.
Do not do this please without showing it to your rheumatologist and seeing what they think.
Good luck with your choice and thanks for commenting, asking, and reading my blog.
Donald Thomas, MD
I had my second Shingrix vaccine 1 week ago. My rheumatologist is starting me on Arava. How long do I need to wait before starting Arava, if at all?
Kathy: As in so many things in medicine, “it all depends.”
If you were my patient and we could afford to wait a full two weeks, I’d start leflunomide (Arava) 2 weeks after the vaccine (the original ACR guidelines recommended a 2-week delay or holding).
However, if I did not think we could wait 2 weeks, It only wait one week (as per the most recent ACR guidelines).
If I needed it to work ASAP (such as if there was a lot of inflammation, and we couldn’t wait), then starting it right away would be the right decision.
Bottom line: ask your rheumy as they would know what best to do.
Link to ACR guidelines (table 3):
https://www.rheumatology.org/Portals/0/Files/COVID-19-Vaccine-Clinical-Guidance-Rheumatic-Diseases-Summary.pdf
Thanks for reading my blog and being proactive in your healthcare and Good luck!
Donald Thomas, MD
Kathy: Sorry, I just saw your message. There is no formal recommendation for Shingrix. However, for COVID vaccines, it is recommended to hold Arava for 1-2 weeks after the vaccine. Optimally, it is best to get all vaccines 2 weeks prior to Arava.
I have just received my first dose of Benlysta IV. I was going to schedule the Shingrix vaccine, as I haven’t received it yet. Is their a suggested timing interval for doing so., such as in between infusions?
I have my second loading dose of Benlysta in 14 days,
Thank you
Julie: There are not recommendations on stopping belimumab or timing it properly for Shingrix. However, we also just do not have data supporting one way or the other. For my patients, I play it “safe” by going by the COVID-19 vaccine recommendations. I recommend they get their Shingrix 14 days after Benlysta infusion, and 14 days before the next infusion. However, I do not have data to back this up.
Thanks for asking!
Donald Thomas, MD
Julie: Sorry I just saw your message. Timing has not been determined for the Shingrix vaccine with Benlysta. A prior recommendation was to time COVID vaccines midway between Benlysta infusions. That has since been dropped with the August 2022 guidelines. For SQ Benlysta, holding the dose for 1-2 weeks after the vaccine is recommended.
Don Thomas, MD
I have RH- blood.never got shingles.Have SLE.Was vaxed for Covid.Do I need to get Shingrix?
Tricia: I do recommend that most of my SLE patients 19 years old and older get the Shingrix vaccine as SLE patients in general are at high risk for shingles. However, make sure to discuss your personal situation with your doctor to determine your personal risk.
Donald Thomas, MD
Should I stop azathioprine prior/post getting either shingles vaccine? Thanks.
Dear Dee: This is one of those areas where we really do not know because no one has formally studied it. What I do, is that if my patient is to at high risk for flaring, I ask them to stop it for 1-2 weeks after the vaccine (depending upon the patient’s risk of flare) if they their SLE is under excellent control. Reason being is that the formal guidelines for COVID vaccines makes this recommendation, and those guidelines were developed by experts in the field. I do this in the hopes that they may have a better response to the vaccine than if they were to stay on it. I hope we do have formal studies in the future to give us better guidance. Thanks for your question!
Donald Thomas, MD
Hi. I was perfectly healthy before I got Covid 2 years ago before my age could be vaccinated. I’m 52. I am dealing with long haul Covid and couldn’t walk I got so bad until I started taking hydroxychloroquine. They are now treating it like lupus. I have high crp levels 2. I’m scared to get the shingles vaccine with everything I’m going through but scared to get shingles. Thoughts?
Lisa: So sorry to hear that. This is one reason why I urge my patients to get their COVID vaccines. It is NOT just like the flu. Two years ago, in addition to many deaths, we saw too many people like you plagued with long term complications. I’ve never had any problems like this with the COVID vaccines in patients.
Please keep the same mental approach to Shingrix. As a physician, I just wish people would see what I see from shingles. At least every few months I have a patient come in crying from excruciating pain, often described like a hot iron on the skin. This is often followed by numerous doctor visits and pain med adjustments just to try to lessen the severity of pain, and I always hear the same thing, “I wish I had gotten my Shingrix as you recommended.” I have also had one patient die from a brain infection from shingles and one patient’s arm is 100% permanently paralyzed because the shingles attacked the nerves that go to her arm muscles.
This is why you’ll rarely see a doc who has not gotten it. When I turned 50, I ran to the pharmacy to get mine.
btw, the worse I’ve seen from Shingrix is a very sore shoulder for a few days to a week, and occasionally a flu-like syndrome… all treatable with Tylenol.
I hope this puts it into perspective for you.
Donald Thomas, MD
Thank you so much for the info. I’m going to get the shingles vaccine next week! I do support vaccines. I wish I was old enough to get tne Covid vaccine before I got sick with it and I wouldn’t be dealing with this. It’s been a rough 2 years. I don’t want shingles on top of this. Thank you.
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