Interacting drugs - summary

+Tetanus Toxoid 

Immunosuppresants                                                                                            administration of tetanus toxoid adsorbed to patients receiving immunosuppressants including corticosteroids or radiation therapy may result in insufficient response to immunization. Remain susceptible despite immunization

Cimetidine                                                                                                                      cimetidine enhance or augument delayed hypersensitivity response to skin-test antigens 

Chloramphenicol                                                                                                        systemic chloramphenicol may impair amnestic response to tetanus toxoid. Avoid concurrent use. 

Tetanus immune globulin                                                                                                       concurrent delay development of active immunity by several  days, however this interaction is not clnically significant and does not preclude concurrent use. 

Tetanus toxoid-

Absorbed ttanus toxoid- a small amount of erythema and induration surrounding the injection site, persisting for a few days is not unusual. A nodule may be palpable for a few weks. Allow suck nodules to recede spontaneously an do not incise.

Adverse reactions often associated with multiple booster dose may be manifesated 2 to > 12 hours after administration by erythema, boggy edema, pruritus, lymphodemnopathy and induration surrounding the site of injection.

Low-grade fever, chills, malaise, generalized aches and pains, headaches, flushing ,generarlized urtiacaria or pruritus lymphadenopathy and induration surrounding the site of injection.

Pain and tenderness if present are usually not the primary compalints.

Fluid tetanus toxoid- markedly hypersenitive pesons may develop a local reaction at the injection site. Cold packs will lessen the discomfort. Mild exageration of patients allergic symptoms, hives, anaphylactoid raections, shock, and death from anapohylaxis may occur.

Diphtheria toxoid 

Local-

Mild to moderate redness,tenderness and induration around the injection site.

Systemic- transcit fever, malaise, generalized aches, and apins, flushing, genearlized urticaria or pruritus, tachcardia, and hypotension, may occur, especially in persons who may received many booster injections. postvaccinal neurological disorders, although uncommon have been reported.

Tetanus toxoid-

Absorbed tetanus toxoid- use fluid tetanus toxoid toimmize the rae patent who is hypersentive to the aluminium adjuvant. Fluid tetanus toxoid- hypersenitivity to tetanus toxoid or any other components.

Special preacutions- Warnings-

Tetanus infection- under no circumstances should tetanus toxoid be used to treat actual tetanus infections.

Immunodefiency- persons receiving immunosuppressive therapy or with other imunodefiencies may have a diminished antibody response. to active eimuninization.

This is the reason for defering primary diphtheria immunization until treatment is discontinued or for injecting an aditionl dose > 1 month after treatment has ceased.

Hypersenitivity- take every precaution to prevent and arrest allergic and other untoward reactions. Ephinephrine 1:1000 andother appropiate agents should be readily avilable to comat allergic reactions.

Elderly- elderly develop lower to normal antitoxin levels following tetanus immunization than younger persons. Skin test responsiveness may be delayed or reduced inmagnitude in older persons.

Pregnancy- use only if clearly needed.

Lactation- it is not known if tetanus toxoid or corresponding antibodis are excreted in breast milk.

Children- safety and and efficacy of tetanus toxoid are known for children as young as 2 months

Diphtheria Toxoid- 

Patients < 6 weeks or > 7 years of age An acute infection is raeson for differung administration of routine primary immunization or routine reacll doses. but not emergency recall doses.

Special preacuitions-

Warnings-

Diphtheria infection- do not use for the treatment of actual diphtheria infections. Immunodeficiency- persons receiving immunosupprssive therapy or with other imunodeficencies may have diminished antibody response to active imunization . This is reason fore deffering primary diphtheria imunization until the treatment is disconinued or for injecting an additional dose > 1 month after immunosuppresive treatmnet has ceased. Nonetheless, routine immunization of symptomatic and asympatomatic HIV-patients is recommended.

Hypersensitivity- have ephonephrine 1:1000 immediately avialable.

Elderly- use contraindiacted after seventh birthday.

Pregnancy- it is not known if diphtheria toxoid or corresponding antibodies are excreted in breast milk.

Lactation- it is not known if diphtheria toxoid or corresponding antibodies are excreted in breast milk.

Children- use in pediatric patients > 7 years of age only. DTwP or DTaP is preferred over Plain diphtheria toxoid.

Tetanus Toxoid- 

Administer IM, preferably into the deltoid or midlateral muscles. In infants the vastus lateralis (mid-thigh laterally) is the preferred site.

Diphtheria Toxoid-

Primary immuninization- Administer 2 injections (0.5ml each ) 6 to 8 weeks apart, and a third dose of 0.5ml approximately 1 year later.

1. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to diphtheria and tetanus toxoids or other related medicines. Also tell your doctor if youn are allergic to any other substances such as foods, preservatives or dyes.

3. Pregnancy- immunization of a pregnant woman can prevent her newborn baby from getting tetanus at birth.

3. Breast feeding- this vaccine has not been shown to cause problems in nursing babies

4. Children- fo children upto 6 weeks of age - use of DT or TD is not recommended For infants and childrten 6 weeks upto 7 years of age use of DT or Td is not recommended For children 7 years of age and older DT is not recommeded. TD is used instead

5. Elderly- TD may be slightly less effective in older people than in young adults

6.Other medical problems- tell your doctor if you have any other medical problems- Fever or infection or illness - use of DT or TD may make the condition worse or may increase the chance of side effects

Missed dose-

1. If you miss a dose of this medicine, and remember it on the day it should be taken, take it as directed.

2. However, if you do not remember the mised dose until the next day,take the missed dose at that time and reschedule your every-other-day doses from then.

3. It is important that this vaccine be taken exactly as directed so that it can give you protection against Tetanus

Pharmacology

Tetanus Toxoid

Adsorbed tetanus toxoid induces specific protective antibodies against the exotoxins excreted by Clostridium tetani. The aluminium salt a mineral adjuvant prolongs and enhances the antigenic properties of tetanus toxoid by retarding the rate of absorption . Its duration is approx 10 years.

Diphtheria Toxoid

Diptheria toxoid is a suspension adsorbed onto 1mg aluminium hydroxide. It reduces antibodies against the endotoxin excreted by Corynebactrium diphtrheriae. Endogenous antitoxin reduces both the risk of developing diphtheria and the seveity of any clinical illness that dose develop.

Tetanus Toxoid 

Pregnancy- Use only if clearly needed. Lactation- It is not known if tetanus toxoid or corresponding antibodis are excreted in breast milk. Children- Safety and and efficacy of tetanus toxoid are known for children as young as 2 months Diphtheria Toxoid 

Pregnancy- It is not known if diphtheria toxoid or corresponding antibodies are excreted in breast milk.

Lactation- It is not known if diphtheria toxoid o corresponding antibodies are excreted in breast milk. Children- Use in pediatric patients > 7 years of age only. DTwP or DTaP is preferred over Plain diphtheria toxoid.