tetanus toxoid, adsorbed

tetanus toxoid

Available forms
Available by prescription only
adsorbed toxoid
Injection: 5 to 10 Lf units of inactivated tetanus/0.5-ml dose, in 0.5-ml syringes and 5-ml vials
toxoid
Injection: 4 to 5 Lf units of inactivated tetanus/0.5-ml dose, in 0.5-ml syringes and 7.5-ml vials

Indications and dosages
 Primary immunization. Adsorbed formulation Adults and children age 7 and older: 0.5 ml I.M. 4 to 8 weeks apart for two doses; then a third dose 6 to 12 months after the second dose.

Pharmacodynamics
Tetanus prophylaxis action: Tetanus toxoid promotes active immunity by inducing production of tetanus antitoxin.

Pharmacokinetics
Absorption: Absorbed slowly. Nonabsorbed formulation provides quicker booster effect.
Distribution: No information available.
Metabolism: No information available.
Excretion: Unknown. Active immunity usually persists for 10 years. Adsorbed tetanus toxoid usually produces more persistent antitoxin titers than fluid tetanus toxoid.

Contraindications and precautions
Contraindicated in immunosuppressed patients and in those with immunoglobulin abnormalities or severe hypersensitivity or neurologic reactions to the toxoid or its ingredients (such as thimerosal). Also contraindicated in patients with thrombocytopenia or any coagulation disorder that would contraindicate I.M. injection unless the potential benefits outweigh the risks. Defer vaccination in patients with acute illness; also defer vaccination during polio outbreaks, except in emergencies.
  Use absorbed form cautiously in infants or children with cerebral damage, neurologic disorders, or history of febrile seizures.

Interactions
Drug-drug. Chloramphenicol, corticosteroids, immunosuppressants: May impair the immune response to tetanus toxoid. Avoid concomitant elective immunization.

Adverse reactions
CNS: headache, seizures, malaise, slight fever, aches and pains.
CV: tachycardia, hypotension, flushing.
Skin: urticaria, pruritus, erythema, induration, nodule (at injection site).
Other: chills, anaphylaxis.

Effects on lab test results
None reported.

Overdose and treatment
No information available.

Special considerations
• Adsorbed toxoids induce higher antitoxin titers and more persistent antitoxin levels.
 ALERT Monitor patient for hypersensitivity reactions, seizures, and injection site reactions.
 ALERT Have epinephrine 1:1,000 solution available to treat allergic reactions.
• Don’t confuse drug with tetanus immune globulin.
• Refrigerate at 36° to 46° F (2° to 8° C). Don’t freeze.
Pregnant patients
• Although there’s no evidence of teratogenicity, it’s recommended that administration be deferred until second trimester.
Breast-feeding patients
• It isn’t known whether tetanus toxoid appears in breast milk. Use cautiously in breast-feeding women.
Pediatric patients
• Tetanus toxoid and tetanus toxoid adsorbed aren’t indicated for children younger than age 7. The vaccine is suitable for children ages 6 weeks to 6 years; however, DtaP is the preferred agent in this age-group for primary and booster immunization.
Geriatric patients
• These patients develop lower antitoxin levels than younger patients after tetanus immunization. Therefore, skin test responsiveness may be delayed or reduced.

Patient education
• Inform patient of possible adverse reactions.
• Encourage patient to report distressing adverse reactions.
• Tell patient that immunization requires a series of injections. Stress the importance of keeping scheduled appointments for subsequent doses.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use