Florinef And Vaccinations

[India]

My POTS and adrenergic excess are well controlled by a combination of Florinef and Atenolol so I am fortunate enough to lead a largely normal and active life. Thus, I am supposed to take a group of students to Vietnam in June of this year. I am somewhat trepidatious about this--for many reasons: the length of the journey, the heat etc etc. But I am determined to manage.

My biggest issue or concern before the trip is with vaccinations. My university employer wants me to get the recommended vaccines for Vietnam which are HEP A, Typhoid, and H1N1.

I have read on the web--and on the NIH website inparticular--that florinef and vaccinations do not mix and to not have vaccinations whilst on Florinef.

Can anybody enlighten me as to 1) whether this is true? 2) if they have had any positive or negative experiences with these or other vaccines while being on florinef, and 3) if there is a contraindication, can anyone tell me why?

Thanks,

India.

[firewatcher]

From RX-list.com:

Patients should not be vaccinated against smallpox while on corticosteroid therapy. Other immunization procedures should not be undertaken in patients who are on corticosteroids, especially on high dose, because of possible hazards of neurological complications and a lack of antibody response.

The use of Florinef Acetate (Fludrocortisone Acetate Tablets USP) in patients with active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used for the management of the disease in conjunction with an appropriate antituberculous regimen. If corticosteroids are indicated in patients with latent tuberculosis or tuberculin reactivity, close observation is necessary since reactivation of the disease may occur. During prolonged corticosteroid therapy these patients should receive chemoprophylaxis.

Children who are on immunosuppressant drugs are more susceptible to infections than healthy children. Chicken pox and measles, for example, can have a more serious or even fatal course in children on immunosuppressant corticosteroids. In such children, or in adults who have not had these diseases, particular care should be taken to avoid exposure. If exposed, therapy with varicella zoster immune globulin (VZIG) or pooled intravenous immunoglobulin (IVIG), as appropriate, may be indicated. If chicken pox develops, treatment with antiviral agents may be considered.

I think, because it is a steroid, it would suppress the body's immune system and might cause the vaccination to not work. (?)

[juliegee]

Although florinef has some steroidal properties, it is not a true corticosteroid. My son has been on florinef for 5 years now and has had some vaccinations, like Hep A and Chicken Pox with NO adverse side effects. I have insisted on one vaccination at a time because of his illness. If this is possible (timing wise) it might be a good idea.

Regarding the effect of florinef on the immune system. This is something I was worried about as my immune system is moderately compromised. My son has recently had his immunoglobulins checked and all were normal after 5 years of ongoing florinef therapy.

Definitely follow the advice of your doc, but I think you have nothing to worry about. Enjoy your trip & tell us all about it when you get back!

Julie

[wareagle]

Julie,

Thanks so much for the info regarding your son! I'm in my 30's and I've NEVER had Chicken pox or the vaccine. My doctor is really concerened about this and I'm terrified of getting chicken pox. I'd like to get the vaccine but I didn't know if I could b/c I take florinef as well. I only take 1/4 tab at a time but I've been taking it for years now. My doc didn't think this should be a problem with getting the vaccine but I've still been extrememly leary about it.

Maybe I should be brave and finally get it done this summer. I know for adults I'll have to get two rounds of the vaccine. I just hope I don't develope shingles!

Look forward to hearing others chime in with their experiences.

[Jan]

I think they can do a blood test to see if you have developed immunity to chicken pox. There is a chance you were exposed sometime in your life and may not need the vaccine.

[wareagle]

Jan-

I've had the blood test to confirm I don't have the anitbodies. It's really strange too b/c I've been exposed several times in my life but have never contracted Chicken Pox or developled an immunity. It's always been a scary possibility hanging over my head. I just hate the idea of getting the vaccine too...but I guess it's the lesser of two evils!

[juliegee]

Wareagle, run to get that vaccination. Chicken Pox in adults are very serious- esp. with an underlying chronic illness... I don't want to scare you, but you are taking a huge risk every day. The vaccination was nothing for Mack. It was actually his second one. In children they recommend two (approximately fifteen years apart)- not sure for adults...

Julie

[scarfgirl]

I agree with Mack's Mom.....that's a risk you don't need to be taking wareagle.

[flop]

I took a high dose of fludrocortisone (300 micrograms daily) for several years. During that time I had several vaccinations with no particular problems (just the usual sore arm, temperature etc that everyone else had).

I have also spent time on moderate doses of prednisolone so I know a fair bit about corticosteroids. My doctor and pharmacist both say that fludrocortisone is taken in such small doses that it doesn't really have the effects that are written about in the steroid warning leaflets.

There are 5 different types of steroid hormones - glucocorticoids, mineralocorticoids, androgens, oestrogens and progestagens. They have very different mechanisms of action on the body. Fludrocortisone is a mineralocorticoid. Prednisolone is a glucocorticoid.

Mineralocorticoids (e.g. Florinef) are similar to the naturally occuring aldosterone in the body and work by increasing sodium and fluid reabsorption in the kidney.

Glucocorticoids (e.g. Prednisone) are involved in the regulation of glucose levels and in providing feedback to the immune system - high levels of glucocorticoids reduce the activity of the immune system and so reduce inflammation.

Always discuss your medications and vaccinations with your doctor but usually taking florinef should not be a reason to avoid vaccination.

Flop

[India]

Thank you all for your responses. My cardiologist just sent back a terse "I have no idea" in reply to my query! It didn't inspire confidence.

Thanks Flop for the information about different corticosteroids. That clarifies things a bit. What you read on the web is often just a very blanket description.

I will keep you all apprised of the trip. 16 students in Vietnam. Yikes!

India