Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

  1. Twinrix

Canadian Brand Name

  1. Twinrix Adult
  2. Twinrix Junior


Hepatitis A and hepatitis B combination vaccine is used to prevent infection caused by all known subtypes of the hepatitis A and hepatitis B virus. The vaccine works by causing your body to produce its own protection (antibodies) against the disease.

Hepatitis A is a serious disease of the liver that can cause death. It is caused by the hepatitis A virus (HAV), and is spread most often through infected food or water. Hepatitis A may also be spread by close person-to-person contact with infected persons (such as between persons living in the same household). Although some infected persons do not appear to be sick, they are still able to spread the virus to others.

Hepatitis A is less common in the U.S. and other areas of the world that have a higher level of sanitation and good water and sewage (waste) systems. However, it is a significant health problem in parts of the world that do not have such systems. If you are traveling to certain countries or remote (out-of-the-way) areas, hepatitis A vaccine will help protect you from hepatitis A disease.

Hepatitis B is caused by hepatitis B virus (HBV), and is spread by contact with body fluids, such as blood, saliva, semen, or vaginal fluids; by needle sticks or sharing needles; or from mother to child.

Hepatitis A and hepatitis B combination vaccine is recommended for all persons 18 years of age or older who are at risk from infection from their jobs or some behaviors, or from traveling to the following parts of the world:

  • Africa.
  • Central and South America.
  • Eastern and Southern Europe.
  • South and Southeast Asia (except Japan).
  • The Caribbean.
  • The Middle East.
  • The former Soviet Union

Hepatitis A and Hepatitis B combination vaccine is also recommended for:

  • Military personnel.
  • Persons living in or moving to areas that have a high rate of HAV infection and who are at a high risk of HBV infection.
  • Males who have sex with males.
  • Persons who use illegal injection drugs.
  • Persons at risk through their work, such as laboratory workers who handle live hepatitis A and hepatitis B virus, police, and those who give first aid or medical help, and workers who come in contact with stool or sewage.
  • People who work in child daycare centers and correctional facilities, residents of drug and alcohol treatment centers, and patients and staff in hemodialysis units.
  • People who are at increased risk for HBV infection and who are in close contact with patients that have hepatitis A or B.
  • Persons with hemophilia.
  • Persons with chronic liver disease.

This vaccine is to be given only by or under the supervision of a doctor.

This product is available in the following dosage forms:

  • Suspension

Before Using

In deciding to use a vaccine, the risks of taking the vaccine must be weighed against the good it will do. This is a decision you and your doctor will make. For this vaccine, the following should be considered:


Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.


Appropriate studies have not been performed on the relationship of age to the effects of hepatitis A and hepatitis B combination vaccine in the pediatric population. Safety and efficacy have not been established.


Appropriate studies on the relationship of age to the effects of hepatitis A and hepatitis B combination vaccine have not been performed in the geriatric population. However, no geriatric-specific problems have been documented to date.


There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this vaccine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Receiving this vaccine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Atidarsagene Autotemcel
  • Elivaldogene Autotemcel
  • Teplizumab-mzwv
  • Ublituximab-xiiy

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this vaccine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Allergy to neomycin or
  • Allergy to yeast—Should not be used in patients with these conditions.
  • Moderate or severe illness with fever—Your dose may need to be given at a later time.
  • Weak immune system—This condition may decrease the useful effects of the vaccine.

Proper Use

A nurse or other trained health professional will give you this vaccine. This vaccine is given as a shot into one of your muscles, usually in the deltoid area (shoulder or upper arm).

This vaccine is usually given as 3 or 4 doses. The first 2 doses are given at least 1 month (for patients receiving 3 doses) or 7 days apart (for patients receiving 4 doses). The third dose is given at least 6 months (for patients receiving 3 doses) or 21 to 30 days (for patients receiving 4 doses) after the first dose. The booster dose is given at least 12 months (for patients receiving 4 doses) after the first dose. To get the best possible protection against infection with the HAV or HBV, you should complete your vaccine dosing schedule.


It is important that your doctor check your progress to make sure this vaccine is working properly. Blood tests may be needed to check for unwanted effects.

Fainting may occur after you receive this vaccine. Your doctor may want you to be observed after you get the injection to prevent and manage fainting.

This vaccine may not protect everyone who receives it. This vaccine will not treat symptoms of hepatitis A or hepatitis B infection if you already have the disease. It is very important to take precautions to reduce the risk of hepatitis A or hepatitis B infection.

Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

  1. Fever more than 99.5 degrees F
  2. unusual tiredness or weakness


  1. Difficulty with breathing or swallowing
  2. hives
  3. itching, especially of the hands or feet
  4. reddening of the skin, especially around the ears
  5. swelling of the eyes, face, or inside of the nose
  6. unusual tiredness or weakness (sudden and severe)

Incidence not known

  1. Agitation
  2. back pain
  3. being forgetful
  4. black, tarry stools
  5. bleeding gums
  6. blistering, peeling, or loosening of the skin
  7. blood in the urine or stools
  8. bloody nose
  9. blurred vision
  10. burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  11. chest tightness
  12. chills
  13. coma
  14. confusion
  15. cough
  16. dark urine
  17. diarrhea
  18. difficulty controlling your bladder or bowels
  19. difficulty with walking
  20. dizziness
  21. drowsiness
  22. fast, irregular, pounding, or racing heartbeat or pulse
  23. feeling of discomfort
  24. feeling sad or depressed
  25. general feeling of illness
  26. general tiredness and weakness
  27. hallucinations
  28. headache
  29. heavier menstrual periods
  30. inability to move the arms and legs
  31. increased sweating
  32. inflammation of the joints
  33. irritability
  34. itching
  35. joint or muscle pain
  36. large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  37. light-colored stools
  38. muscle aches or cramps
  39. nausea or vomiting
  40. numbness or tingling in your arms, face, hands, or legs
  41. partial or slight paralysis
  42. pinpoint red spots on the skin
  43. puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  44. rash
  45. red, irritated eyes
  46. redness, soreness, or itching skin
  47. seizures
  48. severe headache
  49. slurred speech or problems with swallowing
  50. sore throat
  51. sores, ulcers, or white spots in the mouth or on the lips
  52. sores, welting, or blisters
  53. stiff neck or back
  54. sudden numbness and weakness in the arms and legs
  55. swollen lymph glands
  56. trouble breathing
  57. unusual bleeding or bruising
  58. unusual tiredness or weakness
  59. upper right abdominal or stomach pain
  60. yellow eyes and skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  1. Body aches or pain
  2. ear congestion
  3. hard lump, redness, soreness, or swelling at the injection site
  4. loss of voice
  5. nasal congestion
  6. runny nose
  7. sneezing


  1. Bruising at the injection site
  2. dry mouth
  3. fainting or lightheadedness when getting up suddenly from a lying or sitting position
  4. feeling of constant movement of self or surroundings
  5. feeling of warmth
  6. headache, severe and throbbing
  7. hyperventilation
  8. large, flat, blue or purplish patches in the skin at the injection site
  9. loss of appetite
  10. muscle pain or stiffness
  11. pain, swelling, or redness in the joints
  12. redness of the face, neck, arms, and occasionally, upper chest
  13. restlessness
  14. sensation of spinning
  15. shaking
  16. sleepiness or unusual drowsiness
  17. sleeplessness
  18. small, red or purple spots on the skin
  19. stomach pain
  20. sweating
  21. trouble with sleeping
  22. unusually fast heartbeat
  23. unusually warm skin
  24. weakness
  25. weight loss

Incidence not known

  1. Acid or sour stomach
  2. belching
  3. continuing ringing or buzzing or other unexplained noise in the ears
  4. disturbed color perception
  5. double vision
  6. earache
  7. hair loss or thinning of the hair
  8. halos around lights
  9. hearing loss
  10. heartburn
  11. indigestion
  12. night blindness
  13. overbright appearance of lights
  14. painful blisters on the trunk of the body
  15. stomach discomfort or upset
  16. tunnel vision
  17. weakness of the muscles in your face

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.