Description and Brand Names

Drug information provided by: Merative, Micromedex®

US Brand Name

1. Twinrix

Canadian Brand Name

1. Twinrix Adult
2. Twinrix Junior

Descriptions

Hepatitis A and hepatitis B combination vaccine is used to prevent infection caused by 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.
• Persons engaging in high-risk sexual activity, such as homosexual and bisexual 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:

Allergies

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.

Pediatric

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.

Geriatric

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.

Breastfeeding

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.

• 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 from a disease or medicine—The vaccine may not work as well in patients with this condition.

Proper Use

A nurse or other trained health professional will give you this vaccine. This vaccine is given as a shot into your muscles.

This vaccine is usually given as 3 doses. After the first dose, two more doses are given 1 month and 6 months after the first dose, unless your doctor tells you otherwise.

It is important that you receive all doses at the right time. If you miss your scheduled shot, call your doctor to make another appointment as soon as possible.

Precautions

It is very important that you return to your doctor's office at the right time for all of the doses. Be sure to notify your doctor of any unwanted effects that occur after you receive this vaccine.

This vaccine may cause a serious type of allergic reaction called anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash, itching, swelling of the tongue and throat, or trouble breathing after you get the injection.

Tell your doctor if you are allergic to latex. The needle cover and the rubber plunger of the prefilled syringe contains dry natural latex rubber, which may cause an allergic reaction in people with a latex allergy.

This vaccine may not protect you against hepatitis A or hepatitis B infection if you are already infected with the virus at the time you receive the shot.

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

Rare

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. chills
12. coma
13. confusion
14. convulsions or seizures
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. severe headache
48. shortness of breath
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. tightness in the chest
57. unusual bleeding or bruising
58. unusual tiredness or weakness
59. upper right abdominal or stomach pain
60. wheezing
61. 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

Rare

1. Abdominal or stomach pain
2. bruising at the injection site
3. dry mouth
4. fainting or lightheadedness when getting up suddenly from a lying or sitting position
5. feeling of constant movement of self or surroundings
6. feeling of warmth
7. headache, severe and throbbing
8. hyperventilation
9. large, flat, blue or purplish patches in the skin at the injection site
10. loss of appetite
11. muscle pain or stiffness
12. pain, swelling, or redness in the joints
13. redness of the face, neck, arms, and occasionally, upper chest
14. restlessness
15. sensation of spinning
16. shaking
17. sleepiness or unusual drowsiness
18. sleeplessness
19. small, red or purple spots on the skin
20. sweating
21. trouble with sleeping
22. unable to sleep
23. unusually fast heartbeat
24. unusually warm skin
25. weakness
26. 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.

Portions of this document last updated: March 01, 2023

Original article: https://www.mayoclinic.org/drugs-supplements/hepatitis-a-and-hepatitis-b-vaccine-intramuscular-route/description/drg-20061965

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