Javascript is not enabled.

Javascript must be enabled to use this site. Please enable Javascript in your browser and try again.

Skip to content
Content starts here
CLOSE ×
Search
CLOSE ×
Search
Leaving AARP.org Website

You are now leaving AARP.org and going to a website that is not operated by AARP. A different privacy policy and terms of service will apply.

5 Medications That Interact With the Flu Shot

Some drugs can make the influenza vaccine less effective


spinner image syringe surrounded by various pills and capsules
Photo Collage: AARP; (Source: Getty Images (2))

Imagine showing up for a pain injection and your pain management physician cancels your appointment because you just received the flu vaccine.

John Meyerhoffer, an 85-year-old retired police officer, has debilitating knee pain. He receives steroid injections every three to four months to manage his pain.

“I went to my primary care doctor a week before my pain injection,” Meyerhoffer says. “We discussed my upcoming shot, and I got my flu vaccine.”

When John hobbled into pain management for his injection the following week, he was sent home to wait for two weeks because he had received the flu vaccine. 

Getting a flu vaccine is an annual rite of passage for some 70 percent of Americans over age 65.  What most flu vaccine recipients do not know is that there are several medications that can decrease the effectiveness of the flu vaccine

Work with your doctor

It is important to share what medications or treatments you are getting with your physician and pharmacist. Given the risk of death or serious complications with the flu, your physician or pharmacist can help you weigh the risk of delaying treatment with medication that could hamper your immune response versus getting the vaccine while taking such medication.   

The Center for Disease Control and Prevention (CDC) says that 70 to 85 percent of seasonal flu-related deaths occur in older adults. Jodie Pepin, clinical pharmacy program director at Harbor Health in Round Rock, Texas, points out that when considering whether to delay a vaccine due to a potential drug interaction, you must weigh the risks and benefits.

Here are five types of medications that can diminish the protection offered by the flu vaccine.

1. Steroid pain injections

Steroid pain injections, also called corticosteroid or cortisone shots, reduce inflammation and pain by delivering medication into a joint or the epidural space around the nerves of the spine. These pain injections typically include a local anesthetic and a steroid that can minimize inflammation and pain for several months in some cases. 

 A Mayo Clinic study analyzing more than 15,000 patients, who received steroid shots for pain in hips, knees, shoulders or other joints, found that those who got the injections a few weeks prior to the flu vaccine, experienced a reduction in vaccine effectiveness.

“When getting an injected steroid in a joint or epidural space, you get some systemic absorption of the medication, which causes a transient dampening of your immune system,” says William Raoofi, M.D., of the Center for Interventional Pain Medicine at Mercy Medical Center in Baltimore, Maryland, “Then when you are vaccinated and exposed to the weakened flu virus, your immune system is not as good at responding to it.”

When suppressed, your immune system does not effectively recognize the inactive flu virus introduced by the vaccine. Then your immune system could fail to launch a strong attack on the live virus if you are exposed later.

Raoofi adds that as you age, your body produces fewer and weaker immune cells that cannot remember the virus you were vaccinated against.  Steroids can further weaken your ability to launch a strong immune response to protect yourself if you are exposed to the flu later. 

When an older adult comes into his office for a steroid injection and has received or plans to receive the flu vaccine within the next two weeks, Raoofi says he reschedules the appointment for two weeks after the vaccine.

“It is a risk-benefit decision,” he says. Due to the high risk of death or complications for an older person with the flu, Raoofi says that it is important to leave a two-week window for the immune system to ramp up its response to the flu virus before receiving the steroid injection. 

2. Oral prednisone

Prednisone is a steroid that is taken orally to decrease inflammation, suppress an overactive immune system or replace cortisol. It treats conditions like asthma, arthritis and inflammatory bowel disease. Prednisone, combined with medications like cyclosporine, also suppresses the immune system after organ transplantation to prevent rejection.

At doses of 20 mg per day for two weeks or more, prednisone can decrease your body’s ability to form antibodies, weakening your immune response to the flu vaccine. “High doses of steroids can weaken your immune system and potentially reduce the effectiveness of the flu vaccine," Pepin says.

3. Non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and aspirin

Over-the-counter pain relievers and fever reducers, taken before or after a flu vaccination, may also decrease your response to the vaccine. These medications include acetaminophen (Tylenol), aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Motrin, Advil) and naproxen (Aleve).

Alcohol and the Flu Shot

The National Institute on Alcohol Abuse and Alcoholism has found that if you drink a lot (5 drinks in a day for men and 4 drinks in a day for women) in one sitting, the alcohol slows your immune response for up to 24 hours. Drinking 24 hours before or after a flu vaccine can hinder your body’s ability to react to the vaccine and build immunity. Pepin recommends abstaining from drinking before you get the flu vaccine and for two weeks after being vaccinated to allow your immune system time to launch a full response.

“When you get the flu vaccine, a lot of people will get a temperature of 99 degrees, malaise and pain at the injection site for up to 24 hours,” says Pepin. “This means your immune system is responding to the flu virus.”

According to Pepin, taking acetaminophen or ibuprofen to prevent or reduce your temperature can reduce your ability to ramp up your immune response.

If you are uncomfortable after the flu vaccine, Pepin recommends taking acetaminophen (Tylenol) which does not have an anti-inflammatory effect like NSAIDs and aspirin. However, she does not recommend taking acetaminophen until six hours after the vaccine to give your body time to start its immune response.

4. Chemotherapy and radiation therapy

The American Cancer Society confirms that chemotherapy and radiation therapy can diminish your response to the flu vaccine, and encourages consultation with your physician regarding the best time to be vaccinated.

Pepin says it’s important to understand that chemotherapy drugs break down your immune system by attacking not only cancer cells, but also healthy cells.

These healthy cells, often located in your bone marrow, produce  immune cells that support your immune system. The result is that you will not be able to generate as many immune cells to remember and fight the strain of flu you were vaccinated against.

5. Biologics

Biologics include medications that bind to certain proteins on immune cells to fight cancer cells or the inflammation that results when your own body attacks itself.

Medications like atezolizumab (Tecentria), avelumab (Bavencio), durvalumab (Imfinzi), ipilimumab (Yervoy), nivolumab (Opdivo) and pembrolizumab (Keytruda) fight cancer. They help the immune system find and destroy cancer cells and may also damage healthy cells.

Other biologics like etanercept (Enbral), adalimumab (Humira) and infliximab (Remicade) bind to proteins on immune cells to decrease the inflammatory response in autoimmune diseases like rheumatoid arthritis, psoriatic arthritis, psoriasis and inflammatory bowel disease.  

Pepin recommends consulting your physician to determine at what point in your therapy you should get the flu vaccine, keeping in mind that settling for limited protection may be better than delaying your vaccine.

Unlock Access to AARP Members Edition

Join AARP to Continue

Already a Member?

spinner image Red AARP membership card displayed at an angle

Join AARP today for $16 per year. Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP The Magazine.