Hepatitis A, Inactivated, and Hepatitis B Recombinant Vaccine, Injection hep-ah-TY-tiss A in-ak-ti-VAY-ted hep-ah-TY-tiss B ree-KOM-be-nant vak-SEEN

What are other names for this medicine?

Type of medicine: vaccine

Generic and brand names: hepatitis A, inactivated, and hepatitis B recombinant vaccine, injection; Twinrix

What is this medicine used for?

This medicine is given by injection (shots) to prevent diseases caused by hepatitis A and B viruses (HAV and HBV).

Shots of this vaccine will not be effective if you are already infected with HAV or HBV. It will not protect you against other types of hepatitis or liver disease.

This vaccine is recommended for adults at risk for both HAV and HBV infection, such as:

• workers who handle live viruses, human waste, or sewage
• healthcare workers, public safety workers, and prison inmates who might be exposed to infected blood or body fluids
• people in the military
• people with chronic liver disease
• people who get blood transfusions or dialysis
• people who have unprotected sex with an infected person
• people who live with someone who is infected with HAV or HBV
• people who inject illegal drugs
• people who live in or are traveling to areas where hepatitis A and B virus are common

What should my healthcare provider know before I take this medicine?

Before receiving this medicine, tell your healthcare provider if you have ever had:

• an allergic reaction to any medicine or vaccine, or to latex, or baker's yeast
• a bleeding disorder, or if you currently take anticoagulant medicine (medicine that reduces the chance of blood clots forming) such as clopidogrel (Plavix) or warfarin (Coumadin)
• a weakened immune system from diseases such as HIV/AIDS or cancer, or from taking chemotherapy, radiation therapy, medicines to prevent organ transplant rejection, or steroid medicines
• HAV or HBV infection before

If you are severely ill at the time the shot is scheduled, wait until you recover before getting this vaccine. If you have a mild cold or other mild infection, you may still be able to get your shot. Tell your healthcare provider if you currently have an infection of any kind.

Females of childbearing age: Tell your healthcare provider if you are pregnant or plan to become pregnant. It is not known whether this medicine will harm an unborn baby. Do not breast-feed while receiving this medicine without your healthcare provider's approval.

How do I use it?

This vaccine is given by a healthcare provider. You will get 3 doses of vaccine as follows:

• first dose
• 2nd dose one month later
• 3rd dose 6 months after the first dose.

You must receive all 3 shots for the vaccine to be fully effective.

Some adults may receive 3 doses given within 3 to 4 weeks, and a booster dose at 12 months. Ask your provider about this speeded up dosing schedule.

Your healthcare provider will tell you how many shots you will need and when you should get them. Keep all appointments for shots to be sure that you are protected. If a shot is missed or you get behind schedule, get the missed shot as soon as possible.

What should I watch out for?

Most people who get this vaccine do not have any problems with it. You may have soreness where the shot was given, headache, loss of appetite, or tiredness. These side effects usually last 1 or 2 days. Contact your healthcare provider if these symptoms last longer or if you feel worse.

If you need emergency care, surgery, or dental work, tell the healthcare provider or dentist you have received this medicine.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your healthcare provider if you have any side effects that continue or get worse.

Life threatening (Report these to your healthcare provider right away. If you cannot reach your healthcare provider right away, get emergency medical care or call 911 for help.): Allergic reaction (hives; itching; rash; tightness in your chest; trouble breathing; swelling of the lips, tongue, and throat).

Serious (report these to your healthcare provider right away): High fever; unusual bleeding or bruising; severe skin redness, blistering, or peeling.

Other: Irritation or redness at the spot where the shot was given, sweating, weakness, flushing, fever, headache, abdominal pain, diarrhea, nausea, vomiting, loss of appetite, muscle aches, tiredness.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your healthcare provider if you are taking:

• corticosteroids such as betamethasone (Celestone), cortisone, dexamethasone, fludrocortisone (Florinef), hydrocortisone (Cortef), methylprednisolone (Medrol), prednisolone (Orapred), prednisone, and triamcinolone (Aristospan, Kenalog)
• immunosuppressants such as azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Gengraf, Sandimmune, Neoral), mycophenolate (CellCept), sirolimus (Rapamune), and tacrolimus (Prograf)
• medicines to treat cancer or radiation therapy

Keep a record of all vaccines received and when you received them.

If you are not sure if your medicines might interact, ask your pharmacist or healthcare provider. Keep a list of all your medicines with you. List all the prescription medicines, nonprescription medicines, supplements, natural remedies, and vitamins that you take. Be sure that you tell all healthcare providers who treat you about all the products you are taking.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your healthcare provider or pharmacist for more information or if you have any questions.

Keep all medicines out of the reach of children.

Do not share medicines with other people.