With flu shot season just around the corner, the National Advisory Committee on Immunization’s (NACI), updated recommendations regarding the coadministration of COVID-19 vaccines with other vaccines have arrived in a timely manner. Previously, NACI had recommended that the COVID-19 vaccines be administered at least 14 days after or 28 days before other vaccines, as a precautionary measure. However, considering previous experience of giving other vaccines at or around the same time along with the emerging evidence on the COVID-19 vaccines, NACI has now recommended that the COVID-19 vaccines can be given at the same time as, or any time before or after, other vaccines. This includes live and non-live vaccines.
Also, as the third COVID-19 vaccine dose eligibility for Ontario residents continues to expand, we’ve provided the list below regarding who may be eligible as per the most recent recommendations from Ontario’s Ministry of Health, released on October 7, 2021.
When receiving your third dose, you will be asked to show the prescription receipt from one of the listed medications OR the labelled medication container. Some people on medications beyond those listed below, may still be eligible to receive third doses, as the list may not be complete. These individuals will require a referral form/letter from their healthcare provider for a third dose of the COVID-19 vaccine. The recommended timing of the third dose remains the same as previously established, at least 8 weeks since the second dose.
Table of Medications Considered Highly Immunosuppressive for Third Doses (Adapted from: Ministry of Health, COVID-19 Vaccine Third Dose, Recommendations, Version 2.0 October 7, 2021)
| Class | Generic Name | Brand Name |
| Steroids (greater than 20 mg/day of prednisone or equivalent for more than 2 weeks) | Prednisone | |
| Dexamethasone | Decadron | |
Methylprednisolone | SoluMedrol DepoMedrol Medrol | |
Antimetabolites | Cyclophosphamide | Procytox |
| Leflunomide | Arava | |
Methotrexate | Trexall Metoject Otrexup Rasuvo Rheumatrex | |
| Azathioprine | Imuran | |
| 6-Mercaptopurine | Purinethol | |
| Mycophenolic Acid | Myfortic | |
| Mycophenolate Mofetil | CellCept | |
Calcineurin Inhibitors/mTOR Kinase Inhibitor | Tacrolimus | Prograf Advagraf Envarsus PA |
Cyclosporine | Neoral Gengraf Sandimmune | |
| Sirolimus | Rapamune | |
JAK (Janus Kinase) Inhibitors | Baricitinib | Olumiant |
| Tofacitinib | Xeljanz | |
| Upadacitinib | Rinvoq | |
Anti-TNFα (Tumour Necrosis Factor) | Adalimumab | Humira Amgevita Hadlima Hulio Hyrimoz Idacio |
| Golimumab | Simponi | |
| Certolizumab Pegol | Cimzia | |
Etanercept | Enbrel Brenzys Erelzi | |
Infliximab | Remicade Avsola Inflectra Remsima Renflexis | |
Anti-Inflammatory | Sulfasalazine | Salazopyrin Azulfidine |
| 5-Aminosalicylic Acid/Mesalamine | Pentasa | |
Anti-CD20 | Rituximab | Rituxan Ruxience Riximiyo Truxima Riabni |
| Ocrelizumab | Ocrevus | |
| IL-1 RA (Interleukin 1 receptor antagonist) | Anakinra | Kineret |
| Canakinumab | Ilaris | |
| Anti-IL 6 | Tocilizumab | Actemra |
| Sarilumab | Kevzara | |
| Anti-IL 12/23 | Ustekinumab | Stelara |
| Anti-IL 17 | Secukinumab | Cosentyx |
| Ixekizumab | Taltz | |
| Anti-IL17 R | Brodalumab | Siliq |
| Anti-BLyS | Belimumab | Benlysta |
| Anti-IL 23 | Guselkumab | Tremfya |
| Rizankizumab | Skyrizi | |
| Selective T cell Costimulation Blocker | Abatacept | Orencia |
| Fingolimod | Gilenya | |
| S1PR (Sphingosine 1-phosphate receptor agonist) | Siponimod | Mayzent |
| Ozanimod | Zeposia | |
| Phosphodiesterase Inhibitors | Apremilast | Otezla |
Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Since January 2021, Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics.