Information about immunologic drug interactions is needed by pharmacists to make rational drug-use decisions. Previously, reports of interactions involving vaccines, immune globulins, and immunodiagnostic reagents were widely dispersed. In this two-part review article, over 50 individual and categorical interactions are described, as are dozens of vaccine–vaccine and vaccine–immunoglobulin combinations for which interactions have been demonstrated not to occur. Vaccine–vaccine, vaccine–immunoglobulin, and vaccine–drug interactions are reviewed in this first part. Vigilance by all pharmacists is needed to detect previously unreported immunologic drug interactions and to further assess known interactions.
HANSTENPD ed. Drug interactions: clinical significance of drug–drug interactions.5th ed.Philadelphia: Lea & Febiger, 1985.
3.
United States Pharmacopeial Convention.Drug information for the health care professional.Rockville, MD: United States Pharmacopeial Convention, 1989.
4.
MANGINIRJ ed. Drug interaction facts.St. Louis, MO: JB Lippincott, 1989.
5.
MCEVOYGK ed. American hospital formulary service drug information 89.Bethesda, MD: American Society of Hospital Pharmacists, 1989.
6.
SHINNAF ed. Evaluations of drug interactions.St. Louis, MO: CV Mosby, 1989.
7.
GRABENSTEINJD. Don't say biologics if you mean immunologics.Am J Hosp Pharm1988; 45: 1941–2.
8.
KAPLANJE, NELSONDB, SCHONBERGERLBThe effect of immunoglobulin on the response to trivalent oral poliovirus and yellow-fever vaccinations.Bull WHO1984; 62: 585–90.
9.
FELSENFELDO, WOLFRH, GYRKSimultaneous vaccination against cholera and yellow fever.Lancet1973; 1: 457–8.
10.
GATEFFC, LEGONIDECG, BOCHERInfluence de la vaccination anticholerique sur l'immunisation antiamarile associee.Bull Soc Pathol Exot Filiales1973; 66: 258–66.
Immunization Practices Advisory Committee.General recommendations for immunizations.MMWR1989; 38: 205–14, 219-27.
13.
DEFORESTA, LONGSS, LISCHNERHWSimultaneous administration of measles-mumps-rubella vaccine with booster doses of diphtheria-tetanus-pertussis and poliovirus vaccines.Pediatrics1988; 81: 237–46.
14.
YVONNETB, COURSAGETP, DEUBELV, DIOP-MARI, DIGOUTTEJP, CHIRONJP. Simultaneous administration of hepatitis B and yellow-fever vaccines.Dev Biol Stand1986; 65: 205–7.
15.
Immunization Practices Advisory Committee.Adult immunization: recommendations of the Immunization Practices Advisory Committee.MMWR1984; 33(suppl): 1–68.
16.
HILLEMANMR, CARLSONAJJr, MCLEANAA, VELLAPP, WEIBELRE, WOODHOURAF. Streptococcus pneumoniae polysaccharide vaccine: age and dose responses, safety, persistence of antibody, revaccination, and simultaneous administration of pneumococcal and influenza vaccines.Rev Infect Dis1981; 3(suppl): 31–42.
17.
CARLSONAJ, DAVIDSONWL, MCLEANAAPneumococcal vaccine: dose, revaccination, and coadministration of influenza vaccine.Proc Soc Exp Biol Med1979; 161: 558–63.
18.
American College of Physicians.Guide for adult immunization.Philadelphia: American College of Physicians, 1985.
19.
Centers for Disease Control.Health information for international travel 1989.Washington, DC: United States Department of Health and Human Services, 1989.
20.
GIAMMANCOG, DEGRANDIV, LUPOLInterference of oral poliovirus vaccine on RIT 4237 oral rotavirus vaccine.Eur J Epidemiol1988; 4: 121–3.
21.
GALBRAITHNS, CROSBYG, BARNESJM, FERNANDESR.Simultaneous immunization with BCG, diphtheria-tetanus, and oral poliomyelitis vaccines in children aged 13-14.Br Med J1971; 2: 193–7.
22.
Package insert.BCG vaccine USP for intradermal use.Indianapolis: Quad Pharmaceuticals, undated.
23.
WEIBELRE, BUYNAKEB, MCLEANAA, HILLEMANMR. Persistence of antibody after administration of monovalent and combined live attenuated measles, mumps, and rubella virus vaccines.Pediatrics1978; 61: 5–11.
TAURASONM, MYERSMG, NAUEV, O'BRIENTC, SPINDELSS, TRIMMERRW. Effect of interval between inoculation of live smallpox and yellow-fever vaccines on antigenicity in man.J Infect Dis1972; 126: 362–71.
26.
FULGINITIVA ed. Immunization in clinical practice.Philadelphia: JB Lippincott, 1982: 145–50.
27.
RUBENFL, SMITHEA, FOSTERSOSimultaneous administration of smallpox, measles, yellow fever, and diphtheria-pertussis-tetanus antigens to Nigerian children.Bull WHO1973; 48: 175–81.
28.
WEIBELRE, STOKESJJr, BUYNAKEB, HILLEMANMR, GRUNMEIERPW. Clinical-laboratory experiences with combined dried live measles-smallpox vaccine.Pediatrics1966; 37: 913–20.
29.
MEYERHMJr, HOSTETLERDDJr, BERNHEIMBCResponse of Volta children to jet inoculation of combined live measles, smallpox, and yellow-fever vaccines.Bull WHO1964; 30: 783–94.
30.
AJJANN.Vaccination.1st English ed.Lyon, France: Institut Merieux, 1986.
31.
MCBEANAM, GATEFFC, MANCLARKCR, FOSTERSO. Simultaneous administration of live attenuated measles vaccine with DTP vaccine.Pediatrics1978; 62: 288–93.
32.
TOPFHJr, BUESCHEREL, BANCROFTWH, RUSSELLPK. Immunization with live types 7 and 4 adenovirus vaccines: II. Antibody response and protective effect against acute respiratory disease due to adenovirus type 7.J Infect Dis1971; 124: 155–60.
33.
TAKAFUJIET, GAYDOSJC, ALLENRG, TOPFHJrSimultaneous administration of live, enteric-coated adenovirus types 4, 7, and 21 vaccines: safety and immunogenicity.J Infect Dis1979; 140: 48–53.
34.
SCHIFFMANG.Chemistry and immunochemistry of the pneumococcal polysaccharide vaccine with special reference to cross-reactions and immunologic factors.Rev Infect Dis1981; 3(suppl): 18–30.
35.
AMBROSINODM, SIBERGR. Simultaneous administration of vaccines for Haemophilus influenzae type b, pneumococci, and meningococci.J Infect Dis1986; 154: 893–6.
36.
AJJANN, FAYETMT, BIRONGCombination of attenuated measles vaccine (Schwarz) with meningococcus A and A&C vaccine.Dev Biol Stand1978; 41: 209–16.
37.
LAPEYSSONNIEL, OMERIA, NICOLASA, ROUMIANTZOFFM.Etude de la reponse serologique d'enfants soudanais a la vaccination combinee triple (rougeole, tetanos, meningite A).Med Trop (Mars)1979; 39: 71–9.
38.
American Academy of Pediatrics.Recommendations for using pneumococcal vaccine in children.Pediatrics1985; 75: 1153–8.
39.
American Academy of Pediatrics.Report of the committee on infectious diseases.21st ed.Elk Grove Village, IL: American Academy of Pediatrics, 1988.
40.
HENDLEYJO, WENZELJG, ASHEKM, SAMUELSONJS. Immunogenicity of Haemophilus influenzae type b polysaccharide vaccines in 18-month-old infants.Pediatrics1987; 80: 351–4.
41.
LEPOWML, PETERG, GLODEMPResponse of infants to Haemophilus influenzae type b polysaccharide and diphtheria-tetanus-pertussis vaccines in combination.J Infect Dis1984; 149: 950–5.
42.
ESKOLAJ, KAYTYH, GORDONLKSimultaneous administraton of Haemophilus influenzae type b capsular polysaccharidediphtheria toxoid conjugate vaccine with routine diphtheria-tetanus-pertussis and inactivated poliovirus vaccinations of childhood.Pediatr Infect Dis J1988; 7: 480–4.
43.
ESKOLAJ, PELTOLAH, TAKALAAKEfficacy of Haemophilus influenzae type b polysaccharide-diphtheria toxoid conjugate vaccine in infancy.N Engl J Med1987; 317: 717–22.
44.
BERNARDKW, FISHBEINDB, MILLERKDPre-exposure rabies immunization with human diploid-cell vaccine: decreased antibody responses in persons immunized in developing countries.Am J Trop Med Hyg1985; 34: 633–47.
45.
Package insert.Poliovirus vaccine inactivated.Swiftwater, PA: Connaught Laboratories, June 1986.
46.
Package insert.Poliovirus vaccine inactivated (Poliovax).Swiftwater, PA: Connaught Laboratories, April 1988.
47.
CHIRONJP, COURSAGETP, YVONNETBSimultaneous administration of hepatitis B and diphtheria/tetanus/polio vaccines.Lancet1984; 1: 623–4.
48.
SIMOESEAF, BALRAJV, SELVAKUMARR, JOHNTJ. Antibody response of children to measles vaccine mixed with diphtheria-pertussis-tetanus or diphtheria-pertussis-tetanus-poliomyelitis vaccine.Am J Dis Child1988; 142: 309–11.
49.
SIMOESEAF, PADMINIB, STEINHOFFMC, JADHAVM, JOHNTJ. Antibody response of infants to two doses of inactivated poliovirus vaccine of enhanced potency.Am J Dis Child1985; 139: 977–80.
50.
BUDDMA. SCHOLTENS RG, MCGEHEE RF, Jr, GARDNER P. An evaluation of measles and smallpox vaccines simultaneously administered.Am J Public Health1967; 57: 80–6.
51.
KRUGMANS, GILESJP, JACOBSAM, FRIEDMANH.Studies with a further attenuated live measles-virus vaccine.Pediatrics1963; 39: 919–28.
52.
ROANTREERJ. The uses of gamma globulin in prophylaxis and treatment.Med Clin North Am1965; 49: 1745–56.
53.
Immunization Practices Advisory Committee.Recommendations for protection against viral hepatitis.MMWR1985; 34: 313–35.
54.
BEASLEYRP, HWANGLY. Measles vaccination not interfered with by hepatitis B immune globulin (letter).Lancet1982; 1: 161.
55.
Package insert.Poliovirus vaccine live oral trivalent (Orimune).Pearl River, NY: Lederle Laboratories, September 1986.
56.
LELIEPN, REESINKHW, GRIJMR, DE JONG-VAN MANENST, REERINK-BRONGERSEE. Simultaneous passive and active administration against hepatitis B: noninterference of hepatitis B immune globulin with the anti-HBs response to reduced doses of heat-inactivated hepatitis B vaccine.Hepalology1986; 6: 971–5.
57.
SZMUNESSW, STEVENSCE, OLESZKOWR, GOODMANA.Passive-active immunization against hepatitis B: immunogenicity studies in adult Americans.Lancet1981; 1: 575–7.
58.
WONGVCW, IPHMH, REESINKHWPrevention of the HBsAg carrier state in newborn infants of mothers who are chronic carriers of HBsAg and HBeAg by administration of hepatitis B vaccine and hepatitis B immunoglobulin.Lancet1984; 1: 921–6.
59.
SEEFFLB, KOFFRS. Passive and active immunoprophylaxis of hepatitis B.Gastroenterology1984; 86: 958–81.
60.
HELMICKCG, JOHNSTONEC, SUMNERJ, WINKLERWG, FAGERS.A clinical study of Merieux human rabies immune globulin.J Biol Stand1982; 10: 357–67.
61.
Centers for Disease Control.Rabies prevention—United States, 1984.MMWR1984; 33: 393–402.
Centers for Disease Control.Human rabies despite treatment with rabies immune globulin and human diploid cell rabies vaccine—Thailand.MMWR1987; 36: 759–60,765.
64.
STIEHMER. Standard and special human immune serum globulins as therapeutic agents.Pediatrics1979; 63: 301–19.
REDFIELDRR, WRIGHTDC, JAMESWD, JONESTS, BROWNC, BURKEDS. Disseminated vaccinia in a military recruit with human immunodeficiency virus (HIV) disease.N Engl J Med1987; 316: 673–6.
68.
ROSENBAUMEH, COHENRA, GLATSTEINHR. Vaccination of a patient receiving immunosuppressive therapy for lymphosarcoma.JAMA1966; 198: 737–40.
69.
ALLISONJ.Methotrexate and smallpox vaccination (letter).Lancet1968; 2: 1250.
70.
GOLDSTEINJA, NEFFJM, LANEJM, KOPLANJP. Smallpox vaccination reactions, prophylaxis, and therapy of complications.Pediatrics1975; 55: 342–7.
71.
Immunization Practices Advisory Committee.Diphtheria, tetanus, and pertussis: guidelines for vaccine prophylaxis and other preventive measures.MMWR1985; 34: 405–26.
MEISSNERHC, SMITHAL. The current status of chloramphenicol.Pediatrics1979; 64: 348–56.
90.
LAMPEKF ed. AMA drug evaluations.6th ed.Philadelphia: WB Saunders, 1986: 1422.
91.
DANIELTM, SUHRLANDLG, WEISBERGERAS. Suppression of the anamnestic response to tetanus toxoid in man by chloramphenicol.N Engl J Med1963; 273: 367–9.
92.
WEISBERGERAS, DANIELTM. Suppression of antibody synthesis by chloramphenicol analogs.Proc Soc Exp Biol Med1969; 131: 570–5.
93.
DELLA BELLAD, PETRESCUD, MARCAG, VERONESEM.Humoral antibody, plaque, and rosette formation in mice treated with thiamphenicol and chloramphenicol.Chemotherapy1973; 18: 99–111.
94.
LIBERMANDF, ROTI-ROTIJL. Effect of chloramphenicol on the growth and viability of exponentially growing mouse leukemic cells (L5178Y).Exp Cell Res1973; 77: 346–50.
95.
PAPPAIOANOUM, FISHBEINDB, DREESENDWAntibody response to preexposure human diploid-cell rabies vaccine given concurrently with chloroquine.N Engl J Med1986; 314: 280–4.
96.
SALMERONG, LIPSKYPE. Immunosuppressive potential of antimalarials.Am J Med1983; 75(1A): 19–24.
97.
TSAITF, BOLINRA, LAZUICKJS, MILLERKD. Chloroquine does not adversely affect the antibody response to yellow-fever vaccine (letter).J Infect Dis1986; 154: 726–7.
98.
VAN DER STRAETENC, KLIPPELJH. Antimalarials and pneumococcal immunization (letter).N Engl J Med1986; 315: 712–3.
TAYLORDN, WASIC, BERNARDK.Chloroquine prophylaxis associated with a poor antibody response to human diploid cell rabies vaccine (letter).Lancet1984; 1: 1405.
101.
GREENWOODBM. Chloroquine prophylaxis and antibody response to immunization (letter).Lancet1984; 2: 402–3.
102.
GREENWOODAM, GREENWOODBM, BRADLEYAK, BALLPAJ, GILLESHM. Enhancement of the immune response to meningococcal polysaccharide vaccine in a malaria endemic area by administration of chloroquine.Ann Trop Med Parasitol1981; 75: 261–3.
103.
ORTBALSDW, LIEBHABERH, PRESANTCA, VAN AMBURGALIII, LEEJY. Influenza immunization of adult patients with malignant disease.Ann Intern Med1977; 87: 552–7.
SIBERGR, WEITZMANSA, AISENBERGAC. Antibody response of patients with Hodgkin's disease to protein and polysaccharide antigens.Rev Infect Dis1981; 3(suppl): 144–59.
106.
SIBERGR, WEITZMANSA, AISENBERGAC, WEINSTEINHJ, SCHIFFMANG.Impaired antibody response to pneumococcal vaccine after treatment for Hodgkin's disease.N Engl J Med1978; 299: 442–8.
107.
SIBERGR, GORHAMC, MARTINP, CORKERYJC, SCHIFFMANG.Antibody response to retreatment immunization and post-treatment boosting with bacterial polysaccharide vaccines in patients with Hodgkin's disease.Ann Intern Med1986; 104: 467–75.
108.
MINORDR, SCHIFFMANG, MCINTOSHLS. Response of patients with Hodgkin's disease to pneumococcal vaccine.Ann Intern Med1979; 90: 887–92.
109.
LEVINEAM, OVERTURFGD, FIELDRF, HOLDORFD, PAGANINI-HALLA, FEINSTEINDJ. Use and efficacy of pneumococcal vaccine in patients with Hodgkin's disease.Blood1979; 54: 1171–5.
110.
ADDIEGOJEJr, AMMANNAJ, SCHIFFMANG, BAEHNERR, HIGGINSG, HAMMONDD.Response to pneumococcal polysaccharide vaccine in patients with untreated Hodgkin's disease.Lancet1980; 2: 450–2.
111.
ZIELINSKICC, STULLERI, DORNERF, POETZIP, MUELLERC, EIBLMM. Impaired primary, but not secondary, immune response in breast cancer patients under adjuvant chemotherapy.Cancer1986; 58: 1648–52.
112.
WEITBERGAB, WEITZMANSA, WATKINSE, HINKLEC, O'ROURKES, DIENSTAGJL. Immunogenicity of hepatitis B vaccine in oncology patients receiving chemotherapy.J Clin Oncol1985; 3: 718–22.
113.
BRIGGSWA, ROZEKRJ, MIGDALSDInfluenza vaccination in kidney transplant recipients: cellular and humoral immune responses.Ann Intern Med1980; 92: 471–7.
114.
KUMARSS, VENTURAAK, VANDERWERFB.Influenza vaccination in renal-transplant patients.JAMA1978; 239: 840–2.
115.
CARROLLRNP, MARSHSD, O'DONOGHUEEPN, BREEZEDC, SHACKMANR.Response to influenza vaccine by renal transplant patients.Br Med J1974; 2: 701–3.
116.
GROSSPA, GOULDAL, BROWNAE. Effect of cancer chemotherapy on the immune response to influenza virus vaccine: review of published studies.Rev Infect Dis1985; 7: 613–8.
117.
STIVERHG, GRAVESP, MEIKLEJOHNG, SCHROTERG, EICKHOFFTC. Impaired antibody response to inactivated influenza A and B vaccine in renal transplant recipients.Infect Immun1977; 16: 738–41.
WINSTONDJ, HOWG, SCHIFFMANG, CHAMPLINRE, FEIGSA, GALERP. Pneumococcal vaccination of recipients of bone marrow transplants.Arch Intern Med1983; 143: 1735–7.
121.
MCEVOYGK ed. American hospital formulary service drug information 89.Bethesda, MD: American Society of Hospital Pharmacists, 1989: 1592–9.
122.
VERSLUISDJ, BEYERWEP, MASURELN, WENTLINGGJ, WEIMARW.Impairment of the immune response to influenza vaccination in renal transplant recipients by cyclosporine, but not azathioprine.Transplantation1986; 42: 376–9.
United States Pharmacopeia! Convention.Drug information for the health care professional.Rockville, MD: United States Pharmacopeial Convention, 1989: 2469–71.
127.
MADDOCKSAC. Indomethacin and vaccination (letter).Lancet1973; 2: 210–1.
128.
KRAMERP, MCCLAINCJ. Depression of aminopyrine metabolism by influenza vaccination.N Engl J Med1981; 305: 1262–4.
129.
RENTONKW, GRAYJD, HALLRI. Decreased elimination of theophylline after influenza vaccination.Can Med Assoc J1980; 123: 288–90.
130.
WALKERS, SCHREIBERL, MIDDELKAMPJN. Serum theophylline levels after influenza vaccination (letter).Can Med Assoc J1981; 125: 243–4.
131.
MEREDITHCG, CHRISTIANCD, JOHNSONRF, TROXELLR, DAVISGL, SCHENKERS.Effects of influenza virus vaccine on hepatic drug metabolism.Clin Pharmacol Ther1985; 37: 396–401.
132.
BUKOWSKYJM, MUNTPW, WIGLER, NAKATSUK.Theophylline clearance: lack of effect of influenza vaccination and ascorbic acid.Am Rev Respir Dis1984; 129: 672–5.
133.
FISCHERRG, BOOTHBH, MITCHELLDQ, KIBBEAH. Influence of trivalent influenza vaccine on serum theophylline levels.Can Med Assoc J1982; 126: 1312–3.
134.
GOLDSTEINRS, CHEUNGOT, SEGUINRDecreased elimination of theophylline after influenza vaccination (letter).Can Med Assoc J1982; 126: 470.
135.
GOMOLINIH, CHAPRONDJ, LUHANPA. Lack of effect of influenza vaccine on theophylline levels and warfarin anticoagulation in the elderly.J Am Geriatr Soc1985; 33: 269–72.
136.
GRABOWSKIN, MAYJJ, PRATTDS, RICHTSMEIERWJ, BERTINOJSJr, SORGEKF. The effect of split virus influenza vaccination on theophylline pharmacokinetics.Am Rev Respir Dis1985; 131: 934–8.
137.
HANNANSE, MAYJJ, PRATTDS, RICHTSMEIERWJ, BERTINOJSJr. The effect of whole virus influenza vaccination on theophylline pharmacokinetics.Am Rev Respir Dis1988; 137: 903–6.
138.
PATRIARCAA, KENDALAP, STRICOFRL, WEBERJA, MEISSNERMK, DATENOB.Influenza vaccination and warfarin or theophylline toxicity in nursing-home residents (letter).N Engl J Med1983; 308: 1601–2.
139.
STULTSBM, HASHISAKIPA. Influenza vaccination and theophylline pharmacokinetics in patients with chronic obstructive lung disease.West J Med1983; 139: 651–4.
140.
WINSTANLEYPA, TJIAJ, BACKDJ, HOBSOND, BRECKENRIDGEAM. Lack of effect of highly purified subunit influenza vaccination on theophylline metabolism.Br J Clin Pharmacol1985; 20: 47–53.
141.
SAN JOAQUINJH, REYESS, MARKSMI. Influenza vaccination in asthmatic children on maintenance theophylline therapy.Clin Pediatr1982; 21: 724–6.
142.
KRAMERP, TSURUM, COOKCE, MCCLAINCJ, HOLTZMANJL. Effect of influenza vaccine on warfarin anticoagulation.Clin Pharmacol Ther1984; 35: 416–8.
143.
GOMOLINIH. Lack of effect of influenza vaccine on warfarin anticoagulation in the elderly.Can Med Assoc J1986; 135: 39–41.
144.
BUSSEYHI, SAKLADJJ. Effect of influenza vaccine on chronic warfarin therapy.Drug Intell Clin Pharm1988; 22: 198–201.
145.
LIPSKYBA, PECORARORE, ROBENNJ, DE BLAQUIEREP, DELANEYCJ. Influenza vaccination and warfarin anticoagulation.Ann Intern Med1984; 100: 835–7.
146.
FARROWPR, NICHOLSONKG. Lack of effect of influenza and pneumococcal vaccines on anticoagulation by warfarin.J Infect1984; 9: 157–60.
147.
WEIBERTRT, LORENTZSM, NORCROSSWA, KLAUBERMR, JAGGERPI. Effect of influenza vaccine in patients receiving long-term warfarin therapy.Clin Pharm1986; 5: 499–503.
148.
SAWCHUKRJ, RECTORTS, FORDICEJJ, LEPPIKIE. Effect of influenza vaccination on plasma phenytoin concentrations.Ther Drug Monit1979; 1: 285–8.
149.
JANNMW, FIDONEGS. Effect of influenza vaccine on serum anticonvulsant concentrations.Clin Pharm1986; 5: 817–20.
SMITHCD, BLEDSOEMA, CURRANR, GREENL, LEWISJ.Effect of influenza vaccine on serum concentrations of total and free phenytoin.Clin Pharm1988; 7: 828–32.
152.
LEVINEM, BEATTIEBL, MCLEANDM, CORMAND.Phenytoin therapy and immune response to influenza vaccine.Clin Pharm1985; 4: 191–4.
153.
SCAVONEJM, BLYDENGT, GREENBLATTDJ. Lack of effect of influenza vaccine on the pharmacokinetics of antipyrine, alprazolam, paracetamol (acetaminophen), and lorazepam.Clin Pharmacokinet1989; 16: 180–5.
154.
SOLOMONR, MORLINJ, MARTUCCIM, NEYD.Clinical note: adverse drug reaction after administration of influenza vaccine.J Med Soc New Jersey1984; 81: 573–4.
155.
PETRALLIJK, MERIGANTC, WILBURJR. Action of endogenous interferon after measles vaccination.Lancet1965; 2: 401–5.
156.
NAKAYAMAT, URANOT, OSANOM, MAEHARAN, SASAKIK, MAKINOS.Long-term regulation of interferon production by lymphocytes from children inoculated with live measles virus vaccine.J Infect Dis1988; 158: 1386–90.
157.
SORRELLTC, FORBESIJ, BURNESSFR, RISCHBIETHRHC. Depression of immunological function in patients treated with phenytoin sodium (sodium diphenylhydantoin).Lancet1971; 2: 1233–5.
158.
GROBPJ, HEROLDGE. Immunological abnormalities and hydantoins.Br Med J1972; 2: 561–3.
159.
Centers for Disease Control.Rabies postexposure prophylaxis with human diploid cell rabies vaccine: lower neutralizing antibody titers with Wyeth vaccine.MMWR1985; 34: 90–2.
