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Shingrix vs. Zostavax: Differences, similarities, and which is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

There are currently two vaccines that can be given to prevent herpes zoster, more commonly known as shingles: Shingrix and Zostavax. A shingles vaccine is recommended for adults once they turn 50.

Most people have been infected with the varicella zoster virus if they’ve ever had chickenpox. After chickenpox resolves, the varicella zoster virus lies dormant in the body for years, if not forever. Later in life, the virus can reactivate as shingles and cause a painful rash that usually wraps around the face or torso.

Although Shingrix and Zostavax work in similar ways to prevent shingles, there are some important differences between the two.

What are the main differences between Shingrix and Zostavax?

Shingrix (What is Shingrix?) is a recombinant, adjuvanted zoster vaccine that was first FDA-approved in 2017. It uses the varicella-zoster glycoprotein E antigen to produce an immune response in the body. An adjuvant, or added ingredient, helps boost the body’s immune response to the virus. Because Shingrix is an inactivated vaccine, it can be used in immunocompromised patients or those with a weakened immune system.

Shingrix is administered as an injection into the muscle (intramuscular). It is given in two separate doses with a period of two to six months in between. The second dose is necessary to ensure long-term effectiveness.

Zostavax, approved in 2006, is a live attenuated herpes zoster vaccine. In other words, Zostavax contains a weakened version of the actual virus to produce an immune response. For this reason, it is not recommended for those who are immunocompromised. Or else, the vaccine itself could cause an infection.

Zostavax is administered as a single injection underneath the skin (subcutaneous). It comes in a frozen version and a refrigerator-stable version. The frozen version must be kept frozen during transport and storage to ensure its effectiveness while the refrigerator-stable Zostavax can be kept in a refrigerator until it needs to be used.

Main differences between Shingrix and Zostavax
Shingrix Zostavax
Drug class Vaccine Vaccine
Brand/generic status Brand name only Brand name only
What is the generic name? Zoster Vaccine Recombinant, Adjuvanted Zoster Vaccine Live
What form(s) does the drug come in? Suspension for intramuscular injection Suspension for subcutaneous injection
What is the standard dosage? Administer 1 dose (0.5 ml) and then another dose (0.5 ml) between 2 and 6 months later Administer one dose (0.65 ml) once
How long is the typical treatment? Vaccination is complete in 2 to 6 months after 2 doses Vaccination is complete after 1 dose
Who typically uses the medication? Adults 50 years of age and older Adults 50 years of age and older

Conditions treated by Shingrix and Zostavax

Shingrix and Zostavax are FDA approved to prevent shingles (herpes zoster). Both vaccines are indicated to prevent shingles in adults aged 50 years and older. Shingrix and Zostavax are not used to prevent primary varicella infection, also known as chickenpox.

Postherpetic neuralgia is a common type of nerve pain that arises with shingles. Because Shingrix and Zostavax can prevent shingles, they can also prevent postherpetic neuralgia (PHN) and other painful complications from shingles. However, these vaccines are not labeled to treat PHN.

Condition Shingrix Zostavax
Prevention of herpes zoster (shingles) Yes Yes

Is Shingrix or Zostavax more effective?

Shingrix and Zostavax have both been proven to prevent shingles. However, Shingrix is a newer vaccine that is considered more effective than Zostavax. Shingrix is even recommended for those who have already received the Zostavax vaccine in the past.

Clinical trials have shown that Shingrix is 97% effective at preventing shingles in adults aged 50 to 69 years old. Shingrix is also effective in preventing shingles in older adults—adults over the age of 70, Shingrix is 91% effective.

Zostavax has a 70% efficacy rate in preventing shingles in adults aged 50 to 69 years old, according to the Zoster Efficacy and Safety Trial (ZEST). Results from the Shingles Prevention Study showed that Zostavax is 51% effective against shingles. Compared to Shingrix, the effectiveness of Zostavax decreases in older age groups. Based on the SPS results, Zostavax is 64% effective in adults aged 60 to 69 years old; 41% effective in adults aged 70 to 79 years old; and 18% effective in adults aged 80 years and older.

Your healthcare provider will most likely recommend Shingrix over Zostavax. Shingrix is especially recommended for immunocompromised patients since it is a non-live vaccine. Ask your doctor or pharmacist about which shingles vaccine is right for you.

Coverage and cost comparison of Shingrix vs. Zostavax

For adults aged 50 years and older, only plans with Medicare Part D coverage will cover the Shingrix vaccine. However, there may still be a copay even with Medicare Part D coverage. The average cash price for one Shingrix dose is $167, though you may be able to use a prescription discount card to lower this cost. Check with your local pharmacy to see if you can use a Shingrix SingleCare card.

Like Shingrix, Zostavax is primarily covered by Medicare Part D plans or Medicare Advantage plans with Medicare Part D coverage. The copay for Zostavax with insurance can vary. With an average cash price of $278, Zostavax can be expensive with or without insurance. Using a prescription discount card for Zostavax may be able to reduce this cost.

  Shingrix Zostavax
Typically covered by insurance? Yes Yes
Typically covered by Medicare Part D? Yes Yes
Standard dosage 1 injection (0.5 ml) and then another injection (0.5 ml) 2 to 6 months later 1 single-dose injection (0.65 ml)
Typical Medicare copay $0–$164 $0–$237
SingleCare cost $155+ N/A

Common side effects of Shingrix vs. Zostavax

The most common side effects of Shingrix and Zostavax involve reactions at the site of injection. After a Shingrix or Zostavax injection, you may experience pain, redness, or swelling around the injection site. You may also feel soreness or itching around the injection area.

Compared to Zostavax, Shingrix has been reported to cause more systemic reactions like headache, fever, muscle pain (myalgia), and fatigue. While these side effects may be bothersome, they are usually mild and disappear on their own.

  Shingrix Zostavax
Side effect Applicable? Frequency Applicable? Frequency
Redness at the site of injection Yes 39% Yes 36%
Pain at the site of injection Yes 86% Yes 34%
Swelling at the site of injection Yes 29% Yes 26%
Itching at the site of injection Yes 2% Yes 7%
Headache Yes 45% Yes 1%
Fever Yes 26% Yes 2%
Muscle pain Yes 53% No *
Fatigue Yes 51% No *

*not reported
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Shingrix), DailyMed (Zostavax)

Drug interactions of Shingrix vs. Zostavax

Immunosuppressive drugs such as cyclosporine and tacrolimus can decrease the effectiveness of vaccines. Steroids, like prednisone, and chemotherapy can also have immunosuppressive effects that can alter how vaccines work.

Those who are on immunosuppressive therapy should avoid Zostavax altogether; Zostavax contains the live virus, which could result in an infection.

Antiviral drugs such as acyclovir and famciclovir can interfere with the effects of the Zostavax vaccine. The Advisory Committee on Immunization Practices (ACIP) recommends that people who are on antiviral drugs stop taking antiviral medications 24 hours before getting a Zostavax vaccine. Treatment with antiviral drugs should not be resumed for at least 14 days after vaccination with Zostavax.

Drug Drug Class Shingrix Zostavax
Cyclosporine
Tacrolimus
Prednisone
Chemotherapy
Immunosuppressive therapies Yes Yes
Acyclovir
Valacyclovir
Famciclovir
Antiviral agents No Yes

Consult a healthcare professional for other possible drug interactions

Warnings of Shingrix and Zostavax

Shingrix and Zostavax can cause hypersensitivity, or allergic, reactions in those with allergies to vaccine ingredients. Zostavax may cause severe allergic reactions in those with a known allergy to gelatin or neomycin. Severe allergic reactions can lead to severe rash and trouble breathing (anaphylaxis).

Zostavax should be avoided in those who take immunosuppressive agents and those who are affected by medical conditions that weaken the immune system.

Ask your doctor or pharmacist about other precautions before getting a shingles vaccine.

Frequently asked questions about Shingrix vs. Zostavax

What is Shingrix?

Shingrix is a recombinant vaccine used to prevent herpes zoster, or shingles, in adults aged 50 years or older. Approved in 2017, Shingrix is an inactivated vaccine that does not contain the live varicella-zoster virus. It is administered in two doses with two to six months in between the first dose and second dose. Shingrix is manufactured by GlaxoSmithKline.

What is Zostavax?

Zostavax is a live attenuated zoster vaccine that was FDA approved in 2006. As a live attenuated vaccine, Zostavax contains a live, weakened version of the varicella-zoster virus. Zostavax is administered in a single dose in adults aged 50 years or older. It is manufactured by Merck.

Are Shingrix and Zostavax the same?

Both Shingrix and Zostavax can decrease the risk of shingles. However, they differ in effectiveness, administration, and side effects. Shingrix is a recombinant zoster vaccine and Zostavax is a live vaccine. Meaning, Shingrix contains an inactivated form of the varicella-zoster virus and Zostavax contains a live, weakened form of the virus. Another difference is that Shingrix is injected into the muscle while Zostavax is injected underneath the skin. Compared to Zostavax, Shingrix is a newer shingles vaccine.

Is Shingrix or Zostavax better?

Shingrix is more effective than Zostavax. Shingrix is 97% effective at preventing shingles in adults aged 50 to 69 years old whereas Zostavax is only 70% effective at preventing shingles in the same age group. Shingrix consistently prevents shingles in older adults while the effectiveness of Zostavax decreases with increasing age. However, Shingrix has more systemic side effects than Zostavax.

Can I use Shingrix or Zostavax while pregnant?

The Centers for Disease Control and Prevention (CDC) does not recommend Shingrix or Zostavax in women who are pregnant. There are not enough studies to determine the safety of Shingrix or Zostavax in pregnant women. Consult your doctor or healthcare provider before getting a shingles vaccine.

Can I use Shingrix or Zostavax with alcohol?

Drinking alcohol does not alter the effectiveness of Shingrix or Zostavax. It is generally safe to drink in moderation after getting vaccinated with a shingles vaccine.

How long does the Shingrix vaccine last?

Clinical trials have shown that Shingrix remains effective for at least four years after the second dose. It is suggested that Shingrix lasts even longer than that. Still, more studies are being conducted on the effectiveness of Shingrix long term.

How long is Zostavax effective?

Protection from shingles lasts around five years after vaccination with Zostavax. After five years, the effectiveness of Zostavax may decrease over time. The CDC recommends getting the new shingles vaccine, Shingrix, even if you have already received the Zostavax vaccine in the past.

What happens if you don’t get a second Shingrix shot?

The second Shingrix shot is important to ensure complete protection with the vaccine. However, you don’t need to worry if more than six months have passed before you receive the booster shot. Just make sure you receive the second shot as close to the two to six month timeframe as possible.