Twinrix (hepatitis A and hepatitis B [recombinant] vaccine)

Twinrix generic or biosimilar

Twinrix is available only as a brand-name medication. It’s not currently available in biosimilar form.

A biosimilar medication is a drug that’s similar to the brand-name biologic drug (also called the parent drug). Twinrix is a biologic medication, which is also frequently called a “biologic.” Biologic medications are made using living cells, and an exact copy of them cannot be made.

Generic drugs, on the other hand, are medications made using chemicals. A generic drug is an exact copy of the active ingredient (what makes a drug work) found in the brand-name medication.

Biosimilar medications are considered just as effective and safe as their brand-name parent drug. And, like generics, biosimilars often cost less than the brand-name medication they’re based on.

Twinrix dosage

Your Twinrix dosing schedule will depend on whether you receive the standard Twinrix schedule or the accelerated schedule. The alternative Twinrix vaccine schedule may be used when you need protection sooner — for example, if you have travel scheduled and need protection as soon as possible.

The following information describes Twinrix schedules that are commonly used or recommended.Your doctor will determine the best Twinrix schedule to fit your needs.

Drug form and strength

Twinrix comes as a liquid suspension inside prefilled syringes to be given as an intramuscular (IM) injection. It’s available in 1-milliliter (mL) syringes.

Dosage for preventing hepatitis A and B

The standard Twinrix schedule consists of three doses. After you receive your first dose, you’ll receive the second dose 1 month later. Then, you’ll receive your third dose 6 months after your first dose.

The accelerated alternative Twinrix vaccine schedule consists of four doses. You’ll receive your second dose 7 days after your first dose. Then, you’ll receive your third dose 21 to 30 days after your first dose. Finally, you’ll receive your fourth dose — considered a “booster” dose — 12 months after your first dose.

The table below compares the standard and alternative Twinrix vaccine schedules. Talk with your pharmacist or doctor if you have questions about your Twinrix schedule.

About receiving Twinrix

Below you’ll find information about key dosage issues.

• If you miss a dose: If you miss a scheduled Twinrix dose, talk with your doctor or pharmacist about rescheduling. They can provide more information on how a missed dose affects your Twinrix schedule.
• Length of time to work: You likely won’t feel Twinrix working after receiving doses. In studies, most people had a high level of antibodies against hepatitis A and hepatitis B about 1 month after receiving the final dose of Twinrix in the schedule. Talk with your doctor or pharmacist to learn more about how long Twinrix takes to work to offer protection against hepatitis A and B.

Twinrix side effects

Twinrix can cause mild or serious side effects. The following lists contain some of the key side effects that may occur after you receive Twinrix. These lists do not include all possible side effects.

Note that, in studies, side effects of the standard and alternative Twinrix dosing schedules were similar. The Twinrix booster given with the alternative schedule is not expected to cause different side effects.

For more information about the possible side effects of Twinrix, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may be concerning or bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs and vaccines it has approved. If you would like to notify the FDA about a side effect you’ve had with Twinrix, you can do so through the Vaccine Adverse Event Reporting System (VAERS).

Mild side effects

Below is a partial list of mild side effects of Twinrix. To learn about other mild side effects, talk with your doctor or pharmacist or view Twinrix’s prescribing information.

Mild side effects of Twinrix can include:

• injection site reactions, such as soreness, swelling, or skin discoloration at the site where Twinrix is injected
• fatigue
• headache
• diarrhea
• nausea and vomiting
• fever
• symptoms of an upper respiratory infection, such as a runny or stuffy nose

Most of these side effects may go away within a few days to a couple of weeks. However, if they become more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Twinrix aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

• fainting (syncope) after receiving Twinrix, which can result in broken bones, concussion, or other injuries caused by falling. Syncope may be accompanied by other symptoms that you may experience immediately after a dose of Twinrix, including:
  • vision problems, such as blurry vision or double vision
  • paresthesia (numbness, tingling, or burning)
  • twitching or jerking of your arms or legs

ALLERGIC REACTION

For some people, Twinrix can cause an allergic reaction.

In general, symptoms of allergic reaction can be mild or serious.

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should continue receiving the vaccine.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Twinrix, your doctor may recommend a different vaccine instead.

Twinrix uses

The Food and Drug Administration (FDA) approves vaccines such as Twinrix to prevent certain conditions.

Twinrix for preventing hepatitis A and hepatitis B

Twinrix is prescribed to help prevent hepatitis A and hepatitis B infection. Hepatitis A and hepatitis B are both viral infections that affect your liver, but they have some differences.

About hepatitis A

Hepatitis A is a liver infection caused by the hepatitis A virus (HAV). Hepatitis A causes inflammation in the liver. It does not cause chronic (long-term) liver disease and rarely causes serious liver damage, but the infection can cause symptoms for months in some cases. There is no specific treatment available for HAV infection.

HAV is spread through contaminated water or food and can also be passed between people. It’s possible to have an HAV infection without showing symptoms. When symptoms do appear, they often resemble those of the flu and can include:

• fever
• fatigue
• nausea and vomiting
• abdominal pain and diarrhea
• appetite loss

About hepatitis B

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). HBV also causes inflammation in the liver. Sometimes, hepatitis B is short-term and may even go away without treatment. But in rare cases, it can be chronic (long-term) and can lead to cirrhosis or even liver cancer. There is no specific treatment for HBV.

HBV can spread when certain bodily fluids of someone who has the virus, such as blood or semen, enter the body of someone who does not have it. HBV is present in saliva but does not spread through it. So a person cannot contract HBV through drinking water, eating food, kissing, holding hands, or sharing utensils.

HBV sometimes does not cause symptoms early on. But possible early symptoms of HBV can include:

• fever
• fatigue
• nausea and vomiting
• joint pain
• abdominal pain

Chronic HBV can cause jaundice. Other symptoms of HBV include abdominal pain and persistent fatigue and joint pain.

Twinrix and children

Twinrix is not approved for use in children in the United States. It may be used in children in some other countries.

However, other vaccines that help protect against hepatitis A and hepatitis B are approved for use in children. Talk with your child’s doctor to learn more about vaccine options for protecting your child from hepatitis A and hepatitis B.

Twinrix interactions

Twinrix can interact with several other medications.

Before receiving Twinrix, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you take. Sharing this information can help you avoid potential interactions.

Interactions with medications and lab tests

Below is a list of medications and lab tests that can interact with Twinrix. This list does not contain all drugs that may interact with Twinrix. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Alcohol interaction

Alcohol is not known to interact with Twinrix. It’s likely safe to consume alcohol after receiving a dose of Twinrix.

However, if you choose to consume alcohol on the day you receive a Twinrix dose, it’s best to do so in moderation. Binge drinking could affect how well your immune system responds to a dose of Twinrix, although this has not been well studied.

Twinrix cost and coupons

As with all medications, the cost of Twinrix can vary. The actual price you’ll pay depends on your insurance plan, your location, and where you receive your vaccine (such as at a pharmacy or health clinic).

Many Medicare, Medicaid, and private insurance plans provide Twinrix and other vaccines for free. Your local or state health department may offer free or low cost vaccines, including Twinrix. You’ll need to contact them to confirm which vaccines they offer and whether you’re eligible.

Drug coupons: You can visit Optum Perks for price estimates of Twinrix. These estimates are based on the use of Optum Perks coupons. Note: Optum Perks coupons cannot be used with any insurance copays or benefits.

Financial and insurance assistance: If you need financial support to pay for Twinrix or need help understanding your insurance coverage, help is available.

Biosimilar version: Twinrix is not available in a biosimilar form. A biosimilar drug is a similar version of a biologic drug called the parent drug. Twinrix is a biologic medication, which means it’s made using living cells. It isn’t possible to make an exact copy of a biologic medication. But biosimilars are close and are considered as safe and effective as the parent biologic medication.

Learn more about saving money on prescriptions.

Similar drugs

Other vaccines are available that can help prevent hepatitis A and hepatitis B. Some may be a better fit for you than others. If you’re interested in finding an alternative to Twinrix, talk with your doctor. They can tell you about other vaccines that may work well for you.

The following drugs are similar to Twinrix:

• other vaccines for hepatitis A, such as:
  • Havrix
  • Vaqta
• other vaccines for hepatitis B, such as:
  • Engerix-B
  • Heplisav-B
  • Recombivax HB

Things to consider when receiving Twinrix

If you can become pregnant, consider the following information about pregnancy and breastfeeding.

Twinrix and pregnancy

There aren’t well-controlled clinical trials to confirm the safety of receiving Twinrix during pregnancy. But based on data since Twinrix was approved for use, Twinrix is considered safe to receive during pregnancy. Receiving the vaccine does not appear to increase the risk of pregnancy loss or congenital anomalies (commonly known as birth defects).

However, you should still talk with your doctor about whether they feel Twinrix is safe for you.

Twinrix and breastfeeding

In general, Twinrix is consideredTrusted Source safe to receive while breastfeeding. However, you should still ask your doctor whether they feel Twinrix is safe for you.

How Twinrix works

Twinrix is used as a vaccination against hepatitis A and hepatitis B. Hepatitis A and hepatitis B are viral infections that cause inflammation of the liver. Hepatitis A can cause only short-term infection, and it usually doesn’t cause serious symptoms or complications (although those do happen in rare cases).

On the other hand, hepatitis B infections can be short-term (acute) or long-term (chronic). Over time, chronic hepatitis B can lead to cirrhosis or even liver cancer.

Twinrix contains inactivated (killed) forms of the hepatitis A and hepatitis B viruses. After you receive Twinrix, your immune system detects these inactivated forms (called antigens) in your blood. Because Twinrix contains inactivated forms of hepatitis A and hepatitis B, it cannot cause either infection.

The presence of antigens triggers an immune response, including the production of antibodies against hepatitis A and hepatitis B. The antibodies destroy the vaccine antigen.

This process also produces memory cells in your immune system, which allow it to quickly identify hepatitis A or hepatitis B in your system if you’re exposed to either virus. This way, it can quickly produce antibodies again and help prevent the virus from settling and causing infection.