Should I Stop My Medications Before Getting the Second BNT Shot?

Should I stop taking muscle relaxants before getting the BNT vaccine?

Hello Doctor: I am a patient with ankylosing spondylitis.
A month ago, I was experiencing pain in my sacroiliac joint, and my CRP was 0.57 and ESR was 20.
At that time, I switched to a different medication, taking one 60mg dose of Voltaren (diclofenac) daily and two 500mg doses of Celebrex (celecoxib).
For nearly a month now, I have not had any pain in my sacroiliac joint.
However, I am unsure if my CRP and ESR levels have decreased.
My next follow-up appointment is over a month away.
I am now due to receive my second dose of the BNT vaccine (BioNTech/Pfizer).
I would like to ask the doctor if I need to stop taking my medications (Voltaren and Celebrex) before receiving the second dose of the BNT vaccine.
Is it necessary to wait until my next appointment to confirm that my CRP and ESR levels have returned to normal before getting the BNT vaccine? Thank you, Doctor.

Hao, 20~29 year old female. Ask Date: 2022/03/25

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
I believe it would be better to administer the BNT vaccine after the symptoms improve or the inflammatory markers decrease.
Some patients with rheumatic diseases who receive the COVID-19 vaccine before their condition stabilizes often experience exacerbation of their rheumatic symptoms.
Additionally, if symptoms have already diminished, it is advisable to pause the administration of Wankesi during the vaccination, while Salazopyridine can be continued without any impact.
This is a message from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare, caring for you.

Reply Date: 2022/03/25

More Info

When considering whether to stop medications before receiving the second dose of the BNT (BioNTech) vaccine, it is essential to evaluate both the medications you are currently taking and your overall health status. You mentioned that you have ankylosing spondylitis and are currently taking 60 mg of a medication (likely a corticosteroid) and 500 mg of another medication (possibly a non-steroidal anti-inflammatory drug or NSAID).
First, it is important to understand the role of these medications in managing your condition. Corticosteroids, such as the one you are taking, can suppress the immune system, which might raise concerns about vaccine efficacy and the potential for adverse reactions. However, it is also crucial to manage your underlying condition effectively. Stopping these medications abruptly could lead to a flare-up of your ankylosing spondylitis, which could be detrimental to your health.

In general, current guidelines suggest that patients on stable doses of immunosuppressive medications, including corticosteroids, should continue their medications when receiving vaccinations. The rationale is that the benefits of controlling your disease outweigh the potential risks associated with vaccination. Moreover, studies have shown that individuals on immunosuppressive therapies can still mount an adequate immune response to vaccines, although the response may be somewhat diminished compared to those not on such therapies.

Regarding your CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) levels, these are markers of inflammation in the body. While it is beneficial to have these levels monitored, the decision to receive the vaccine should not be solely based on these values. If you are currently asymptomatic and your condition is stable, it is generally advisable to proceed with the vaccination.
However, it is always best to consult with your healthcare provider before making any changes to your medication regimen or vaccination schedule. They can provide personalized advice based on your medical history, current health status, and the specifics of your treatment plan.
In summary, it is typically not necessary to stop your medications before receiving the second dose of the BNT vaccine, especially if your condition is stable and well-managed. Continuing your medications will help prevent a flare-up of your ankylosing spondylitis, and you can still receive the vaccine to protect against COVID-19. Always communicate with your healthcare provider to ensure that you are making the best decision for your health.

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