Belumosudil and Typhoid Vaccine: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 15, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Typhoid Vaccine
Belumosudil
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
This combination needs a conversation with your care team before you get vaccinated. Belumosudil (Rezurock) is a medicine that calms down your immune system. The live version of the typhoid vaccine (Vivotif) works by giving you a tiny, weakened dose of the actual bacteria. Normally your immune system easily handles it. But when your immune defenses are turned down by belumosudil, that weakened vaccine can actually cause the infection it was meant to prevent.
The good news is this is very manageable. Your doctor or pharmacist can choose the right timing, or use a different (non-live) typhoid option. Please don't get any live vaccine without checking with them first.
Contraindicated: live typhoid vaccine (Vivotif, oral Ty21a) with belumosudil.
- Mechanism: Belumosudil, a ROCK2 inhibitor used for chronic GVHD, produces immunosuppression. A blunted humoral and cell-mediated response permits the attenuated Salmonella typhi strain to replicate and cause active infection.
- Direction: Reduced immune response, increased risk of vaccine-derived infection.
- Evidence: Established; onset unspecified.
- Management: Avoid live vaccines during immunosuppressive therapy. Note the parenteral polysaccharide Vi vaccine (Typhim Vi) is inactivated and not live; efficacy may still be reduced. Live vaccination may be considered only after immunocompetence is restored (generally at least 3 months off immunosuppression).
What happens
An increased risk of infection by the live vaccine
Interaction Deep Dive
The typhoid vaccine should not be given to individuals who cannot generate an adequate humoral or cell-mediated immune response, whether because of a congenital or acquired immunodeficiency, which includes those receiving immunosuppressive or antimitotic agents2. A live vaccine may be administered to patients with leukemia, lymphoma, or other malignancies provided their disease is in remission, their immunocompetence has been restored, and at least 3 months have passed since chemotherapy was stopped1.
Why it happens (mechanism)
Decreased immune response allows live vaccine to produce infection
How to manage this interaction
Keep taking your belumosudil as prescribed and do not get a live vaccine on your own. Bring this up with your prescriber or pharmacist before any travel or vaccination appointment.
- The live oral typhoid vaccine (Vivotif) should be avoided while you are on immunosuppressive therapy.
- Your care team may choose the inactivated injectable typhoid vaccine (Typhim Vi) instead, though your response to it may be weaker.
- Live vaccination may be reconsidered once your immune system has recovered, typically at least 3 months after stopping immunosuppressive treatment, as decided by your care team.
- Tell every provider you are taking belumosudil so vaccine choices can be tailored to you.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Belumosudil and Typhoid Vaccine together?
Do not receive the live typhoid vaccine (Vivotif) while taking belumosudil, because your lowered immune response can let the weakened vaccine cause infection; ask your care team about the inactivated injectable version or the right timing instead. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Belumosudil and Typhoid Vaccine interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Belumosudil and Typhoid Vaccine interaction managed?
Keep taking your belumosudil as prescribed and do not get a live vaccine on your own. Bring this up with your prescriber or pharmacist before any travel or vaccination appointment. The live oral typhoid vaccine (Vivotif) should be avoided while you are on immunosuppressive therapy. Your care team may choose the inactivated injectable typhoid vaccine (Typhim Vi) instead, though your response to it… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Belumosudil or Typhoid Vaccine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Centers for Disease Control and Prevention (CDC): Vaccines & Immunizations: altered immunocompetence. Centers for Disease Control and Prevention (CDC). Atlanta, GA. 2024.
- Product Information: VIVOTIF(R) oral coated capsules, live typhoid vaccine ty21a oral coated capsules. Bavarian Nordic Inc (per Dailymed), Morrisville, NC, 2024. DailyMed
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