Dupixent Drug Interactions: What to Avoid and What to Tell Your Doctor

One of Dupixent's notable advantages over other systemic therapies is its clean drug interaction profile. According to the prescribing information, Dupixent has no known drug-to-drug interactions and is not metabolized through the liver or excreted through the kidneys. This simplifies its use for patients on complex medication regimens.

However, "no formal drug-to-drug interactions" is not the same as "completely safe to combine with everything." There are important considerations patients and prescribers should know about.

Dupixent and Live Vaccines: Avoid Them

The most important drug-vaccine interaction with Dupixent is with live vaccines. While Dupixent is not an immunosuppressant, the prescribing information advises against receiving live vaccines while on treatment. Live vaccines include:

Zostavax (the older live shingles vaccine — Shingrix, the non-live recombinant version, is acceptable)

Yellow fever vaccine

Live nasal influenza vaccine (FluMist) — standard injectable flu shots are fine

MMR (measles, mumps, rubella) vaccine in adults — if you need it, schedule before starting Dupixent

Varivax (chickenpox vaccine) — live virus; avoid while on Dupixent

Before starting Dupixent, complete all age-appropriate vaccinations recommended by current guidelines.

Non-Live Vaccines: Safe to Receive on Dupixent

Non-live (inactivated or recombinant) vaccines can be given while on Dupixent. Clinical studies confirmed that Dupixent does not impair the immune response to standard vaccines. Safe vaccines while on Dupixent include:

COVID-19 mRNA vaccines (Pfizer-BioNTech, Moderna)

Flu shot (injectable — not FluMist)

Shingrix (recombinant shingles vaccine)

Pneumococcal (Prevnar 20, Pneumovax 23)

Tetanus/Tdap boosters

Dupixent and CYP450 Substrates: Monitor Carefully

While Dupixent itself is not metabolized by CYP450 liver enzymes, it can indirectly affect the metabolism of other drugs. Chronic inflammation (like the type 2 inflammation Dupixent treats) suppresses CYP450 enzyme activity. When Dupixent reduces inflammation, CYP450 enzyme formation can normalize — which means some drugs that are CYP450 substrates may have different blood levels after you start Dupixent.

Drugs that require extra monitoring when starting or stopping Dupixent include:

Warfarin (Coumadin) — a blood thinner with a narrow therapeutic window. INR monitoring is advisable when starting or stopping Dupixent.

Cyclosporine — used for organ transplant and some autoimmune conditions; monitor blood levels.

Carbamazepine (Tegretol) — an antiepileptic and mood stabilizer; monitor levels and therapeutic effect.

Clonidine and other drugs with narrow therapeutic indices — levels may shift after Dupixent initiation as inflammation resolves.

Dupixent and Corticosteroids: Don't Stop Abruptly

If you are using systemic corticosteroids (oral prednisone or prednisolone) when you start Dupixent, your doctor may want you to continue them for a period before gradually tapering off. Do not stop corticosteroids abruptly when starting Dupixent — particularly for asthma patients, where an abrupt steroid taper can trigger a severe exacerbation.

Topical corticosteroids can continue to be used alongside Dupixent as needed. Dupixent does not interact negatively with topical treatments.

Can You Use Dupixent With Other Biologics?

Generally, Dupixent should not be combined with other biologic medications (JAK inhibitors like Rinvoq or Cibinqo, or other immunomodulating biologics). Insurance plans typically deny coverage for Dupixent if the patient is simultaneously on another biologic immunomodulator. There is also a theoretical risk of increased immunosuppression when multiple biologics are combined.

What to Tell Your Doctor Before Starting Dupixent

Before starting Dupixent, tell your doctor about:

All prescription and over-the-counter medications, vitamins, and supplements you take

Any upcoming vaccinations — live vaccines should be completed before starting

Any history of parasitic (helminth) infections — Dupixent may reduce your body's ability to fight certain parasites

Pregnancy, plans to become pregnant, or breastfeeding — Dupixent is a biologic IgG antibody that crosses the placenta; discuss risk vs. benefit with your doctor

If you are on warfarin, cyclosporine, or other drugs with narrow therapeutic windows — your levels may need closer monitoring after starting Dupixent

The Bottom Line on Dupixent Drug Interactions

Dupixent's lack of formal drug-to-drug interactions makes it a relatively safe choice for patients on complex regimens. But live vaccines must be avoided, CYP450 substrates with narrow therapeutic windows need monitoring, and corticosteroids should be tapered gradually rather than stopped abruptly. Always give your prescriber a complete medication list. For a full review of what to watch for while on Dupixent, see our post on Dupixent side effects.