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What Should we do About IM (Intramuscular) Injections for Warfarin-Treated Patients?

Henry I. Bussey, Pharm.D.
March, 2009

IM Injections should be avoided when the INR is supra-therapeutic but I'm not aware of studies evaluating IM Injections in patients with therapeutic INRs. Also, in our anticoagulation clinic, we continue to administer IM injections in warfarin-treated patients if the INR is not above the target range.

Various sources, however, indicate that flu vaccine, pneumovax, and other vaccinations can be administered subcutaneously with an adequate immune response. The CDC website (, about half-way down the page, indicates that a dose of influenza vaccine given subcutaneously should be counted as an effective dose and not be re-administered. Also, the American Academy of Allergy and Immunology describe several studies in which subcutaneously administered immunizations were successful in inducing immunogenicity; and pneumovax is available for either intramuscular or subcutaneous (but not intradermal) injection (

If you have additional information or a different take on this issue, please feel free to submit your comments to Marie Walker at

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Monday, July 22, 2024