Version July 2025
Dosage guidance:
Safety: Respiratory syncytial virus (RSV) vaccine (mRNA) (mResvia) is NOT indicated for use in pregnant persons for prevention of lower respiratory tract RSV disease in infants; refer to monograph for RSV vaccine (recombinant) (Abrysvo).
Respiratory syncytial virus (RSV)–associated lower respiratory tract disease prevention: Adults 60 to 74 years of age who are at increased risk of severe RSV disease: IM: 0.5 mL as a single dose. Note: Persons who have previously received RSV vaccination are NOT recommended to receive another dose at this time (Ref).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Respiratory syncytial virus (RSV)–associated lower respiratory tract disease prevention:
Adults 60 to 74 years of age who are at increased risk of severe RSV disease: IM: 0.5 mL as a single dose. Note: Persons who have previously received RSV vaccination are NOT recommended to receive another dose at this time (Ref).
Adults ≥75 years of age: IM: 0.5 mL as a single dose. Note: Persons who have previously received RSV vaccination are NOT recommended to receive another dose at this time (Ref).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults.
>10%:
Local: Pain at injection site (56%)
Nervous system: Chills (12%), fatigue (31%), headache (27%)
Neuromuscular & skeletal: Arthralgia (22%), axillary swelling (≤15%; including tenderness), myalgia (26%)
1% to 10%:
Gastrointestinal: Nausea (≤7%), vomiting (≤7%)
Local: Erythema at injection site (2%), swelling at injection site (4%)
Miscellaneous: Fever (3%)
<1%:
Dermatologic: Urticaria
Nervous system: Facial nerve paralysis
Severe hypersensitivity (eg, anaphylaxis) to respiratory syncytial virus vaccine or any component of the formulation.
Concerns related to adverse effects:
• Anaphylactoid/Hypersensitivity reactions: Immediate treatment (including injectable epinephrine 1 mg/mL) for anaphylactoid and/or hypersensitivity reactions should be available during vaccine use (ACIP [Kroger 2023]).
• Shoulder injury related to vaccine administration: Vaccine administration that is too high on the upper arm may cause shoulder injury (eg, shoulder bursitis, tendinopathy) resulting in shoulder pain and reduced range of motion following injection. Use proper injection technique for vaccines administered in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013).
• Syncope: Syncope has been reported with use of injectable vaccines and may result in serious secondary injury (eg, skull fracture, cerebral hemorrhage); typically reported in adolescents and young adults and within 15 minutes after vaccination. Procedures should be in place to avoid injuries from falling and to restore cerebral perfusion if syncope occurs (ACIP [Kroger 2023]).
Disease-related concerns:
• Acute illness: The decision to administer or delay vaccination because of current or recent febrile illness depends on the severity of symptoms and the etiology of the disease. Postpone administration in patients with moderate or severe acute illness (with or without fever); vaccination should not be delayed for patients with mild acute illness (with or without fever) (ACIP [Kroger 2023]).
• Bleeding disorders: Use with caution in patients with bleeding disorders (including thrombocytopenia); bleeding/hematoma may occur from IM administration; if the patient receives antihemophilia or other similar therapy, IM injection can be scheduled shortly after such therapy is administered (ACIP [Kroger 2023]).
Concurrent drug therapy issues:
• Anticoagulant therapy: Use with caution in patients receiving anticoagulant therapy; bleeding/hematoma may occur from IM administration (ACIP [Kroger 2023]).
• Vaccines: In order to maximize vaccination rates, the Advisory Committee on Immunization Practices recommends simultaneous administration (ie, >1 vaccine on the same day at different anatomic sites) of all age-appropriate vaccines (live or nonlive) for which a person is eligible at a single visit, unless contraindications exist (ACIP [Kroger 2023]).
Special populations:
• Altered immunocompetence: Consider deferring immunization during periods of severe immunosuppression (eg, patients receiving chemo/radiation therapy or other immunosuppressive therapy, including high-dose corticosteroids); may have a reduced response to vaccination. In general, household and close contacts of persons with altered immunocompetence may receive all age-appropriate vaccines. Nonlive vaccines should be administered ≥2 weeks prior to planned immunosuppression when feasible; nonlive vaccines administered during chemotherapy should be readministered after immune competence is regained (ACIP [Kroger 2023]; IDSA [Rubin 2014]).
Other warnings/precautions:
• Antipyretics: Antipyretics have not been shown to prevent febrile seizures; antipyretics may be used to treat fever or discomfort following vaccination (ACIP [Kroger 2023]). One study reported that routine prophylactic administration of acetaminophen to prevent fever prior to vaccination decreased the immune response of some vaccines; the clinical significance of this reduction in immune response has not been established (Prymula 2009).
• Effective immunity: Vaccination may not result in effective immunity in all patients. Response depends upon multiple factors (eg, type of vaccine, age of patient) and is improved by administering the vaccine at the recommended dose, route, and interval (ACIP [Kroger 2023]).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Suspension Prefilled Syringe, Intramuscular [preservative free]:
MResvia: 50 mcg/0.5 mL (0.5 mL) [contains dmg-peg 2000]
No
Suspension Prefilled Syringe (MResvia Intramuscular)
50 mcg/0.5 mL (per 0.5 mL): $348.00
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
IM: Administer by IM injection into the deltoid muscle; the anterolateral thigh may also be used (ACIP [Kroger 2023]). Use proper injection technique in the deltoid muscle (eg, injecting in the central, thickest part of the muscle) to reduce the risk of shoulder injury related to vaccine administration (Cross 2016; Foster 2013). Do not mix with other vaccines or injections; separate needles and syringes should be used for each injection. To prevent syncope-related injuries, adults should be vaccinated while seated or lying down (ACIP [Kroger 2023]). If purchased under CDC contract, US law requires that the date of administration, the vaccine manufacturer, lot number of vaccine, vaccine information statement edition date and date it was provided, and the administering person's name, title, and address be recorded.
For patients at risk of hemorrhage following IM injection, the Advisory Committee on Immunization Practices recommends that the vaccine should be administered IM if, in the opinion of the physician familiar with the patient's bleeding risk, the vaccine can be administered by this route with reasonable safety. If the patient receives antihemophilia or other similar therapy, IM vaccination can be scheduled shortly after such therapy is administered. A fine needle (≤23-gauge) can be used for the vaccination and firm pressure applied to the site (without rubbing) for at least 2 minutes. The patient should be instructed concerning the risk of hematoma from the injection. Patients on anticoagulant therapy should be considered to have the same bleeding risks and treated as those with clotting factor disorders (ACIP [Kroger 2023]).
Respiratory syncytial virus–associated lower respiratory tract disease prevention: Active immunization for the prevention of lower respiratory tract disease caused by respiratory syncytial virus (RSV) in persons ≥60 years of age.
Advisory Committee on Immunization Practices recommendations: The Advisory Committee on Immunization Practices recommends vaccination in persons ≥75 years of age and in persons 60 to 74 years of age who are at increased risk of severe RSV disease. Risk factors for severe RSV disease include the following (CDC/ACIP [Britton 2024]):
Chronic medical conditions (eg, cardiovascular disease, lung or respiratory disease, liver disease, hematologic conditions, diabetes mellitus with end-stage organ damage or requiring insulin or sodium-glucose cotransporter-2 inhibitor, end-stage kidney disease, dependence on renal replacement therapy)
Neurologic or neuromuscular conditions that may impair airway clearance or respiratory muscle weakness
Moderately or severely immunocompromising conditions
Severe obesity (BMI ≥40 kg/m2)
Persons residing in a nursing home
Other chronic conditions or risk factors that may increase the risk for severe disease due to viral respiratory infection (eg, frailty)
Respiratory syncytial virus vaccine (mRNA) may be confused with respiratory syncytial virus vaccine (recombinant) and respiratory syncytial virus vaccine (recombinant [adjuvanted]).
RSV vaccine (mRNA) may be confused with RSVPreF3 vaccine (respiratory syncytial virus vaccine [recombinant (adjuvanted)]; Arexvy) and RSVpreF vaccine (respiratory syncytial virus vaccine [recombinant]; Abrysvo).
RSV vaccine may be confused with RZV vaccine (zoster vaccine [recombinant]).
Respiratory syncytial virus (RSV) vaccines (eg, Abrysvo, Arexvy, mResvia), which are only approved for use in adult patients, have the potential to be confused with anti-RSV monoclonal antibodies (eg, nirsevimab [Beyfortus], palivizumab [Synagis]) and in some cases have been inadvertently administered to pediatric patients (ISMP [Bertagnoli 2024]; Moro 2024).
Respiratory syncytial virus vaccine (mRNA) (mResvia) may be confused with respiratory syncytial virus vaccine (recombinant) (Abrysvo). mResvia is NOT indicated for use in pregnancy. Only Abrysvo should be given to pregnant patients to prevent RSV lower respiratory tract disease in infants (ISMP [Bertagnoli 2024]).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: May decrease therapeutic effects of Vaccines. Management: Consider avoiding routine prophylactic use of acetaminophen before or during vaccine administration when possible. Acetaminophen is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider Therapy Modification
Anti-CD20 B-Cell Depleting Therapies: May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to initiation or 6 months after anti-CD20 B-cell depleting therapies. If vaccinated prior to B cell recovery, consider assessing immune response to vaccination. Risk D: Consider Therapy Modification
Atidarsagene Autotemcel: May increase adverse/toxic effects of Vaccines. Atidarsagene Autotemcel may decrease therapeutic effects of Vaccines. Risk X: Avoid
Cladribine: May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting cladribine when possible. Patients vaccinated less than 14 days before initiating or during cladribine should be revaccinated at least 3 months after therapy is complete Risk D: Consider Therapy Modification
Corticosteroids (Systemic): May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to immunosuppressive corticosteroids if possible. If patients are vaccinated less than 14 days prior to or during such therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider Therapy Modification
Dinutuximab Beta: May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Risk X: Avoid
Elivaldogene Autotemcel: May increase adverse/toxic effects of Vaccines. Specifically, there may be a greater risk for contracting an infection from any live vaccine. Elivaldogene Autotemcel may decrease therapeutic effects of Vaccines. Management: Administration of vaccines is not recommended in the 6 weeks before myeloablative conditioning, and until hematologic recovery after elivaldogene autotemcel treatment. Risk X: Avoid
Fingolimod: May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Vaccine efficacy may be reduced. Complete all age-appropriate vaccinations at least 2 weeks prior to starting fingolimod. If vaccinated during fingolimod therapy, revaccinate 2 to 3 months after fingolimod discontinuation. Risk D: Consider Therapy Modification
Immunosuppressants (Cytotoxic Chemotherapy): May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting chemotherapy when possible. Patients vaccinated less than 14 days before or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider Therapy Modification
Immunosuppressants (Miscellaneous Oncologic Agents): May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to initiation of immunosuppressants when possible. Patients vaccinated less than 14 days before or during therapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider Therapy Modification
Immunosuppressants (Therapeutic Immunosuppressant Agents): May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Give non-live/inactivated/non-replicating vaccines at least 2 weeks prior to starting immunosuppressants when possible. Patients vaccinated less than 14 days before or during therapy should be revaccinated at least 2 to 3 months after therapy is complete. Risk D: Consider Therapy Modification
Methotrexate: May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Administer vaccines at least 2 weeks prior to methotrexate initiation, if possible. If patients are vaccinated less than 14 days prior to or during methotrexate therapy, repeat vaccination at least 3 months after therapy if immunocompetence restored. Risk D: Consider Therapy Modification
Propacetamol: May decrease therapeutic effects of Vaccines. Management: Consider avoiding routine prophylactic use of propacetamol before or during vaccine administration when possible. Propacetamol is still recommended to treat fevers and/or pain that occurs after vaccination. Risk D: Consider Therapy Modification
Siponimod: May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Avoid administration of non-live/inactivated/non-replicating vaccines during treatment with siponimod and for 1 month after discontinuation due to potential decreased vaccine efficacy. Risk D: Consider Therapy Modification
Teplizumab: May decrease therapeutic effects of Vaccines (Non-Live/Inactivated/Non-Replicating). Management: Vaccination with non-live/inactivated/non-replicating vaccines is not recommended in the 2 weeks prior to teplizumab therapy, during treatment, or for 6 weeks following completion of therapy. Risk D: Consider Therapy Modification
This vaccine is not approved for use in patients <60 years of age.
It is not known if the components of this vaccine are present in breast milk.
This vaccine is not approved for use in patients <60 years of age.
According to the manufacturer, the decision to breastfeed following vaccination should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother.
Monitor for hypersensitivity and syncope for 15 minutes following administration (ACIP [Kroger 2023]).
Promotes active immunization against respiratory syncytial virus prefusion F (RSVPre) glycoprotein to protect against RSV-A- and/or B-associated lower respiratory tract disease (Wilson 2023). The vaccine contains nucleoside modified mRNA encoding the RSV F glycoprotein stabilized in the prefusion conformation (pre-F protein).
Onset: Protection from respiratory syncytial virus–associated lower respiratory tract disease was observed starting at 14 days postvaccination (Wilson 2023).
Duration: A single dose of respiratory syncytial virus (RSV) vaccine provides protection for at least 2 RSV seasons. For RSV vaccine (mRNA), efficacy for first season follow-up data (median of 18.8 months postvaccination) showed that efficacy declined to 48.4% against RSV-lower respiratory tract disease with ≥3 symptoms: 80.9%; efficacy over 2 seasons: 48.4% (CDC/ACIP [Britton 2024]).
