Drug Action
Reduces replication of influenza A and B viruses by inhibiting viral neuraminidase.
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Drug reference
Reduces replication of influenza A and B viruses by inhibiting viral neuraminidase.
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Prevention of influenza ▶BY MOUTH ▶Child 1–11 months: 3 mg/kg once daily for 10 days for post-exposure prophylaxis ▶Child 1–12 years (body-weight 10–15 kg): 30 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks during an epidemic ▶Child 1–12 years (body-weight 15–23 kg): 45 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks during an epidemic ▶Child 1–12 years (body-weight 23–40 kg): 60 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks during an epidemic ▶Child 1–12 years (body-weight 40 kg and above): 75 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks during an epidemic ▶Child 13–17 years: 75 mg once daily for 10 days for post- exposure prophylaxis; for up to 6 weeks during an epidemic ▶Adult: 75 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks during an epidemic Treatment of influenza ▶BY MOUTH ▶Child 1–11 months: 3 mg/kg twice daily for 5 days ▶Child 1–12 years (body-weight 10–15 kg): 30 mg twice daily for 5 days ▶Child 1–12 years (body-weight 15–23 kg): 45 mg twice daily for 5 days ▶Child 1–12 years (body-weight 23–40 kg): 60 mg twice daily for 5 days ▶Child 1–12 years (body-weight 40 kg and above): 75 mg twice daily for 5 days ▶Child 13–17 years: 75 mg twice daily for 5 days ▶Adult: 75 mg twice daily for 5 days Treatment of influenza, in the immunocompromised ▶BY MOUTH ▶Adult: 75 mg twice daily for 10 days Infection l UNLICENSED USE Not licensed for use in premature infants.
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Flavours of oral liquid formulations may include tutti-frutti.
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NICE decisions ▶Oseltamivir, zanamivir, and amantadine for prophylaxis of influenza (September 2008) NICE TA158 Oseltamivir is not a substitute for vaccination, which remains the most effective way of preventing illness from influenza. . Oseltamivir is not recommended for seasonal prophylaxis against influenza. . When influenza is circulating in the community, oseltamivir is an option recommended (in accordance with UK licensing) for post-exposure prophylaxis in at- risk patients who are not effectively protected by influenza vaccine, and who have been in close contact with someone suffering from influenza-like illness in the same household or residential setting. Oseltamivir should be given within 48 hours of exposure to influenza. (National surveillance schemes, including those run by Public Health England, should be used to Infection indicate when influenza is circulating in the community.) . During local outbreaks of influenza-like illness, when there is a high level of certainty that influenza is present, oseltamivir may be used for post-exposure prophylaxis in at-risk patients (regardless of influenza vaccination) living in long-term residential or nursing homes. At risk patients include those aged 65 years or older or those who have one or more of the following conditions: . chronic respiratory disease (including asthma and chronic obstructive pulmonary disease); . chronic heart disease; . chronic renal disease; . chronic liver disease; . chronic neurological disease; . immunosuppression; . diabetes mellitus. The Department of Health in England has advised (November 2010 and April 2011) that ‘at risk patients’ also includes patients under 65 years of age who are at risk of developing medical complications from influenza (treatment only) or women who are pregnant. This guidance does not cover the circumstances of a pandemic, an impending pandemic, or a widespread epidemic of a new strain of influenza to which there is little or no immunity in the community. www.nice.org.uk/guidance/ta158 ▶Oseltamivir, zanamivir, and amantadine for treatment of influenza (February 2009) NICE TA168 Oseltamivir is not a substitute for vaccination, which remains the most effective way of preventing illness from influenza. . When influenza is circulating in the community, oseltamivir is an option recommended (in accordance with UK licensing) for the treatment of influenza in at- risk patients who can start treatment within 48 hours of the onset of symptoms. (National surveillance schemes, including those run by Public Health England, should be used to indicate when influenza is circulating in the community.) . During local outbreaks of influenza-like illness, when there is a high level of certainty that influenza is present, oseltamivir may be used for treatment in at-risk patients living in long-term residential or nursing homes. At risk patients include those aged over 65 years or those who have one or more of the following conditions: . chronic respiratory disease (including asthma and chronic obstructive pulmonary disease); . chronic heart disease; . chronic renal disease; . chronic liver disease; . chronic neurological disease; . immunosuppression; . diabetes mellitus. The Department of Health in England has advised (November 2010 and April 2011) that ‘at risk patients’ also includes patients under 65 years of age who are at risk of developing medical complications from influenza (treatment only) or women who are pregnant. This guidance does not cover the circumstances of a pandemic, an impending pandemic, or a widespread epidemic of a new strain of influenza to which there is little or no immunity in the community. www.nice.org.uk/guidance/ta168 Tamiflu ® is not prescribable in NHS NHS restrictions primary care except for the treatment and prophylaxis of influenza as indicated in the NICE guidance; endorse prescription ‘SLS’.
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→Appendix 1: oseltamivir
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▶Common or very common Dizziness. gastrointestinal discomfort. herpes simplex. nausea. sleep disorders. vertigo. vomiting ▶Uncommon Arrhythmia. consciousness impaired (in adults). seizure. skin reactions ▶Rare or very rare Angioedema. anxiety. behaviour abnormal. confusion. delirium. delusions. haemorrhage. hallucination. hepatic disorders. self-injurious behaviour. severe cutaneous adverse reactions (SCARs). thrombocytopenia. visual impairment
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Although safety data are limited, oseltamivir can be used in women who are pregnant when the potential benefit outweighs the risk (e.g. during a pandemic).
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Although safety data are limited, oseltamivir can be used in women who are breast-feeding when the potential benefit outweighs the risk (e.g. during a pandemic). Oseltamivir is the preferred drug in women who are breast-feeding.
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▶In adults Avoid for treatment and prevention if eGFR less than 10 mL/minute/1.73 m2. ▶In children Avoid for treatment and prevention if estimated glomerular filtration rate less than 10 mL/minute/1.73 m2. Dose adjustments ▶In adults For treatment, use 30 mg twice daily if eGFR 30–60 mL/minute/1.73 m2 (30 mg once daily if eGFR 10–30 mL/minute/1.73 m2). For prevention, use 30 mg once daily if eGFR 30–60 mL/minute/1.73 m2 (30 mg every 48 hours if eGFR 10–30 mL/minute/1.73 m2). ▶In children For treatment, use 40% of normal dose twice daily if estimated glomerular filtration rate 30–60 mL/minute/1.73 m2 (40% of normal dose once daily if estimated glomerular filtration rate 10–30 mL/minute/1.73 m2). For prevention, use 40% of normal dose once daily if estimated glomerular filtration rate 30–60 mL/minute/1.73 m2 (40% of normal dose every 48 hours if estimated glomerular filtration rate 10–30 mL/minute/1.73 m2).
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If suspension not available, capsules can be opened and the contents mixed with a small amount of sweetened food, such as sugar water or chocolate syrup, just before administration.
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Oral suspension CAUTIONARY AND ADVISORY LABELS 9 EXCIPIENTS: May contain Sorbitol ▶Tamiflu (Roche Products Ltd) Oseltamivir (as Oseltamivir phosphate) 6 mg per 1 ml Tamiflu 6mg/ml oral suspension sugar-free | 65 ml P £10.27 DT = £10.27 Capsule CAUTIONARY AND ADVISORY LABELS 9 ▶Tamiflu (Roche Products Ltd) Oseltamivir (as Oseltamivir phosphate) 30 mg Tamiflu 30mg capsules | 10 capsule P £7.71 DT = £7.71 Oseltamivir (as Oseltamivir phosphate) 45 mg Tamiflu 45mg capsules | 10 capsule P £15.41 DT = £15.41 Oseltamivir (as Oseltamivir phosphate) 75 mg Tamiflu 75mg capsules | 10 capsule P £15.41 DT = £15.41
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Medicines for Children leaflet: Oseltamivir for influenza (flu) www.medicinesforchildren.org.uk/oseltamivir-influenza-flu
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75 mg once daily for 10 days for post-exposure
First-line fragment. Read the complete Indications and Dose section above.
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75 mg twice daily for 5 days
First-line fragment. Read the complete Indications and Dose section above.
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75 mg twice daily for 10 days
First-line fragment. Read the complete Indications and Dose section above.
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