Names and pronunciation
(oss-el-tam′ih-veer) Tamiflu
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Drug reference
(oss-el-tam′ih-veer) Tamiflu
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Func. class.: Antiviral
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Chem. class.: Neuraminidase inhibitor
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Do not confuse: Tamiflu/Thera-Flu
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ACTION: Inhibits influenza virus neuraminidase with possible alteration of virus particle aggregation and release
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USES: Prevention and treatment of influenza type A or B
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Unlabeled uses: Avian flu (H5N1)
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CONTRAINDICATIONS: Hyper- sensitivity Precautions: Pregnancy, neonates, breastfeeding, infants, children, geriatric patients, renal/hepatic/pulmonary/car- diac disease, psychosis, viral infection
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SIDE EFFECTS CNS: Headache, dizziness, fatigue, insomnia, seizures, delirium, self-injury (children) GI: Nausea, vomiting INTEG: Toxic epidermal necrolysis, Stevens- Johnson syndrome, erythema multiforme RESP: Cough
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INTERACTIONS • Decrease: effect, live, attenuated influ- enza virus vaccine, avoid prior to use (2 days before or after 14 days)
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DOSAGE AND ROUTES • Treatment should begin ≤2 days after onset of symptoms Treatment of influenza • Adult/child >40 kg: PO 75 mg bid × 5 days, begin treatment within 2 days of onset of symptoms • Child 23-40 kg and ≥1 yr: PO 60 mg bid × 5 days • Child 15-23 kg and ≥1 yr: PO 45 mg bid × 5 days • Child ≤15 kg and ≥1 yr: PO 30 mg bid × 5 days • Neonate ≥14 days/infant: PO 3 mg/ kg/dose bid × 5 days Prevention of influenza • Adult/child ≥13 yr: PO 75 mg/day (capsule) or 12.5 mL (suspension) daily × 1 wk after exposure (vaccinated) or 2 wk (unvaccinated) • Child/adolescent ≤15 kg: PO 30 mg daily; >15 kg to 23 kg: PO 45 mg daily; >23 kg to 40 kg: PO 60 mg daily; >40 kg: PO 75 mg daily Renal dose • Adult: PO Treatment: CCr 10-30 mL/min, 30 mg/day × 5 days; CCr 30-60 mL/min, 30 mg bid × 5 days; Prophylaxis: CCr 10-30 mL/min, 30 mg every other day; CCr 30-60 mL/min, 30 mg daily H1N1 influenza A virus (unlabeled) • Adult/adolescent/child >40 kg: PO 75 mg bid × 5 days • Adolescent/child 24-40 kg: PO 60 mg bid × 5 days • Child >1 yr and 15-23 kg: PO 45 mg bid × 5 days • Child >1 yr and ≤15 kg: PO 30 mg bid × 5 days
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Available forms: Caps 30, 45, 75 mg; powder for oral susp 6 mg/mL
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Administer: • Within 2 days of symptoms of influ- enza; continue for 5 days • At least 4 hr before bedtime to prevent insomnia • Without regard to food; give with food for GI upset • Take with full glass of water • Store in tight, dry container • Oral susp: 6 mg/mL concentration, take care to use correct dose; loosen powder from side of bottle, add 55 mL, shake well (6 mg/mL), remove push bottle adapter into neck of bottle, close tightly to ensure sealing, use within 17 days of preparation when re- frigerated or within 10 days at room temperature, write expiration date on bottle, shake well before use, use oral syringe provided but only with markings for 30, 45, 60 mg, confirm that dosing instructions are in same units as syringe provided
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Assess: • Bowel pattern before, during treatment • Influenza: fever, fatigue, sore throat, headache, muscle soreness, aches
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Evaluate: • Therapeutic response: absence of fe- ver, malaise, cough, dyspnea in infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About all aspects of product therapy • To avoid hazardous activities if dizzi- ness occurs • To take as soon as symptoms appear; to take full course even if feeling better • To take missed dose as soon as re- membered if within 2 hr of next dose • To stop immediately; to report to pre- scriber skin rash, delirium, psychosis, hallucinations (child) • That this product should not be substi- tuted for flu shot • That this product will not treat the O common cold • To avoid other products unless ap- proved by prescriber HIGH ALERT
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PHARMACOKINETICS Rapidly absorbed, protein binding 3%, converted to oseltamivir carboxylate (active form), active forms half-life 1-3 hr, metabo- lite 6-10 hr, excreted in urine (99%)
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• Adult/child >40 kg: PO 75 mg bid × 5 days, begin treatment within 2 days of onset of symptoms
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• Child 23-40 kg and ≥1 yr: PO 60 mg bid × 5 days
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• Child 15-23 kg and ≥1 yr: PO 45 mg bid × 5 days
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• Child ≤15 kg and ≥1 yr: PO 30 mg bid × 5 days
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• Adult/child ≥13 yr: PO 75 mg/day (capsule) or 12.5 mL (suspension) daily × 1 wk after exposure (vaccinated) or 2 wk (unvaccinated)
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• Child/adolescent ≤15 kg: PO 30 mg daily; >15 kg to 23 kg: PO 45 mg daily; >23 kg to 40 kg: PO 60 mg daily; >40 kg: PO 75 mg daily Renal dose
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• Adult/adolescent/child >40 kg: PO 75 mg bid × 5 days
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• Adolescent/child 24-40 kg: PO 60 mg bid × 5 days
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• Child >1 yr and 15-23 kg: PO 45 mg bid × 5 days
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• Child >1 yr and ≤15 kg: PO 30 mg bid × 5 days
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