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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Post-exposure prophylaxis of influenza ▶BY INHALATION OF POWDER ▶Child 5–17 years: 10 mg once daily for 10 days ▶Adult: 10 mg once daily for 10 days Prevention of influenza during an epidemic ▶BY INHALATION OF POWDER ▶Child 5–17 years: 10 mg once daily for up to 28 days ▶Adult: 10 mg once daily for up to 28 days Treatment of influenza ▶BY INHALATION OF POWDER ▶Child 5–17 years: 10 mg twice daily for 5 days (for up to 10 days if resistance to oseltamivir suspected) ▶Adult: 10 mg twice daily for 5 days (for up to 10 days if resistance to oseltamivir suspected) Treatment of influenza [complicated and potentially life- threatening, resistant to other anti-influenza medicinal products and/or other treatments, including inhaled zanamivir] ▶BY INTRAVENOUS INFUSION ▶Child 6 months–5 years: 14 mg/kg twice daily for 5 to 10 days ▶Child 6–17 years: 12 mg/kg twice daily (max. per dose 600 mg) for 5 to 10 days ▶Adult: 600 mg twice daily for 5 to 10 days l UNLICENSED USE ▶When used by inhalation Use of zanamivir for up to 10 days if resistance to oseltamivir suspected is an unlicensed duration.
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▶When used by inhalation Asthma. chronic pulmonary disease . uncontrolled chronic illness CAUTIONS, FURTHER INFORMATION ▶Asthma and chronic pulmonary disease ▶When used by inhalation Risk of bronchospasm—short- acting bronchodilator should be available. Avoid in severe asthma unless close monitoring possible and appropriate facilities available to treat bronchospasm.
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▶When used by inhalation Except for the treatment and prophylaxis of influenza as indicated in the NICE guidance; endorse prescription ‘SLS’.
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NICE decisions ▶Oseltamivir, zanamivir, and amantadine for prophylaxis of influenza (September 2008) NICE TA158 ▶When used by inhalation Zanamivir is not a substitute for vaccination, which remains the most effective way of preventing illness from influenza. . Zanamivir is not recommended for seasonal prophylaxis against influenza. . When influenza is circulating in the community, zanamivir 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. Zanamivir should be given within 36 hours of exposure to influenza. (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, zanamivir 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 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. Infection 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 ▶When used by inhalation Zanamivir is not a substitute for vaccination, which remains the most effective way of preventing illness from influenza. . When influenza is circulating in the community, zanamivir 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 (within 36 hours for zanamivir in children) 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, zanamivir 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 Scottish Medicines Consortium (SMC) decisions SMC No. SMC2204 ▶With intravenous use The Scottish Medicines Consortium has advised (December 2019) that zanamivir (Dectova ®) is accepted for use within NHS Scotland for the treatment of complicated and potentially life-threatening influenza A or B virus infection in adult and paediatric patients aged 6 months and older when: the patient’s influenza virus is known or suspected to be resistant to anti-influenza medicinal products other than zanamivir, and/or other anti-viral medicinal products for treatment of influenza, including inhaled zanamivir, are not suitable for the individual patient. Zanamivir (Dectova ®) should be used in accordance with official guidance. All Wales Medicines Strategy Group (AWMSG) decisions AWMSG No. 4130 ▶With intravenous use The All Wales Medicines Strategy Group has advised (October 2019) that zanamivir (Dectova ®) is recommended as an option for use within NHS Wales for the treatment of complicated and potentially life- threatening influenza A or B virus infection in adults and children (aged 6 months and older), when: the patient’s Infection influenza virus is known or suspected to be resistant to anti-influenza medicinal products other than zanamivir, and/or other anti-viral medicinal products for treatment of influenza, including inhaled zanamivir, are not suitable for the individual patient. Zanamivir (Dectova ®) should be used in accordance with official guidance.
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GENERAL SIDE-EFFECTS ▶Common or very common Skin reactions ▶Uncommon Oropharyngeal oedema. severe cutaneous adverse reactions (SCARs) ▶Rare or very rare Face oedema ▶Frequency not known Behaviour abnormal. delirium. hallucination. level of consciousness decreased. seizure SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With intravenous use Diarrhoea. hepatocellular injury ▶Uncommon ▶When used by inhalation Bronchospasm. dehydration. dyspnoea. presyncope. throat tightness ▶Frequency not known ▶When used by inhalation Psychiatric disorder SIDE-EFFECTS, FURTHER INFORMATION Neurological and psychiatric disorders occur more commonly in children and adolescents.
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Manufacturer advises avoid unless potential benefit outweighs risk (e.g. during a pandemic).—limited information available; animal studies do not indicate toxicity.
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Manufacturer advises use only if potential benefit outweighs risk (e.g. during a pandemic)— limited information available; present in low levels in milk in animal studies.
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Dose adjustments ▶With intravenous use Manufacturer advises reduce dose if creatinine clearance less than 80 mL/minute—consult product literature for details.
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▶When used by inhalation Other inhaled drugs should be administered before zanamivir. ▶With intravenous use Manufacturer advises for intermittent intravenous infusion, give undiluted or dilute to a concentration of not less than 200 micrograms/mL with Sodium Chloride 0.9%; give over 30 minutes.
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There can be variation in the licensing of different medicines containing the same drug. Solution for infusion ELECTROLYTES: May contain Sodium A ▶Zanamivir (non-proprietary) Zanamivir 10 mg per 1 ml Dectova 200mg/20ml solution for infusion vials | 1 vial P £27.83 Inhalation powder ▶Relenza (GlaxoSmithKline UK Ltd) Zanamivir 5 mg Relenza 5mg inhalation powder blisters with Diskhaler | 20 blister P £16.36 6.7 Respiratory syncytial virus Respiratory syncytial virus Management in children Ribavirin p. 662 is licensed for administration by inhalation for the treatment of severe bronchiolitis caused by the respiratory syncytial virus (RSV) in infants, especially when they have other serious diseases. However, there is no evidence that ribavirin produces clinically relevant benefit in RSV bronchiolitis. Palivizumab below is a monoclonal antibody licensed for preventing serious lower respiratory-tract disease caused by respiratory syncytial virus in children at high risk of the disease; it should be prescribed under specialist supervision and on the basis of the likelihood of hospitalisation. Palivizumab is recommended for: . children under 9 months of age with chronic lung disease (defined as requiring oxygen for at least 28 days from birth) and who were born preterm; . children under 6 months of age with haemodynamically significant, acyanotic congenital heart disease who were born preterm. Palivizumab should be considered for: . children under 2 years of age with severe combined immunodeficiency syndrome; . children under 1 year of age who require long-term ventilation; . children 1–2 years of age who require long-term ventilation and have an additional co-morbidity (including cardiac disease or pulmonary hypertension). For details of the preterm age groups included in the recommendations, see Immunisation against Infectious Disease (2006), available at www.gov.uk/dh. DRUGS FOR RESPIRATORY DISEASES › MONOCLONAL ANTIBODIES
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10 mg once daily for 10 days
First-line fragment. Read the complete Indications and Dose section above.
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10 mg once daily for up to 28 days
First-line fragment. Read the complete Indications and Dose section above.
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10 mg twice daily for 5 days (for up to
First-line fragment. Read the complete Indications and Dose section above.
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14 mg/kg twice daily for 5 to
First-line fragment. Read the complete Indications and Dose section above.
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12 mg/kg twice daily (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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