We need you! Join our contributor community and become a WikEM editor through our open and transparent promotion process.
Oseltamivir
From WikEM
Contents
Administration
- Type: Antiviral
- Routes of Administration: Oral
- Common Trade Names: Tamiflu
Adult Dosing
Influenza
- 75mg PO BID x 5 days
Pediatric Dosing
Influenza
- Age <1 year: 3mg/kg PO BID x 5 days
- <15kg: 30mg PO BID x 5 days
- 15-23kg: 45mg PO BID x 5 days
- 24-40kg: 60mg PO BID x5d
- Adult: 75mg PO BID x 5 days
Special Populations
- Pregnancy Rating: Category C
- Lactation risk: Low concentrations of oseltamivir seen in breast milk; levels are unlikely to lead to toxicity in a breast-fed infant. The manufacturer recommends that caution be used if administered to a nursing woman.
- High Risk for Complications and Recommended for Treatment per CDC:
- Children < 2 yo
- Adults > 65 yo
- Chronic Pulmonary Disease including Asthma
- Cardiovascular disease (excluding hypertension only)
- Renal, hepatic, hematological, and metabolic disorders (including sickle cell, diabetes)
- Neurological and Neurodevelopmental disorders (brain disorders, spinal cord, peripheral nerve disorders, cerebreal palsy, epilepsy, stroke, MR, developmental delay, muscular dystrophy)
- Immunosuppressed including on HAART
- Pregnant or Postpartum (2 weeks after delivery)
- <19 yo on long term aspirin
- American Indians/Alaskan natives
- Morbid Obesity (BMI >= 40)
- Nursing home or chronic care facility residents.
Renal Dosing
- CrCl >30 to 60 mL/minute: 30mg BID for 5 days
- CrCl >10 to 30 mL/minute: 30mg qday for 5 days
- ESRD not undergoing dialysis: Use is not recommended (efficacy in ESRD has not been established.)
Hepatic Dosing
- efficacy in hepatic impairment has not been established
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- dysrhythmia
- erythema multiforme/TEN/SJS
- GI bleed, hepatitis
- seizure, delirium
Common
- abdominal pain, nausea/vomiting
Pharmacology
- Half-life:
- Metabolism:
- Excretion:
Mechanism of Action
- inhibits viral neuroaminidase→ interferes with viral particle release
Comments
- Influenza
- Shortens duration of illness by 16.8 hrs while NNTH (number needed to harm) was 28 in regards to causing nausea and vomiting, HA, and renal and psych syndromes[1]
- Greatest benefit if within 48hrs of symptom onset[2]
- However, may be beneficial up to 4-5 days, including in pregnant patients
- Early treatment of hospitalized patients can reduce death
See Also
References
- ↑ Jefferson T, et al. Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. BMJ. 2014; 348:g2545.
- ↑ CDC Guidelines. 2015-2016. http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm
