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Antivirals, Influenza


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Oseltamivir phosphate(Tamiflu ) [1.4]
Antiviral, neuraminidase inhibitor. Oseltamivir interferes with host cell release of complete viral particles. M.W. 410.4

Adults

  • Treatment of influenza
  • (13 years and older)
    75-mg capsule orally twice per day for 5 days
  • Chemoprophylaxis of influenza (13 years and older)

  • 75-mg capsule once per day for 10 days after the last close contact (within 6 feet) with a person who is a confirmed, probable or suspected case of novel influenza A (H1N1) virus infection during the infectious period of the case.
    Community outbreak: 75 mg once daily for up to 6 weeks

Trivalent inactivated influenza vaccine can be administered at any time relative to use of TAMIFLU
Reduce dosage in renally impaired patients

(30, 45, 75 mg capsules; Available in blister packages of 10)

Tamiflu package insert Genentech, Inc. 12/2014 http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ee3c9555-60f2-4f82-a760-11983c86e97b
https://pubchem.ncbi.nlm.nih.gov/compound/78000

Breast feeding "Limited data indicate that oseltamivir and its active metabolite are poorly excreted into breastmilk. Maternal dosages of 150 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months. Infants over 1 year of age can receive oseltamivir directly in doses much larger than those in breastmilk." LAACTMED 12/2015


  Zanamivir ( Relenza ) [1]
Antiviral, neuraminidase inhibitor
. Prevents the release of progeny viruses from host cell surfaces and, so, further viral replication. M.W. 332.3

Adults

  • Treatment of influenza (7 years of age or older)
    10 mg (two inhalations)  twice a day for 5 days
  • Chemoprophylaxis of influenza (5 years of age or older)
    Household: 10 mg (two inhalations)  once per day for 10 days after the last close contact  (within 6 feet) with a person who is a confirmed, probable or suspected case of novel influenza A (H1N1) virus infection during the infectious period of the case.
    Community outbreak: 10 mg (two inhalations)  once per day for 28 days

Not recommended for treatment or prophylaxis of influenza in individuals with underlying airways disease (such as asthma or chronic obstructive pulmonary disease) due to risk of serious bronchospasm

(5 mg blisters of powder on a ROTADISK for oral inhalation via DISKHALER. Packaged in carton containing 5 ROTADISKs (total of 10 doses) and 1 DISKHALER inhalation device)

Relenza package insert GlaxoSmithKline LLC. 10/2013 http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d7c3bcc3-0c0d-4068-fd80-88cf54a376ef
https://pubchem.ncbi.nlm.nih.gov/compound/60855

Breast feeding

REFERENCES
 

1. Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza Centers for Disease Control and Prevention March 6, 2015. [Accessed 12/13/2015] Available from:  http://www.cdc.gov/flu/professionals/antivirals/avrec_ob.htm
2.Tanaka T, et al "Safety of neuraminidase inhibitors against novel influenza A (H1N1) in pregnant and breastfeeding women" CMAJ 2009; DOI:10.1503/cmaj.090866. Accessed 7-19-09

3. Briggs GG,Freeman RK, Yaffe SJ, Drugs in Pregnancy and Lactation 9th edition,Baltimore, MD: Williams & Wilkins,2011 p 1083 -84,1596 -1597 , 19 -23,1533 -1535
4. Wollenhaupt M, et al., . The safety of oseltamivir in pregnancy: an updated review of post-marketing data. Pharmacoepidemiol Drug Saf. 2014 Jul 4. doi: 10.1002/pds.3673. PMID:24995623
5. Xie HY, et. Al., Infant outcomes among pregnant women who used oseltamivir for treatment of influenza during the H1N1 epidemic. Am J Obstet Gynecol. 2013 Apr;208(4):293.e1-7. PMID:23333544
6.Saito S, et. al., Outcomes of infants exposed to oseltamivir or zanamivir in utero during pandemic (H1N1) 2009. Am J Obstet Gynecol. 2013 Aug;209(2):130.e1-9. PMID:24995623
7. Dunstan HJ, et. al., Pregnancy outcome following maternal use of zanamivir or oseltamivir during the 2009 influenza A/H1N1 pandemic: a national prospective surveillance study. BJOG. 2014 Jun;121(7):901-6.PMID:24602087

 
 

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