ANTIVIRALS›NEURAMINIDASE INHIBITORS
Oseltamivir 20-Jul-2017
lDRUG ACTIONReduces replication of influenza A and B
viruses by inhibiting viral neuraminidase.lINDICATIONS AND DOSE
Prevention of influenza
▶BY MOUTH
▶Neonate: 3 mg/kg once daily for 10 days for post-
exposure prophylaxis.▶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
Treatment of influenza
▶BY MOUTH
▶Neonate: 3 mg/kg twice daily for 5 days.▶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 dayslUNLICENSED USENot licensed for use in premature
infants.
lSIDE-EFFECTS
▶Common or very commonDyspepsia
▶UncommonSkin reactions
lPREGNANCYAlthough 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). Use only if potential benefit outweighs risk
(e.g. during a pandemic).
lBREAST FEEDINGAlthough 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. Amount probably too small to be
harmful; use only if potential benefit outweighs risk (e.g.
during a pandemic).
lRENAL IMPAIRMENTAvoid fortreatmentandpreventionif
estimated glomerularfiltration rate less than
10 mL/minute/ 1. 73 m^2.
Dose adjustmentsFortreatment,use 40 % of normal dose
twice daily if estimated glomerularfiltration rate
30 – 60 mL/minute/ 1. 73 m^2 ( 40 % of normal dose once daily
if estimated glomerularfiltration rate
10 – 30 mL/minute/ 1. 73 m^2 ).
Forprevention,use 40 % of normal dose once daily if
estimated glomerularfiltration rate30 – 60 mL/minute/ 1. 73 m^2 ( 40 % of normal dose every
48 hours if estimated glomerularfiltration rate
10 – 30 mL/minute/ 1. 73 m^2 ).
lDIRECTIONS FOR ADMINISTRATIONIf 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.
lPRESCRIBING AND DISPENSING INFORMATIONFlavours of
oral liquid formulations may include tutti-frutti.
lPATIENT AND CARER ADVICE
Medicines for Children leaflet: Oseltamivir for influenza (flu)
http://www.medicinesforchildren.org.uk/oseltamivir-for-influenza
lNATIONAL FUNDING/ACCESS DECISIONS
NICE decisions
▶Oseltamivir, zanamivir, and amantadine for prophylaxis of
influenza (September 2008 )NICE TA158
Oseltamivir isnota substitute for vaccination, which
remains the most effective way of preventing illness from
influenza.
.Oseltamivir isnotrecommended 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
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 olderor
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.
http://www.nice.org.uk/guidance/ta158
▶Oseltamivir, zanamivir, and amantadine for treatment of
influenza (February 2009 )NICE TA168
Oseltamivir isnota 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 be428 Viral infection BNFC 2018 – 2019
Infection5