lPATIENT AND CARER ADVICEPatients or carers should be
told to observe the oral solution for crystallisation; the
bottle should be replaced if more than a thin layer of
crystals form (doses should continue to be taken at the
normal time until the bottle is replaced).
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Oral solution
CAUTIONARY AND ADVISORY LABELS5, 21
EXCIPIENTS:May contain Vitamin e
▶Aptivus(Boehringer Ingelheim Ltd)
Tipranavir 100 mg per 1 mlAptivus 100 mg/ml oral solution sugar-
free| 95 mlP£ 129. 65
Capsule
CAUTIONARY AND ADVISORY LABELS5, 21
EXCIPIENTS:May contain Ethanol
▶Aptivus(Boehringer Ingelheim Ltd)
Tipranavir 250 mgAptivus 250 mg capsules| 120 capsuleP
£ 441. 00
ANTIVIRALS›OTHER
Maraviroc
lDRUG ACTIONMaraviroc is an antagonist of the CCR 5
chemokine receptor.
lINDICATIONS AND DOSE
CCR 5 -tropic HIV infection in combination with other
antiretroviral drugs in patients previously treated with
antiretrovirals
▶BY MOUTH
▶Child:(consult local protocol)lUNLICENSED USENot licensed for use in children.
lCAUTIONSCardiovascular disease
lINTERACTIONS→Appendix 1 : maraviroc
lSIDE-EFFECTS
▶Common or very commonAbdominal pain.anaemia.
appetite decreased.asthenia.depression.diarrhoea.
flatulence.headache.insomnia.nausea.rash
▶UncommonHyperbilirubinaemia.increased risk of
infection.myopathy.postural hypotension.proteinuria.
renal failure.seizure
▶Rare or very rareAngina pectoris.granulocytopenia.
hepatic disorders.metastases.neoplasms.pancytopenia.
severe cutaneous adverse reactions (SCARs)
▶Frequency not knownFever.hypersensitivity.immune
reconstitution inflammatory syndrome.organ dysfunction
.osteonecrosis
SIDE-EFFECTS, FURTHER INFORMATIONOsteonecrosis has
been reported in patients with advanced HIV disease or
following long-term exposure to combination
antiretroviral therapy.
lPREGNANCYManufacturer advises use only if potential
benefit outweighs risk—toxicity inanimalstudies.
lHEPATIC IMPAIRMENTManufacturer advises caution in
hepatic impairment, including patients with chronic
hepatitis B or C.
lRENAL IMPAIRMENTIf estimated glomerularfiltration rate
less than 80 mL/minute/ 1. 73 m^2 , consult product
literature.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
▶Celsentri(ViiV Healthcare UK Ltd)
Maraviroc 25 mgCelsentri 25 mg tablets| 120 tabletP£ 147. 09
Maraviroc 75 mgCelsentri 75 mg tablets| 120 tabletP£ 441. 27
Maraviroc 150 mgCelsentri 150 mg tablets| 60 tabletP
£ 519. 14
Maraviroc 300 mgCelsentri 300 mg tablets| 60 tabletP
£ 519. 146.5 Influenza
Influenza
Management
Oseltamivir p. 428 and zanamivir p. 429 are most effective
for the treatment of influenza if started within a few hours of
the onset of symptoms; oseltamivir is licensed for use within
48 hours of thefirst symptoms while zanamivir is licensed
for use within 36 hours of thefirst symptoms. In otherwise
healthy individuals they reduce the duration of symptoms by
about 1 – 1. 5 days.
Oseltamivir and zanamivir are licensed for post-exposure
prophylaxis of influenza when influenza is circulating in the
community. Oseltamivir should be given within 48 hours of
exposure to influenza while zanamivir should be given
within 36 hours of exposure to influenza. However, in
children with severe influenza or in those who are
immunocompromised, antivirals may still be effective after
this time if viral shedding continues [unlicensed use].
Oseltamivir and zanamivir are also licensed for use in
exceptional circumstances (e.g. when vaccination does not
cover the infecting strain) to prevent influenza in an
epidemic.
There is evidence that some strains of influenza A virus
have reduced susceptibility to oseltamivir, but may retain
susceptibility to zanamivir. Resistance to oseltamivir may be
greater in severely immunocompromised children.
Zanamivir should be reserved for patients who are severely
immunocompromised, or when oseltamivir cannot be used,
or when resistance to oseltamivir is suspected. For those
unable to use the dry powder for inhalation, zanamivir is
available as a solution that can be administered by nebuliser
or intravenously [unlicensed].
Information on pandemic influenza, avian influenza, and
swine influenza may be found atwww.gov.uk/phe.
Immunisation against influenza is recommended for
persons at high risk, and to reduce transmission of infection.Oseltamivir in children under 1 year of age
Data on the use of oseltamivir in children under 1 year of age
is limited. Furthermore, oseltamivir may be ineffective in
neonates because they may not be able to metabolise
oseltamivir to its active form. However, oseltamivir can be
used (under specialist supervision) for the treatment or post-
exposure prophylaxis of influenza in children under 1 year of
age. The Department of Health has advised (May 2009 ) that
during a pandemic, treatment with oseltamivir can be
overseen by healthcare professionals experienced in
assessing children.
Amantadine hydrochloride is licensed for prophylaxis and
treatment of influenza A in children over 10 years of age, but
it is no longer recommended.BNFC 2018 – 2019 Influenza 427
Infection5