JAMA Neurol

New evidence challenges neuropsychiatric concerns over oseltamivir in children

August 7, 2025

Study details: This large retrospective cohort study analyzed data from 692,295 children aged 5 to 17 enrolled in Tennessee Medicaid between 2016 and 2020. Researchers examined the incidence of serious neuropsychiatric events across five exposure groups: untreated influenza, treated influenza, posttreatment, prophylaxis, and no exposure. Primary outcome: hospitalization for a neuropsychiatric event, assessed using a validated algorithm.

Results: During 151,401 influenza episodes, oseltamivir was dispensed in 66.7% of cases. Compared with untreated influenza, oseltamivir treatment was associated with a 47% lower risk of serious neuropsychiatric events (95% confidence interval [CI], 0.33–0.88), with even lower risk during the posttreatment period (incidence rate ratio, 0.42). Children receiving prophylactic oseltamivir had event rates similar to those with no influenza exposure. Adverse events were more strongly linked to influenza itself than to antiviral treatment.

Clinical impact: These findings challenge longstanding concerns about oseltamivir’s neuropsychiatric safety in children. Instead, they support its use as a protective measure against flu-related neurologic and psychiatric complications—reassuring clinicians and caregivers about its role in pediatric influenza management.

Source:

Antoon JW, et al. (2025, August 4). JAMA Neurol. Influenza With and Without Oseltamivir Treatment and Neuropsychiatric Events Among Children and Adolescents. https://pubmed.ncbi.nlm.nih.gov/40758339/