Tamiflu

Adult Dosing .

Dosage forms:  CAP: 30 mg, 75 mg; SUSPENSION: 6 mg per mL

influenza A and B (seasonal flu) tx, uncomplicated

[non-pregnant patients]

Dose: 75 mg PO bid x5 days; Start: within 48h of symptom onset; Info: may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx if immunocompromised

[pregnant patients]

Dose: 75 mg PO bid x5 days; Start: within 48h of symptom onset; Info: may consider higher dose at 105 mg PO bid; may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx if immunocompromised

influenza A and B (seasonal flu) prophylaxis

[75 mg PO qd x7 days after last known exposure]

Start: within 48h of exposure; Info: give for at least 14 days and x7 days after last known case for institutional setting outbreaks; consider pre-exposure prophylaxis if very high risk for complications and cannot receive influenza vaccine, start when influenza activity detected in community and continue for duration of influenza activity

novel influenza A tx (off-label)

[non-pregnant patients]

Dose: 75 mg PO bid x5 days; Start: ASAP after symptom onset; Info: may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx or consider combo tx with baloxavir if immunocompromised

[pregnant patients]

Dose: 75 mg PO bid x5 days; Start: ASAP after symptom onset; Info: may consider higher dose at 105 mg PO bid; may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx or consider combo tx with baloxavir if immunocompromised

novel influenza A post-exposure prophylaxis (off-label)

[75 mg PO bid x5 days after last known exposure]

Start: within 48h of exposure; Info: for patients with high-risk exposure; may consider for patients with medium-risk exposure; may extend to 10 days if ongoing exposure

renal dosing

[seasonal influenza prophylaxis]

CrCl 31-60: 30 mg qd; CrCl 11-30: 30 mg q48h; CrCl <10: avoid use

HD: 30 mg x1 then 30 mg after every other dialysis; consider supplement if next maintenance dose not due right after dialysis; PD: 30 mg x1 then 30 mg qwk; supplement not defined

[all other indications]

CrCl 31-60: 30 mg bid x5 days; CrCl 11-30: 30 mg qd x5 days; CrCl <10: avoid use

HD: 30 mg x1 then 30 mg 3x/wk after dialysis x5 days; consider supplement if next maintenance dose not due right after dialysis; PD: 30 mg x1; supplement not defined

hepatic dosing

[see below]

Child-Pugh Class A or B: no adjustment; Child-Pugh Class C: not defined

Peds Dosing .

Dosage forms:  CAP: 30 mg, 45 mg, 75 mg; SUSPENSION: 6 mg per mL

influenza A and B (seasonal flu) tx, uncomplicated

[preterm infants, <38 wk postmenstrual age (off-label)]

Dose: 1 mg/kg/dose PO bid x5 days; Start: within 48h of symptom onset; Info: may extend tx if immunocompromised

[preterm infants, 38-40 wk postmenstrual age (off-label)]

Dose: 1.5 mg/kg/dose PO bid x5 days; Start: within 48h of symptom onset; Info: may extend tx if immunocompromised

[preterm infants, >40 wk postmenstrual age (off-label)]

Dose: 3 mg/kg/dose PO bid x5 days; Start: within 48h of symptom onset; Info: may extend tx if immunocompromised

[<14 days old (off-label)]

Dose: 3 mg/kg/dose PO bid x5 days; Start: within 48h of symptom onset; Info: for full-term infants; may extend tx if immunocompromised

[14 days old-11 mo]

Dose: 3 mg/kg/dose PO bid x5 days; Start: within 48h of symptom onset; Info: for full-term infants; may extend tx if immunocompromised

[1-12 yo, <15 kg]

Dose: 30 mg PO bid x5 days; Start: within 48h of symptom onset; Info: may extend tx if immunocompromised

[1-12 yo, 15-23 kg]

Dose: 45 mg PO bid x5 days; Start: within 48h of symptom onset; Info: may extend tx if immunocompromised

[1-12 yo, 23.1-40 kg]

Dose: 60 mg PO bid x5 days; Start: within 48h of symptom onset; Info: may extend tx if immunocompromised

[1-12 yo, >40 kg]

Dose: 75 mg PO bid x5 days; Start: within 48h of symptom onset; Info: may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx if immunocompromised

[13 yo and older, non-pregnant patients]

Dose: 75 mg PO bid x5 days; Start: within 48h of symptom onset; Info: may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx if immunocompromised

[13 yo and older, pregnant patients]

Dose: 75 mg PO bid x5 days; Start: within 48h of symptom onset; Info: may consider higher dose at 105 mg PO bid; may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx if immunocompromised

influenza A and B (seasonal flu) prophylaxis

[3-11 mo (off-label)]

Dose: 3 mg/kg/dose PO qd x7 days after last known exposure; Start: within 48h of exposure; Info: for full-term infants; give for at least 14 days and x7 days after last known case for institutional setting outbreaks; consider pre-exposure prophylaxis if very high risk for complications and cannot receive influenza vaccine, start when influenza activity detected in community and continue for duration of influenza activity; not recommended in <3 mo unless situation critical

[1-12 yo, <15 kg]

Dose: 30 mg PO qd x7 days after last known exposure; Start: within 48h of exposure; Info: give for at least 14 days and x7 days after last known case for institutional setting outbreaks; consider pre-exposure prophylaxis if very high risk for complications and cannot receive influenza vaccine, start when influenza activity detected in community and continue for duration of influenza activity

[1-12 yo, 15-23 kg]

Dose: 45 mg PO qd x7 days after last known exposure; Start: within 48h of exposure; Info: give for at least 14 days and x7 days after last known case for institutional setting outbreaks; consider pre-exposure prophylaxis if very high risk for complications and cannot receive influenza vaccine, start when influenza activity detected in community and continue for duration of influenza activity

[1-12 yo, 23.1-40 kg]

Dose: 60 mg PO qd x7 days after last known exposure; Start: within 48h of exposure; Info: give for at least 14 days and x7 days after last known case for institutional setting outbreaks; consider pre-exposure prophylaxis if very high risk for complications and cannot receive influenza vaccine, start when influenza activity detected in community and continue for duration of influenza activity

[1-12 yo, >40 kg]

Dose: 75 mg PO qd x7 days after last known exposure; Start: within 48h of exposure; Info: give for at least 14 days and x7 days after last known case for institutional setting outbreaks; consider pre-exposure prophylaxis if very high risk for complications and cannot receive influenza vaccine, start when influenza activity detected in community and continue for duration of influenza activity

[13 yo and older]

Dose: 75 mg PO qd x7 days after last known exposure; Start: within 48h of exposure; Info: give for at least 14 days and x7 days after last known case for institutional setting outbreaks; consider pre-exposure prophylaxis if very high risk for complications and cannot receive influenza vaccine, start when influenza activity detected in community and continue for duration of influenza activity

novel influenza A tx (off-label)

[preterm infants, <38 wk postmenstrual age]

Dose: 1 mg/kg/dose PO bid x5 days; Start: ASAP after symptom onset; Info: may extend tx if immunocompromised

[preterm infants, 38-40 wk postmenstrual age]

Dose: 1.5 mg/kg/dose PO bid x5 days; Start: ASAP after symptom onset; Info: may extend tx if immunocompromised

[preterm infants, >40 wk postmenstrual age]

Dose: 3 mg/kg/dose PO bid x5 days; Start: ASAP after symptom onset; Info: may extend tx if immunocompromised

[<14 days old]

Dose: 3 mg/kg/dose PO bid x5 days; Start: ASAP after symptom onset; Info: for full-term infants; may extend tx if immunocompromised

[14 days old-11 mo]

Dose: 3 mg/kg/dose PO bid x5 days; Start: ASAP after symptom onset; Info: for full-term infants; may extend tx if immunocompromised

[1-12 yo, <15 kg]

Dose: 30 mg PO bid x5 days; Start: ASAP after symptom onset; Info: may extend tx or consider combo tx with baloxavir if immunocompromised

[1-12 yo, 15-23 kg]

Dose: 45 mg PO bid x5 days; Start: ASAP after symptom onset; Info: may extend tx or consider combo tx with baloxavir if immunocompromised

[1-12 yo, 23.1-40 kg]

Dose: 60 mg PO bid x5 days; Start: ASAP after symptom onset; Info: may extend tx or consider combo tx with baloxavir if immunocompromised

[1-12 yo, >40 kg]

Dose: 75 mg PO bid x5 days; Start: ASAP after symptom onset; Info: may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx or consider combo tx with baloxavir if immunocompromised

[13 yo and older, non-pregnant patients]

Dose: 75 mg PO bid x5 days; Start: ASAP after symptom onset; Info: may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx or consider combo tx with baloxavir if immunocompromised

[13 yo and older, pregnant patients]

Dose: 75 mg PO bid x5 days; Start: ASAP after symptom onset; Info: may consider higher dose at 105 mg PO bid; may consider incr. to 150 mg PO bid if hospitalized with severe disease or immunocompromised; may extend tx or consider combo tx with baloxavir if immunocompromised

novel influenza A post-exposure prophylaxis (off-label)

[3-11 mo]

Dose: 3 mg/kg/dose PO bid x7 days after last known exposure; Start: within 48h of exposure; Info: for full-term infants with high-risk exposure; may consider for full-term infants with medium-risk exposure; may extend to 10 days if ongoing exposure; not recommended in <3 mo unless situation critical

[1-12 yo, <15 kg]

Dose: 30 mg PO bid x7 days after last known exposure; Start: within 48h of exposure; Info: for patients with high-risk exposure; may consider for patients with medium-risk exposure; may extend to 10 days if ongoing exposure

[1-12 yo, 15-23 kg]

Dose: 45 mg PO bid x7 days after last known exposure; Start: within 48h of exposure; Info: for patients with high-risk exposure; may consider for patients with medium-risk exposure; may extend to 10 days if ongoing exposure

[1-12 yo, 23.1-40 kg]

Dose: 60 mg PO bid x7 days after last known exposure; Start: within 48h of exposure; Info: for patients with high-risk exposure; may consider for patients with medium-risk exposure; may extend to 10 days if ongoing exposure

[1-12 yo, >40 kg]

Dose: 75 mg PO bid x7 days after last known exposure; Start: within 48h of exposure; Info: for patients with high-risk exposure; may consider for patients with medium-risk exposure; may extend to 10 days if ongoing exposure

[13 yo and older]

Dose: 75 mg PO bid x7 days after last known exposure; Start: within 48h of exposure; Info: for patients with high-risk exposure; may consider for patients with medium-risk exposure; may extend to 10 days if ongoing exposure

renal dosing

[seasonal influenza prophylaxis]

renal impairment: not defined, consider adult renal dosing for guidance

HD/PD: not defined, consider adult renal dosing for guidance

[all other indications, <1 yo]

renal impairment: not defined

HD/PD: not defined

[all other indications, 1 yo and older]

CrCl 31-60: give 50% usual dose q12h; CrCl 11-30: give 50% usual dose q24h; CrCl <10: not defined

HD: 7.5 mg x1 after dialysis if wt <16 kg; 10 mg x1 after dialysis if wt 16-23 kg; 15 mg x1 after dialysis if wt 24-40 kg; 30 mg x1 then 30 mg 3x/wk after dialysis if wt >40 kg; consider supplement if next maintenance dose not due right after dialysis; PD: give 50% usual dose x1; supplement not defined

hepatic dosing

[see below]

Child-Pugh Class A or B: no adjustment; Child-Pugh Class C: not defined

Contraindications / Cautions .

com.epocrates.rxweb.beans.StringCollection@6ff10e2c
• hypersensitivity to drug or ingredient
• CrCl <10 (patients not on hemodialysis or peritoneal dialysis)
• caution: renal impairment
• caution: fructose intolerance, hereditary (PO suspension form)

Adverse Reactions .

Serious Reactions

com.epocrates.rxweb.beans.StringCollection@754c830e
• delirium
• behavioral disturbance
• self-injury, including fatal
• anaphylaxis
• Stevens-Johnson syndrome
• toxic epidermal necrolysis
• erythema multiforme

Common Reactions

com.epocrates.rxweb.beans.StringCollection@90224
• nausea
• vomiting
• diarrhea
• headache
• pain
• diaper rash

Pregnancy/Lactation .

Pregnancy

Clinical Summary

may use during pregnancy; consider incr. tx dose to 105 mg bid or if severe disease, incr. to 150 mg bid; drug of choice for influenza treatment during pregnancy, especially in patients up to 2wk postpartum; drug of choice for influenza prophylaxis during pregnancy; risk of embryo-fetal toxicity not expected based on human data

Lactation

Clinical Summary

may use while breastfeeding; no known risk of infant harm based on limited human data and drug properties; no human data available to assess effects on milk production

Pharmacology .

com.epocrates.rxweb.beans.DrugOtherInfoBean@44fbe39c

Metabolism: for oseltamivir: liver; CYP450: none

Excretion: for oseltamivir: urine primarily, feces <20%; Half-life: 6-10h

Subclass: Influenza (Flu)

Mechanism of Action
for oseltamivir: prodrug converted to oseltamivir carboxylate, which inhibits influenza neuraminidase

Formulary .

No Formulary Selected

Manufacturer/Pricing .

Manufacturer: Genentech, Inc.

com.epocrates.rxweb.beans.DrugOtherInfoBean@3468f216

DEA/FDA: Rx

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