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oseltamivir (Rx)Brand and Other Names:Tamiflu

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 30mg
  • 45mg
  • 75mg

powder for oral suspension

  • 6mg/mL
more...

Influenza A and B Prophylaxis

75 mg PO qDay for at least 10 days

Dosing considerations

  • Initiate within 48 hours of exposure
  • For community outbreak, may administer for up to 6 weeks

Influenza A and B Treatment

75 mg PO q12hr x5 days

Dosing considerations

  • Initiate within 48 hours of influenza symptom onset

H1N1 Influenza A (Swine Flu) Prophylaxis (Off-label)

75 mg PO qDay

Dosing considerations

  • Postexposure prophylaxis: Initiate within 7 days of exposure and continue for at least 10 days
  • Preexposure prophylaxis (community outbreak): Initiate during potential exposure period and continue for 10 days after last known exposure

H1N1 Influenza A (Swine Flu) Treatment (Off-label)

75 mg PO q12hr x5 days

Dosing considerations

  • Initiate within 48 hours of influenza symptom onset

Dosing Modifications

Renal impairment (CrCl 10-30 mL/min)

  • Prophylaxis: 75 mg PO qOD, OR 30 mg PO qDay
  • Treatment: 75 mg PO qDay x5 days

Renal impairment (CrCl <10 mL/min)

  • Administer with caution

Dosage Forms & Strengths

capsule

  • 30mg
  • 45mg
  • 75mg

powder for oral suspension

  • 6mg/mL
more...

Influenza A and B Prophylaxis

<1 year: Safety and efficacy not established for prophylaxis

≥1 year

  • <15 kg: 30 mg PO qDay x10 days
  • 15-23 kg: 45 mg PO qDay x10 days
  • 23-40 kg: 60 mg PO qDay x10 days
  • >40 kg: 75 mg PO qDay x10 days

Dosing considerations

  • Start within 2 days of exposure

Influenza A and B Treatment

<2 weeks: Safety and efficacy not established for treatment

Aged 2 weeks to <1 year

  • 3 mg/kg PO BID x5 days

≥1 year

  • <15 kg: 30 mg PO q12hr x5 days
  • 15-23 kg: 45 mg PO q12hr x5 days
  • 23-40 kg: 60 mg PO q12hr x5 days
  • >40 kg: 75 mg PO q12hr x5 days

Dosing considerations

  • Start within 24-48 hours of symptom onset

H1N1 Influenza A (Swine Flu) Prophylaxis (Off-label)

<1 year

  • <3 months: Data limited; not recommended unless situation judged critical
  • 3-5 months: 20 mg PO qDay x10 days
  • 6-11 months: 25 mg PO qDay x10 days

≥1 year

  • <15 kg: 30 mg PO qDay x10 days
  • 15-23 kg: 45 mg PO qDay x10 days
  • 23-40 kg: 60 mg PO qDay x10 days
  • >40 kg: Administer as in adults

H1N1 Influenza A (Swine Flu) Treatment (Off-label)

Acute illness and age <1 year

  • <3 months: 12 mg PO q12hr x5 days
  • 3-5 months: 20 mg PO q12hr x5 days
  • 6-11 months: 25 mg PO q12hr x5 days

Acute illness and age ≥1 year

  • <15 kg: 30 mg PO q12hr x5 days
  • 15-23 kg: 45 mg PO q12hr x5 days
  • 23-40 kg: 60 mg PO q12hr x5 days
  • >40 kg: Administer as in adults
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Interactions

Interaction Checker

oseltamivir and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Abdominal pain

            Conjunctivitis

            Ear disorder

            Epistaxis

            Insomnia

            Nausea

            Vomiting

            Vertigo

            <1%

            Aggravation of diabetes

            Anemia

            Arrhythmia

            Confusion

            Delirium

            Hemorrhagic colitis

            Hepatitis

            Humerus fracture

            Peritonsillar abscess

            Pneumonia

            Pseudomembranous colitis

            Pyrexia

            Rash

            Seizure

            Transaminases increased

            Toxic epidermal necrolysis

            Unstable angina

            Swelling of face or tongue

            Postmarketing Reports

            Hypothermia

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            Warnings

            Contraindications

            Hypersensitivity

            Cautions

            Use caution in patients with chronic cardiac disease, severre hepatic impairment, renal imapairment, respiratory disease

            Most effective when used within 24-48 hr of onset of symptoms

            Age <1 year: Safety and efficacy for PROPHYLAXIS of influenza has not been established

            Oral suspension should be mixed prior to dispensing

            Safety and efficacy in immunocompromised patients not established

            Therapy is not a substitute for influenza virus vaccine

            Serious skin/hypersensitivity reactions such as Stevens-Johnson Syndrome, toxic epidermal necrolysis and erythema multiforme; discontinue therapy and initiate appropriate treatment if allergic-like reactions occur or are suspected

            Patients with influenza, including those receiving therapy, particularly pediatric patients, may be at an increased risk of confusion or abnormal behavior early in their illness, potentially fatal neuropsychiatric adverse events; monitor for signs of abnormal behavior

            Oral suspension and hereditary fructose intolerance

            • Fructose can be harmful to patients with hereditary fructose intolerance
            • One dose of 75 mg oral suspension delivers 2 g of sorbitol; this is above the daily maximum limit of sorbitol for patients with hereditary fructose intolerance, and may cause dyspepsia and diarrhea
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            Pregnancy & Lactation

            Pregnancy category: C

            Prompt use of antiviral drugs during the 2009 H1N1 influenza pandemic improved survival among severely ill pregnant women; the CDC examined reports of severe flu (resulting in death or ICU admission) in 347 pregnant women during the pandemic; only 4 women (7%) of those who died received an antiviral within 2 days of symptom onset, compared with 41% of survivors. (MMWR Sept 9, 2011;60[35]:1192-6)

            Lactation: Unknown; use caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Inhibits viral neuraminidases; stops release of virus from cells and prevents virus from crossing mucous lining of respiratory tract

            Absorption

            Bioavailability: 75%

            Peak plasma time: 2.5-6 hr

            Distribution

            Protein bound: 3% (oseltamivir carboxylase); 42% (oseltamivir)

            Vd: 23-26 L

            Elimination

            Half-life: 1-3hr (oseltamivir); 6-10 hr (oseltamivir carboxylate)

            Excretion: Feces; urine (>90% as oseltamivir carboxylate)

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            Administration

            Oral Administration

            Tablets and oral suspension may be take with or without food

            Tolerability may be enhanced if taken with food

            Emergency Preparation of Oral Suspension from 75 mg Capsules

            Instructions below are for 100 mL of 6 mg/mL suspension

            1. Place 7 mL of distilled water into a polyethyleneterephthalate (PET) or glass bottle

            2. Empty content of eight 75-mg capsules (ie, 600 mg) into bottle

            3. Gently swirl the suspension to ensure adequate wetting of the powder for at least 2 minutes

            4. Slowly add 91 mL of Ora-Sweet, cherry syrup, or simple syrup

            5. Close bottle and shake well for about 30 minutesInstruct patient to shake well before use

            Stable for 5 days at room temperature or 5 weeks refrigerated at 2-8°C (36-46°F)

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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