peramivir (Rx)

Brand and Other Names:Rapivab
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

IV solution

  • 200mg/20mL (10mg/mL)
  • Dilute to recommended final volume before administering

Influenza

Indicated for treatment of acute uncomplicated influenza in patients who have been symptomatic for ≤2 days

600 mg IV as a single dose

Dosage Modifications

Renal impairment

  • CrCl ≥50 mL/min: No dosage adjustment necessary
  • CrCl 30-49 mL/min: 200 mg IV as a single dose
  • CrCl 10-29 mL/min: 100 mg IV as a single dose
  • Hemodialysis: Administer after dialysis

Dosing Considerations

Limitations of use

  • Efficacy based on clinical trials of naturally occurring influenza in which the predominant influenza infections were influenza A virus; a limited number of subjects infected with influenza B virus were enrolled
  • Influenza viruses change over time and emergence of resistance substitutions could decrease drug effectiveness
  • Efficacy not established in patients with serious influenza requiring hospitalization

Dosage Forms & Strengths

IV solution

  • 200mg/20mL (10mg/mL)
  • Dilute to recommended final volume according to age and weight before administering

Influenza

Indicated for treatment of acute uncomplicated influenza in patients aged ≥6 months who have been symptomatic ≤2 days

<6 months: Safety and efficacy not established

≥6 months

6 months to 12 years: 12 mg/kg IV as a single dose; not to exceed 600 mg/dose

≥13 years: 600 mg IV as a single dose

Dosage Modifications

Renal impairment

  • 6 months to 2 years
    • CrCl >50 mL/min: No dosage adjustment necessary
    • CrCl <50 mL/min: Data are not available
  • 2-12 years
    • CrCl >50 mL/min: No dosage adjustment necessary
    • CrCl 30-49 mL/min: 4 mg/kg IV as a single dose
    • CrCl 10-29 mL/min: 2 mg/kg IV as a single dose
  • ≥13 years
    • CrCl >50 mL/min: No dosage adjustment necessary
    • CrCl 30-49 mL/min: 200 mg IV as a single dose
    • CrCl 10-29 mL/min: 100 mg IV as a single dose

Dosing Considerations

Limitations of use

  • Efficacy based on clinical trials of naturally occurring influenza in which the predominant influenza infections were influenza A virus; a limited number of subjects infected with influenza B virus were enrolled
  • Influenza viruses change over time and emergence of resistance substitutions could decrease drug effectiveness
  • Efficacy not established in patients with serious influenza requiring hospitalization
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Interactions

Interaction Checker

and peramivir

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    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (0)

              Serious - Use Alternative (1)

              • influenza virus vaccine quadrivalent, intranasal

                peramivir decreases effects of influenza virus vaccine quadrivalent, intranasal by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid live attenuated influenza vaccine within 2 wk before or 48 hr after administration of neuraminidase inhibitors; inactivated influenza vaccine can be administered at any time relative to use of neuraminidase inhibitors.

              Monitor Closely (29)

              • acyclovir

                acyclovir increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • adefovir

                adefovir increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • aldesleukin

                aldesleukin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • amikacin

                amikacin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • amphotericin B deoxycholate

                amphotericin B deoxycholate increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • carboplatin

                carboplatin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • cidofovir

                cidofovir increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • cisplatin

                cisplatin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • clofarabine

                clofarabine increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • contrast media (gadolinium)

                contrast media (gadolinium) increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • contrast media (iodinated)

                contrast media (iodinated) increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • flucytosine

                flucytosine increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • foscarnet

                foscarnet increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • ganciclovir

                ganciclovir increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • gentamicin

                gentamicin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • ifosfamide

                ifosfamide increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • immune globulin IV (IGIV)

                immune globulin IV (IGIV) increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • ioversol

                ioversol increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • neomycin PO

                neomycin PO increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • oxaliplatin

                oxaliplatin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • pemetrexed

                pemetrexed increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • penicillamine

                penicillamine increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • pentamidine

                pentamidine increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • streptomycin

                streptomycin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • tacrolimus

                tacrolimus increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • tenofovir DF

                tenofovir DF increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • tobramycin

                tobramycin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • vancomycin

                vancomycin increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              • zoledronic acid

                zoledronic acid increases levels of peramivir by decreasing renal clearance. Use Caution/Monitor. Caution when peramivir coadministered with nephrotoxic drugs.

              Minor (0)

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                Adverse Effects

                1-10%

                Adults

                • Diarrhea (8%)
                • Neutrophils <1 x 109/L (8%)
                • Increased serum glucose (>160 mg/dL) (5%)
                • Creatine phosphokinase (≥6 xULN) (5%)
                • Constipation (4%)
                • Insomnia (3%)
                • AST and ALT increased (3%)
                • Hypertension (2%)

                Aged 6 months to 17 years

                • Generally, similar to adults, except for following
                • Vomiting (3%)
                • Proteinuria (3%)

                Postmarketing Reports

                Dermatologic: Stevens-Johnson syndrome, exfoliative dermatitis, rash

                General disorders and administration site conditions: Anaphylactic/anaphylactoid reactions

                Psychiatric: Abnormal behavior, hallucination

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                Warnings

                Contraindications

                Known serious hypersensitivity or anaphylaxis to peramivir or any component of the product; severe allergic reactions have included anaphylaxis, erythema multiforme, and Stevens-Johnson Syndrome

                Cautions

                Serious skin reactions reported including erythema multiforme and Stevens-Johnson syndrome; discontinue and initiate appropriate treatment

                Influenza can be associated with neurologic and behavioral symptoms including hallucinations, delirium, and abnormal behavior, in some cases resulting in fatal outcomes; postmarketing surveillance has reported delirium and abnormal behavior leading to injury in patients receiving neuraminidase inhibitors

                Serious bacterial infections may begin with influenza-like symptoms or may coexist with or occur as complications during the course of influenza; peramivir has not been shown to prevent such complications

                Drug interaction overview

                • Inactivated influenza vaccine: May administered at any time relative to use of peramivir
                • Live attenuated influenza vaccine (LAIV; intranasal): Antiviral drugs may inhibit viral replication and reduce vaccine efficacy; avoid LAIV within 2 weeks before or 48 hr after peramivir unless medically indicated
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                Pregnancy & Lactation

                Pregnancy

                Limited available data with use in pregnant women are insufficient to determine a drug- associated risk of adverse developmental outcomes; there are risks to the mother and fetus associated with influenza in pregnancy

                Animal studies

                • Administered during organogenesis in rats
                  • Dose 8 x human recommended dose
                  • Single IV bolus injection: No adverse effects observed
                  • Continuous IV infusion: Reduced renal papilla and dilated ureters were observed
                • Administered in rabits
                  • Administration of drug during organogenesis at exposures 8 times those in humans at recommended dose resulted in developmental toxicity (abortion or premature delivery) at a maternally toxic dose

                Lactation

                There are no data on presence of drug in human milk, effects on breastfed infant, or on milk production; drug is present in rat milk limited clinical data during lactation preclude a clear determination of risk of therapy to an infant during lactation; therefore, developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

                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.

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                Pharmacology

                Mechanism of Action

                Elicits antiviral activity by inhibiting influenza virus neuraminidase, an enzyme that releases viral particles from the plasma membrane of infected cells

                Absorption

                Peak plasma concentration

                • 6 months to <2 years: 38,000 ng/mL
                • 2 to <7 years: 47,400 ng/mL
                • 7 to <13 years: 61,200 ng/mL
                • 13 to <18 years: 51,500 ng/mL
                • Adults: 45,700 ng/mL

                AUC

                • 6 months to <2 years: 46,200 ng⋅h/mL
                • 2 to <7 years: 62,700 ng⋅h/mL
                • 7 to <13 years: 76,300 ng⋅h/mL
                • 13 to <18 years: 65,500 ng⋅h/mL
                • Adults: 68,500 ng⋅h/mL

                Distribution

                Protein bound: <30%

                Vd: 12.56 L

                Metabolism

                Not significantly metabolized

                It is not a substrate for CYP enzymes, does not affect glucuronidation, and is not a substrate or inhibitor of P-gp

                Elimination

                Half-life: 20 hr (single 600-mg IV dose)

                Clearance: ~90% (renal)

                Excretion: Urine ~90%

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                Administration

                IV Compatibilities

                0.9% NaCl

                0.45% NaCl

                D5W

                Lactated Ringer solution

                Compatible with materials commonly used for administration (eg, PVC bags, PVC-free bags, polypropylene syringes, polyethylene tubing)

                IV Preparation

                Contains no preservatives or bacteriostatic agents; do not use if seal over vial opening is broken or missing

                Visually inspect vial for particulate matter and discoloration

                Dilute appropriate dose in 0.9% or 0.45% NaCl, D5W, or lactated Ringer solution to final concentration of 1-6 mg/mL as recommended by age and weight

                Maximum infusion volume by age and weight

                • Infants aged 6 months to 1 year (any weight): 25 mL

                Adults and pediatric patients aged ≥1 yr

                • 5 kg to <10 kg: 25 mL
                • 10 kg to <15 kg: 50 mL
                • 15 kg to <20 kg: 75 mL
                • ≥20 kg: 100 mL

                IV Administration

                Administer IV over 15-30 minutes

                Do not mix or infuse with other IV medications

                Storage

                Unopened vials: Store in original cartons at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F)

                Diluted solution: Administer immediately or refrigerate at 2-8°C (36-46°F) for up to 24 hr

                If refrigerated, allow diluted solution to reach room temperature then administer immediately

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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Rapivab (PF) intravenous
                -
                200 mg/20 mL (10 mg/mL) vial
                Rapivab (PF) intravenous
                -
                200 mg/20 mL (10 mg/mL) vial

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

                Patient Education
                peramivir (PF) intravenous

                PERAMIVIR - INJECTION

                (per-AM-i-vir)

                COMMON BRAND NAME(S): Rapivab

                USES: Peramivir is used to treat symptoms caused by the flu virus (influenza) if you have had symptoms for 2 days or less. It helps make the symptoms (such as stuffy nose, cough, sore throat, fever/chills, aches, tiredness) less severe and shortens the recovery time by about 1 to 2 days.This medication works by stopping the flu virus from growing. It is not a substitute for the flu vaccine. (See also Notes section.)

                HOW TO USE: This medication is given as a single dose as directed by your doctor. It is given slowly into a vein, usually over 15 to 30 minutes. The dosage is based on your medical condition, age, and response to treatment. Children's dosage is also based on weight.Tell your doctor if your condition persists or worsens, or if new symptoms appear.

                SIDE EFFECTS: This drug usually has no side effects. If you have any unusual effects, contact your doctor or pharmacist promptly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.The flu itself or peramivir may rarely cause serious mental/mood changes. This may be more likely in children. Tell your doctor right away of any signs of unusual behavior, including: confusion, hallucinations, agitation, self-injury.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

                PRECAUTIONS: Before using peramivir, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease (including dialysis treatment).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

                DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Tell your doctor if you have received flu vaccine in the nose within 2 weeks before treatment with this medication. This medication may lower your protection from flu vaccine given in the nose. Wait at least 2 days after ending treatment with this medication before receiving flu vaccine given in the nose.

                OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

                NOTES: Do not share this medication with others.This medication is not a substitute for the flu vaccine. Talk with your doctor about the risks and important benefits of getting a yearly flu shot.

                MISSED DOSE: Not applicable.

                STORAGE: Not applicable. This medication is given in a hospital or clinic and will not be stored at home.

                Information last revised September 2017. Copyright(c) 2021 First Databank, Inc.

                IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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                Formulary

                FormularyPatient Discounts

                Adding plans allows you to compare formulary status to other drugs in the same class.

                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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