Medications & Antivirals

• What are antivirals and what are their benefits? Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that can be used for prevention or treatment of flu viruses. More…
  
  
• Which antivirals may be effective for H1N1? Two types of antivirals, Oseltamivir (TAMIFLU®) and Zanamivir (RELENZA®) may be effective against the H1N1 flu. In addition, PERAMIVIR IV has been authorized to treat certain patients. More…
  
  
• What antivirals can be given to my child? More…
  
  
• There have been isolated reports of small clusters of patients with an Oseltamivir (TAMIFLU®)-resistant H1N1 virus. More...
  
  
• H1N1 clinical and antiviral guidance is currently available. More…
  
  
• States officials are asked to closely monitor possible price gouging by private providers for antivirals, vaccines, and vaccine administrations. More...
  
  

What are Antivirals?

• Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that can be used to treat H1N1 (Swine) flu, or to prevent infection with H1N1 flu viruses. These medications must be prescribed by a health care professional.
  
  
• If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. The sooner a sick person is treated with an antiviral, the greater effect it will have on the patient’s recovery.
  
  
• Influenza antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with influenza. When used to prevent the flu, antiviral drugs are about 70% to 90% effective.
  
  
• There are four influenza antiviral drugs approved for use in the United States (oseltamivir, zanamivir, amantadine and rimantadine). Among these, Oseltamivir (TAMIFLU®) and zanamivir (RELENZA®) are effective in treating the 2009 H1N1 flu. A fifth drug, PERAMIVIR IV, has been authorized under an Emergency Use Authorization (EUA) to treat certain patients with suspected or confirmed 2009 H1N1 influenza virus infection.
  
  More on the Benefits of Antiviral Drugs
  
  Factsheet on Antiviral Drugs

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Antivirals and H1N1

• Clinicians should consider treating any person with confirmed or suspected H1N1 flu with an antiviral drug. Visit: Interim Guidance on Antiviral Recommendations.
  
  
• Oseltamivir (TAMIFLU®) and zanamivir (RELENZA®) have shown to be effective in treating the 2009 H1N1 flu. In addition, PERAMIVIR IV, has been authorized under an Emergency Use Authorization (EUA) to treat certain patients with suspected or confirmed 2009 H1N1 influenza virus infection.
  

General information on Oseltamivir (TAMIFLU®), Zanamivir (RELENZA®) and Peramivir.

General Information on Oseltamivir (TAMIFLU®)	General Information on Zanamivir (RELENZA®)
Oseltamivir (TAMIFLU®) is approved to both treat and prevent influenza A and B virus infection.	Zanamivir (Relenza ®) is approved to treat and, in some cases, prevent influenza A and B virus infection.
Oseltamivir (TAMIFLU®) is effective in people 1 year of age and older.	Zanamivir (Relenza ®) is effective in people 7 years and older and can prevent influenza A and B virus infection in people 5 years and older.
Oseltamivir (TAMIFLU®) comes in capsule form and in liquid form that can be measured for proper dosage.	Zanamivir (Relenza ®) is packaged in a medicine disk called a Rotadisk® and is inhaled by mouth using a delivery device called a Diskhaler®.
What are the possible side effects from taking TAMIFLU®? The most common side effects of TAMIFLU® are nausea and vomiting. These are not usually severe and usually happen in the first 2 days of treatment. More information and recommended dosage, side effects and warnings (PDF- 63.4 KB)	What are the possible side effects from taking Relenza ®? People should be aware of the risk of increased difficulty breathing, especially among people with a history of underlying breathing problems. If patients have increased difficulty breathing, they should stop Relenza and get medical attention right away. More information and recommended dosage, side effects and warnings (PDF - 28.1 KB)

General Information on PERAMIVIR IV

Peramivir IV is an experimental drug, used to treat certain people in the hospital with 2009 H1N1. Specifically, Peramivir IV is authorized for the following patients who are admitted to a hospital: Adult patients for whom therapy with an IV agent is clinically appropriate, based upon one or more of the following reasons: patient is not responding to either oral or inhaled antiviral therapy, or drug delivery by a route other than IV (e.g. enteral oseltamivir or inhaled zanamivir) is not expected to be dependable or is not feasible, or the clinician judges IV therapy is appropriate due to other circumstances. Pediatric patients for whom an IV agent is clinically appropriate because: patient not responding to either oral or inhaled antiviral therapy, or drug delivery by a route other than IV (e.g. enteral oseltamivir or inhaled zanamivir) is not expected to be dependable or is not feasible Peramivir IV is given to you through a vein (intravenous or IV) one time each day for 5 days or more depending on what your health care provider thinks is best for you. What are the possible side effects from taking Peramivir IV? Possible side-effects include diarrhea, nausea, vomiting and a decrease in white blood cell count. Antiviral Treatment Options, including Intravenous Peramivir, for Treatment of Influenza in Hospitalized Patients for the 2009-2010 Season

        Fact Sheet for Patients and Parents/Caregivers (PDF - 29.1 KB)

        Fact Sheet for Patients and Parents/Caregivers - Spanish (PDF-29.1 KB) 

General Information on Amantadine	General Information on Rimantadine
Amantadine is not effective against H1N1 flu.	Rimantadine is not effective against H1N1 flu.

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Antiviral Medications and Children

If your child gets sick, antiviral drugs can make the illness milder and make him or her feel better faster. They may also prevent serious influenza complications. Most people do not need these antiviral drugs to fully recover from the flu.

• Children younger than 5 years old and children with chronic medical conditions, such as asthma and diabetes, might benefit from antiviral medications. Ask the doctor about any special treatment requirements.
• Even if the child is feeling a little better, he or she should continue taking antiviral medication as directed by the doctor.

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Reports of Oseltamivir-Resistant H1N1 Virus

There have been isolated reports of small clusters of patients with an Oseltamivir (TAMIFLU®)-resistant H1N1 virus in late 2009. Reports have been sporadic and infrequent, with no conclusive evidence that Oseltamivir-resistant H1N1 viruses are circulating within communities or worldwide.

The original reported clusters occurred in a single ward in a hospital, and both involved patients whose immune systems were severely compromised or suppressed. More information from the World Health Organization regarding immunocompromised hospital patients and Oseltamivir resistance

As of September 25, 2009, the World Health Organization has indicated that person-to-person transmission of an Oseltamivir (TAMIFLU®)-resistant virus has not been conclusively demonstrated. According to WHO, no evidence suggests that Oseltamivir (TAMIFLU®)-resistant viruses are causing a different or more severe form of H1N1 illness to date.

In addition, antiviral resistance has been tested in the United States and the results reported to CDC. The results have been summarized in the CDC, FluView Influenza Week 47 Report.

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Guidance for Antiviral Drugs and the Flu

• The following H1N1 clinical and antiviral guidance is currently available:
  • Questions and Answers for Health Care Providers: Renal Dosing and Administration Recommendations for Peramivir IV (PDF - 22 KB)
  • Quick Facts for Clinicians on Antiviral Treatments for 2009 H1N1
    
  • Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
    
    
  • Questions and Answers: Use of Antiviral Medicines for the Treatment and Prevention of Flu among Women who are Pregnant or Postpartum for the 2009-2010 Season
    
    
  • Clinicians Considering the Use of Peramivir IV
    
    
  • Emergency Use Authorization of Peramivir IV
    
    
  • Antiviral Treatment Options, including Intravenous Peramivir, for Treatment of Influenza in Hospitalized Patients for the 2009-2010 Season
    
    
  • Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season
    
    
  • Interim Guidance for the Detection of Novel Influenza A Virus Using Rapid Influenza Diagnostic Tests
    
    
  • Interim Antiviral Guidance for 2008-09
    
    
  • Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak
    
    
  • Dosage, Administration, and Storage
    
    
  • Antiviral Safety Information
    
    
  • CDC Guidelines for Large-Scale Influenza Vaccination Clinic Planning
    
    
  • Influenza (Flu) Antiviral Drugs and Related Information - FDA
    
    

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Price Gouging

Letter to Governors (PDF - 212 KB) (Office of the Secretary, U.S. Department of Health and Human Services and Attorney General, U.S. Department of Justice)
This document asks all governors to monitor possible incidences of private providers charging excessive fees for antivirals, vaccines, or vaccine administration.

Letter to Attorney Generals (PDF - 205 KB) (Office of the Secretary, U.S. Department of Health and Human Services and Attorney General, U.S. Department of Justice)
This document asks all state attorney generals to monitor possible incidences of private providers charging excessive fees for antivirals, vaccines, or vaccine administration.

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Videos and Podcasts

• • Antiviral Drugs for the 2009-2010 Influenza Season - Podcast for Clinicans
    (7:04 | 10/19/2009 | CDC)
    This podcast discusses the use of antiviral drugs for the treatment and prevention of influenza, including 2009 H1N1, during the 2009-2010 influenza season.

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