Detailed oseltamivir dosage information for adults and children. These renal dose adjustments may be useful for pediatric patients who weigh more than 40 kg. When a patient is initiated on crrt, antimicrobial therapy often requires adjustment to ensure adequate drug concentrations are achieved. It is therefore suggested that it is necessary to adjust oseltamivir dosage in patients with renal impairment. Renal dosage adjustment guidelines for antimicrobials. Patients under the care of a kidney specialist will be advised to contact their gp or renal unit for further advice if they develop worsening symptoms. Subjects with preexisting renal impairment creatinine clearance, 4060 mlminute received 75 mg oseltamivir twice daily. While further investigation is required in patients with high residual renal function, this subpopulation may respond better to alternative dosing regimens such as 75 mg oseltamivir prior to apd and a second dose after 48 h, or 30 mg daily for five consecutive days.
Dailymed tamiflu oseltamivir phosphate capsule tamiflu. Dosage adjustments are recommended in adult patients with moderate to severe renal impairment creatinine clearance 60 mlmin or less and for patients on dialysis. Oseltamivir dosage for treatment of influenza in adults with renal impairment17. Oseltamivir phosphate and oseltamivir carboxylate not metabolized by cyp enzymes. The information on dosage adjustments in renal impairment given in this book is based on. Conclusions in prophylactic studies oseltamivir reduces the proportion of symptomatic influenza. Oseltamivir helps shorten the time that flu symptoms such as a stuffy or runny nose, sore throat, cough, muscle or joint aches, tiredness, headache, fever, and chills last. In this case it is important to treat the infection aggressively for the first 24hrs and recheck renal function before reducing the dose accordingly. Osetamivir blocks neuraminidases on the surfaces of influenza viruses, interfering with host cell release of complete viral particles. Oseltamivir carboxylate eliminated 99% by renal excretion. Therapy should begin within 48 hours of onset of influenza symptoms. Antiviral dosage duration tables centers for disease.
In patients with negligible or low residual renal elimination, a 75 mg dose of oseltamivir produced exposures at the upper end of established safety ranges and was generally well tolerated. Prophylaxis of influenza for the prophylaxis of influenza, dose adjustment is recommended for adult patients with creatinine clearance between 10 and 60 mlmin and patients with endstage renal disease esrd undergoing hemodialysis or continuous peritoneal dialysis receiving tamiflu see clinical pharmacology 12. In patients with rapidly changing renal function i. For the treatment of acute, uncomplicated illness due to influenza a and b infection in patients symptomatic for no more than 48 hours.
Shc antimicrobial dosing guidelines in adults on renal. It works by stopping the spread of the flu virus in the body. Find patient medical information for oseltamivir oral on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. In apd patients with anuria or low residual renal elimination, a single 75 mg dose of oseltamivir produced exposures at. Tamiflu for oral suspension is the preferred formulation for patients who cannot swallow capsules.
Tamiflu reference guide for safe and effective use from the american. For patients who cannot swallow capsules, tamiflu for oral suspension is the preferred formulation. Phe seasonal influenza antiviral treatment guideline phe. Endstage renal disease esrd, not undergoing dialysis.
By oliver hsu, pharmd candidate, at the university of the pacific. Availability of lower dose oseltamivir capsules, an increased pharmacokinetic database, and a desire to align drug exposure across the spectrum of renal function prompted reassessment of oral dosing in patients with renal impairment. Tamiflu is not recommended for people with endstage renal disease esrd who are not receiving dialysis. Renal dosing treatment of influenza dose adjustment is recommended for adult patients with creatinine clearance between 10 and 60 mlmin and patients with endstage renal disease esrd undergoing hemodialysis or continuous peritoneal dialysis receiving tamiflu for the treatment of influenza. While the usual clinical dose of zanamivir may not have this effect, a higher. Side effects of oseltamivir in endstage renal failure. Oseltamivir dose reduction is recommended for patients with endstage renal disease esrd. Alternative dosing of oseltamivir for specific patient.
Use 30 mg oseltamivir dosing in patients with renal insufficiency february 2015 youll hear that this years flu vaccine is not a good match for circulating flu. Carefully twist and pull apart the tamiflu capsule, and pour the contents into the food. The information provided here on dosing in renal impairment and renal failure is intended specifically for consideration when patients have an existing history of chronic kidney disease ckd and renal failure results have been previously documented for the purpose of managing ckd. In continuous ambulatory peritoneal dialysis capd patients, the peak concentration of the active metabolite following a single 30 mg oseltamivir dose or once weekly oseltamivir was 3fold higher than in patients with normal renal function receiving the approved adult dose. The fda notes that us clinicians usually prescribe liquid medicines in milliliters ml or teaspoons, but oseltamivir is dosed in milligrams mg, and the dosing dispenser prepackaged with. However, dosing recommendations are not available for treatment or prophylaxis of influenza in these. For patients less than 1 year of age, provide an appropriate dosing device that can accurately measure and administer small volumes. In light of the high incidence of h1n1 infections in renal replacement therapy patients in brunei darussalam, an oseltamivir tamiflu prophylactic dosing regimen of 75 mg every 5 days for renal replacement therapy patients was initiated by the ministry. Dosing of oseltamivir phosphate is via the oral route, and it is not. Potential dosing errors with oseltamivir in children.
Acute renal failure, the serum creatinine levels will no longer provide a true reflection of renal function. Patients with endstage renal disease who developed h1n1 infections have an increased risk of morbidity and mortality. Dosing of oseltamivir phosphate is via the oral route, and it is not necessary to time administration with meals. The recommended oral dose of tamiflu for treatment of influenza in pediatric patients 2 weeks to less than 1. Neuraminidase inhibitor, zanamivir, relenza, oseltamivir, tamiflu. Tamiflu oseltamivir phosphate dose, indications, adverse. Adjust the tamiflu dosage in patients with moderate or severe renal impairment see dosage and administration 2. Obese patients have more functional nephrons and, because oseltamivir carboxylate undergoes renal elimination, it is cleared faster in obese patients. Linda truong, pharmd candidate, at the university of the pacific. For crcl dose for oncedaily dosing, draw a single random level 8 to 12 hours after dose given adjustments are made based on a published hartford nomogram.
Shc antimicrobial dosing guidelines in adults on renal replacement therapies these are general dosing guidelines for reference only. Oseltamivir is appropriate for the treatment of acute, uncomplicated influenza a or b illness in adults and pediatric patients, including neonates greater than 2 weeks of age1. Current weightbased dosing recommendations are not appropriate for premature infants. Pdf oseltamivir dosing in children undergoing hemodialysis. The recommended dosage of tamiflu for prophylaxis of influenza in adults and adolescents years and older is 75 mg orally once daily one 75 mg capsule or 12. Identification of new oral dosing regimens for the. Oseltamivir phosphate capsules are not recommended for people with endstage renal disease esrd who are not receiving dialysis. Greenhalgh s, greenhalgh e, belmares j, koval j, kennedy j. An englishlanguage literature search was conducted using medline 1966february 2014 using the terms oseltamivir and influenza limited to humans and adults older than 19 years. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.
Iv peramivir is restricted to id consult approval only. Renal functionbased dose adjustments adult inpatient. Oseltamivir phosphate capsules do not prevent bacterial infections that may happen with the flu. Dosing of tamiflu oseltamivir, in renal impairment. Mild renal dysfunction crcl greater than 60 to 90 mlmin. Renal dosing modifications are intended to maximize outcomes through the establishment and maintenance of therapeutic drug concentrations, and minimize toxicity that may result from excessive accumulation of the drug or its metabolites. This book is distributed under the terms of the creative commons. Initiate within 48 hours of influenza symptom onset. Song, ma, pharmd, assistant professor, pharmacy practice, university of the pacific, stockton, ca, pharmacy clerkship and.
Oseltamivir is not a substitute for vaccination, which remains the most effective way of preventing illness from influenza when influenza is circulating in the community, oseltamivir is an option recommended in accordance with uk licensing for the treatment of influenza in atrisk patients who can start treatment within 48 hours of the onset of symptoms. By oliver hsu, pharmd candidate, at the university of the pacific linda truong, pharmd candidate, at the university of the pacific. Oseltamivir is not recommended for patients with end stage renal failure creatinine clearance 10 mlmin or less who are not receiving dialysis. The following procedure theoretically results in a dose of 37. Renal elimination of oseltamivir carboxylate accounts for more than 99% of the administered dose. Oseltamivir tamiflu children renal failure is not listed as an adverse effect of oseltamivir in uk product literature 1. Subjects with preexisting renal impairment creatinine clearance, 4060 ml minute received 75 mg oseltamivir twice daily. In a pharmacokinetic study of oseltamivir prophylaxis in humans, alternate daily dosing of oseltamivir. Oseltamivir mechanism, indication, contraindications. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020, wolters kluwer updated. Administration of 100 mg of tamiflu twice daily about 1. Oseltamivir tamiflutm is an antiviral medication used to treat both influenza a and influenza b, and to. Tamiflu oseltamivir dosing, indications, interactions. Oseltamivir dose should be reduced to 75 mg once a day for treatment and 75 mg every other day or 30.
Place a large teaspoon of the sweet food into a clean small bowl. The information on dosage adjustments in renal impairment given in this book is based on cockcroftgault creatinine clearance and not egfr, since the majority. For patients less than 1 year of age, remove the provided 10 ml oral dosing dispenser from the packaging, and provide an. Oseltamivir dosing in critically ill patients with severe.
Dose in renal impairment gfr mlmin gfr mlmin dosage. Tamiflu is not a substitute for an annual flu vaccination. Oseltamivir is in a class of medications called neuraminidase inhibitors. Highlights of prescribing information these highlights do not. In acute on chronic renal impairment the initial dose should correspond to the previous level of chronic renal impairment. A 10 ml oral dosing dispenser is provided with the oral suspension. Medical information for oseltamivir on pediatric oncall including mechanism, indication, contraindications, dosing, adverse effect, interaction. Antiviral oseltamivir dosing recommendations 201209 20. Determine the dose of oseltamivir for the patient then determine the total. Use 30 mg oseltamivir dosing in patients with renal insufficiency. Abacavir abacavir lamivudine abacavir lamivudine zidovudine acarbose acebutolol acetaminophen acetazolamide acetohexamide acetohydroxamic acid acetylsalicylic acid aspirin acrivastine acyclovir adefovir adenosine albuterol inhaled albuterol oral alfentanil alfentanil allopurinol alprazolam alteplase tissuetype plasminogen activator. It is available in capsule form of three different dosages 30, 45 and 75 mg and as an oral powder for reconstitution to suspension for pediatric patients. When tamiflu for oral suspension is not available from wholesaler or the manufacturer, tamiflu capsules may be opened and mixed.
Oct 01, 2009 alternative dosing of oseltamivir for specific patient populations. Recommended oseltamivir treatment dosing in relation to renal. For patients with creatinine clearance of 1030 ml per minute, a reduction of the treatment dosage of oseltamivir to 30 mg orally once daily for five days and in the chemoprophylaxis dosage to 30 mg every other day is recommended pdf icon external icon. For dose adjustments in patients with renal impairment for both treatment and prevention see dosage and administration.
Prospective intervention study on higherdose oseltamivir. Oseltamivir is the only influenza antiviral medication licensed for the treatment of influenza in infants at least 2 weeks of age, and specific dosing guidelines are available for this age group. The manufacturer of oseltamivir revised their dosing recommendations for the use of oseltamivir in patients with renal impairment following a request by the committee for medicinal products for human use chmp. If influenza outbreak duration is less than 10 days, oseltamivir prophylaxis may be discontinued. For future influenza pandemics, it will be important to have the disposition. Rh wrote two books published in 2008 about the harm of oseltamivir and antipyretics. Tamiflu does not prevent bacterial infections that may happen with the flu. Apr 26, 2019 oseltamivir phosphate capsules do not treat or prevent illness that is caused by infections other than the influenza virus. The renal drug handbook the st georges hospital, adult critical. Many medical organizations recommend it in people who have complications or are at high risk of complications within 48 hours of first symptoms of infection. Do not take tamiflu if you are allergic to oseltamivir phosphate or any of the ingredients in tamiflu. Instructions to the patient should be provided based on these units of measure ie, ml.
Use an oral dosing dispensing device that measures the appropriate volume in ml with the oral suspension. Dosage of oseltamivir for preventing the flu in adults and adolescents oseltamivir should be started as soon as one has been in close contact with someone who has the flu preferably within two days. However, higher doses are recommended for further investigation in patients with high residual renal function. Alternative dosing of oseltamivir for specific patient populations. Guidelines for outbreak prevention, control and management in supportive living and home living sites july 2019. Cvvhd removes solutes including drugs via diffusion. Oseltamivir is a synthetic derivative prodrug of ethyl ester with antiviral activity. When providing oseltamivir suspension for children dosing. Pharmacokinetics and safety of oseltamivir in patients with endstage renal disease treated with automated peritoneal dialysis. In treatment studies it also modestly reduces the time to first alleviation of symptoms, but it causes nausea and vomiting and increases the risk of headaches and renal and psychiatric syndromes.
Premature infants might have slower clearance of oseltamivir because of immature renal function, and doses recommended for fullterm infants might lead to very high drug concentrations in this age group. Cdc recommends dosing as also recommended by the american. Pediatric patients 1 year to 12 years of age table 1 displays the recommended oral dosage of tamiflu for prophylaxis of influenza in pediatric patients 1 year to 12 years of age based on body weight and provides information about prescribing the capsule or the formulation for oral suspension. Oseltamivir toxicity in a hemodialysis patient shm abstracts. Oseltamivir is also useful for influenza prophylaxis within 48 hours of contact with an. Pharmacokinetics and safety of oseltamivir in patients with. Dosing in patients with renal dysfunction amended 2018. The mechanism of action of oseltamivir is as a neuraminidase inhibitor. Renal dose adjustment guidelines for antimicrobials crrt. Draw peak 30 minutes after infusion ends 4 th dose. Dose adjustment is recommended for adult patients with creatinine clearance between 10 and 60 mlmin and patients with endstage renal disease esrd undergoing hemodialysis or continuous peritoneal dialysis receiving tamiflu for the treatment of influenza. The pharmacokinetics of oseltamivir have not been studied in patients with endstage renal disease i.
Includes dosages for influenza and influenza prophylaxis. The recommended oral dose of tamiflu for treatment of influenza in pediatric patients 1 to 12 years of age is shown in table 1. Side effects of oseltamivir in endstage renal failure patients. Phe guidance on use of antiviral agents for the treatment and. Dosage of oseltamivir for children for the prevention or treatment of the flu in children 1 to 12 years of age or the treatment of the flu in children ages 2 weeks to 12 years, the recommended dosage of oseltamivir will be based on the weight of the child. Nov 01, 2009 when dosing obese patients, there is a concern about sufficient distribution of the drug, as well as increased elimination. It is not known what the prophylactic dose of oseltamivir is for children with renal failure. Pharmacokinetics of oseltamivir and oseltamivir carboxylate.
Talk to your healthcare provider or pharmacist about the specific dosage for your child. Pharmacokinetics and dosage adjustment of oseltamivir and. This is the fdaapproved oral oseltamivir treatment dose for infants 14 days and older and less than 1 year old, and. This study aimed to characterize the pharmacokinetics and tolerability of oseltamivir in automated peritoneal dialysis apd and construct a pharmacokinetic model to assist with optimized dosing. To evaluate the literature for published reports regarding the efficacy of standard versus higher dosing of oseltamivir in critically ill patients with severe influenza. Antiviral agent activity against use recommended for not recommended for use in children adults duration adverse events oral tamiflu oseltamivir influenza a and b treatment 5 days. Inspire a love of reading with prime book box for kids discover delightful childrens books with prime book box, a subscription that delivers new books every 1, 2, or 3 months new customers receive 15% off your first box. Abstract published at hospital medicine 2010, april 811, washington, d. Oseltamivir tamiflu oral suspension is available in a 6 mgml concentration. The data set comprised 128 subjects 71 with varying degrees of renal impairment from 8 studies, which included. Renal dose adjustment guidelines for antimicrobials.
Oct 07, 2014 oseltamivir is indicated for influenza treatment in esrd patients, but the disposition is poorly understood in this patient population. Pharmacokinetics and safety of oseltamivir in patients. Neonates less than 2 weeks of age may also receive oseltamivir for treatment of influenza, but safety and efficacy in this population have not been established2. Oseltamivir increased risk of nausea, vomiting, headache, psychiatric, renal. The recommended dose for flu prevention in people age or older is 75 mg, once a day, for at least 10 days. Treatment or chemoprophylaxis dosing recommendations have been proposed for patients undergoing routine renal dialysis treatment but are based on limited pharmacokinetic data 217, 218.