Tamiflu: 7 things you should know
Medically reviewed by C. Fookes, BPharm. Last updated on Dec 4, 2018.
1. How it works
- Tamiflu is a brand (trade) name for oseltamivir. Oseltamivir is an antiviral agent that may be used to treat acute and uncomplicated infections due to influenza A or B viruses in people who have been symptomatic for no more than 48 hours. The manufacturer suggests oseltamivir works by inhibiting viral neuraminidase, an enzyme that enables viruses to be released from their host cell. However, a Cochrane review suggests oseltamivir reduces symptoms of influenza by inhibiting the release of pro-inflammatory cytokines which reduces the immune response. It may also work centrally (through the brain) to lower temperature. The Cochrane reviewers did not find any evidence of influenza-virus specific action.
- Tamiflu belongs to the class of medicines known as antivirals.
- Tamiflu can be used to treat influenza A or B in adults and children aged two weeks or older who have been symptomatic for no more than 48 hours.
- Tamiflu may be used to reduce the risk of adults and children aged one year or older from becoming infected with influenza A or B viruses.
- May be more effective at preventing the symptoms of influenza rather than treating them.
- Available as a capsule and a powder for oral suspension.
- Tamiflu is available as a generic under the name oseltamivir.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Nausea, vomiting, diarrhea, and headache are the main side effects. Rarely, allergic or skin reactions and breathing problems have been reported.
- Tamiflu has been associated with neuropsychiatric side effects (mainly confusion, delirium and abnormal behavior that has resulted in injury; some cases were fatal). Most of these effects occurred in children and had an abrupt onset and a rapid resolution.
- Tamiflu does not take the place of an early annual influenza vaccination.
- There is always a risk that some influenza type A or B viruses may have developed resistance to Tamiflu and its antiviral effects. Doctors may need to consider local Tamiflu susceptibility patterns before deciding to use Tamiflu.
- Rarely, anaphylaxis and serious skin reactions have been reported with Tamiflu.
- Dosage may need adjusting in people with moderate-to-severe kidney disease. Avoid in people with end-stage kidney failure not undergoing dialysis. May not be suitable for some people with heart or lung disease, hereditary fructose intolerance, a weak immune system or other serious health problems.
- Some studies have raised doubt about the effectiveness of Tamiflu as a treatment for influenza. A Cochrane review found that Tamiflu shortened the duration of symptoms of influenza-like illness by less than a day. Tamiflu is not effective against colds or other viral illnesses.
- Tamiflu will not prevent any secondary bacterial infections associated with the flu.
- Tamiflu may interact with some other medications including the live attenuated influenza vaccination and clopidogrel
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Tamiflu may be taken either with or without food. Taking with food may reduce any gastrointestinal side effects such as nausea or vomiting.
- Tamiflu is usually taken twice daily when used for the treatment of influenza, or once daily when used to reduce the risk of catching influenza.
- Tamiflu is usually taken for five days when used for treatment and 10 days when used for prevention. However, it may be continued for 6 to 12 weeks in certain situations.
- Tamiflu should be started within 48 hours of symptom onset.
- Tamiflu is available as capsules or an oral powder. The powder can be used by people who cannot swallow capsules and must be mixed with water immediately prior to use. Always use a properly calibrated measure when giving a dose of Tamiflu.
- If Tamiflu powder is not available, Tamiflu capsules may be opened and the contents mixed with sweetened liquids (regular or sugar-free) such as chocolate or corn syrup, caramel topping, or light brown sugar dissolved in water. A pharmacist is also able to prepare a suspension of Tamiflu.
- Stop taking Tamiflu and see your doctor urgently if you develop any signs of an allergic reaction to Tamiflu (such as facial swelling or a skin rash), or if the person taking Tamiflu develops any worrying or bizarre behaviors, or appears confused or delirious.
- Tamiflu only treats viruses, it will not treat bacterial infections. Do not use Tamiflu to treat any other infection, or give it to others to take.
- If you have hereditary fructose intolerance, be aware that the oral suspension contains 2 grams of sorbitol which may give you dyspepsia or diarrhea.
- You should not forgo your annual influenza vaccination just because Tamiflu is available. Continue to get a flu shot every year, based on your doctor's advice.
6. Response and Effectiveness
- Tamiflu is rapidly absorbed from the gastrointestinal tract and its ingredient, oseltamivir, is converted by liver enzymes to its active form oseltamivir carboxylate (OC). OC is detected in the blood within 30 minutes of an oral dose. Peak concentrations of OC are reached within three to four hours.
- Some studies have shown Tamiflu only reduces the duration of an influenza-like illness by about a day.
Medicines that interact with Tamiflu may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Tamiflu. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed. Common medications that may interact with Tamiflu include:
- Hepatitis B medications, such as entecavir
- Live influenza vaccine (eg, FluMist Quadrivalent) given either two weeks before or 48 hours after Tamiflu administration. Note that inactivated flu vaccines can be administered at any time relative to Tamiflu use
- pemetrexed, a chemotherapy agent
- warfarin, an anticoagulant (blood thinner).
Alcohol should be avoided while taking Tamiflu because it weakens the immune system and may exacerbate the side effects of Tamiflu.
Note that this list is not all-inclusive and includes only common medications that may interact with Tamiflu. You should refer to the prescribing information for Tamiflu for a complete list of interactions.
- Tamiflu [Package Insert]. Revised 12/2018. Genentech, Inc. https://www.drugs.com/pro/tamiflu.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Tamiflu only for the indication prescribed.
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