UCSFMC & UCSFBCH Dosing and Monitoring of Neuraminidase Inhibitors

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See also UCSF Medical Center & UCSF Children's Hospital Recommendations for Management of Influenza

►Oseltamivir

Contraindications to Oseltamivir

-allergy to oseltamivir

Side Effects & Monitoring

Common: nausea/vomiting

Rare: neuropsychiatric effects

Oseltamivir Dosing, Adults

Renal function

 Treatment1

 Postexposure Prophylaxis

(Consider on case-by-case basis and in consultation with Infection Control)

CrCl ≥61 ml/min 75mg PO bid x 5 days 75 mg PO daily x 7 days
 CrCl 31-60 ml/min 30mg PO bid x 5 days 30 mg PO daily x 7 days
 CrC 10-30ml/min 30mg PO daily x 5 days 30 mg PO every other day  
ESRD Patients on Hemodialysis (HD) 30mg PO post HD x 5 days3

30 mg PO after alternate hemodialysis cycles

(x2 doses total)

 
Continuous renal replacement therapy (CRRT)  75mg po BID x5 days 30mg po daily x7 days
Continuous ambulatory peritoneal dialysis (CAPD) A single 30 mg dose administered immediately after a dialysis exchange 30mg PO once weekly x1 dose total

1For ICU patients, longer courses (e.g. 10 days) may be considered based on severity of illness and repeat RVP testing of lower respiratory tract samples. Please consult ID for assistance in these cases.

2 For critically ill patients with concern for decreased gut absorption or edema, consult ID to discuss use of IV peramivir.  IV peramivir is restricted to ID consult approval only.

3Assuming 3 HD sessions are performed in a 5-day period.  Treatment can be initiated immediately if influenza symptoms develop during the 48 hours between HD sessions; however, the post-HD dose should still be administered independently of time of administration of the initial dose

For pediatric dosing see Pediatric Influenza Empiric Therapy Guidelines

►Peramivir

NOTE: Peramivir is a restricted antimicrobial requiring consultation with the Infectious Diseases Service before release

Adult Dosing

CrCl Dose
≥ 50 ml/min
600mg IV once daily
30-49 ml/min 200mg IV once daily
10-29 ml/min 100mg IV once daily
<10 ml/min 100mg IV on Day 1, then 15mg IV daily
ESRD on intermittent hemodialysis 100mg IV on Day 1, then 100mg IV given 2 hours after the next two HD sessions for a total of 3 doses
CRRT 200mg IV once daily

 

Pediatric Dosing: consult pediatric ID (443-2384)

 

►Zanamivir

Contraindications to Zanamivir

-allergy to zanamivir

-underlying airway disease (COPD or asthma)

Side Effects & Monitoring

Common: cough, bronchospasm

Zanamivir Dosing, Adults

Adjustment for renal function not required

Treatment: 10mg (2 inhalations) BID x5 days

Postexposure Prophylaxis: 10mg (2 inhalations) daily x7 days

For pediatric dosing see Pediatric Influenza Empiric Therapy Guidelines