On Tamiflu and Relenza
As you can tell from reading the news media and the UT website, the local H1N1 vaccination program is becoming more and more robust. Venues are being established on- and off-campus. Remember, if you’re interested in being vaccinated, pre-register. It’ll save you time.
It’s just too bad no one developed an anti-Yankee vaccine.
Meanwhile, the data behind the vaccine indicates that it’s achieving its desired effect. It’s causing a vigorous immune response against the virus and that response is also taking effect in pregnant women
(Link: http://www.hhs.gov/news/press/2009pres/11/20091102a.html).
The latest controversial event, however, is an Australian flu study that has been repudiated by its own authors. These researchers compared the likelihood of developing the flu for healthcare personnel who wore N95 masks and those who wore simple surgical masks. They concluded that those who wore N95s were less likely to catch the flu. Then, faced with growing criticism about their data-collection methodology, they publicly said, “Oooops” and retracted their conclusions
(Link: http://abcnews.go.com/Health/
SwineFluNews/cdc-flu-mask-decision-based-flawed-study-authors/
story?id=8966585). The story that the researchers have been sent to the South Pole to study psoriasis in penguins is just a rumor.
Anyway, with the flu ramping up locally, it will not be unusual to discover that you, a family member, or a friend may be prescribed an antiviral medication such as Tamiflu or Relenza. Therefore, I’ve included the FDA factsheet on both the drugs.
Tamiflu: Consumer Questions and Answers
Link: http://www.fda.gov/Drugs/DrugSafety
/PostmarketDrugSafetyInformationforPatientsandProviders/ucm188859.htm
Q. What is Tamiflu and what is it approved for?
A. Tamiflu (oseltamivir phosphate) is an antiviral drug. It works by attacking the flu virus to keep it from multiplying in your body and by reducing the symptoms of the flu. Tamiflu can sometimes keep you from getting the flu if you take it before you get sick.
The term “flu” refers to illness caused by the influenza virus. The flu is a respiratory infection that can cause symptoms such as fever, chills, aches and pains, cough, and sore throat. The flu can range from mild common cold symptoms, to the typical “flu” symptoms described above, to life-threatening pneumonia and other complications, including secondary bacterial infections.
Tamiflu is used to treat people 1 year of age and older who have the flu (influenza A and B viruses). Tamiflu is also used for prevention (prophylaxis) of the flu in people 1 year of age and older. During the 2009 H1N1 influenza (“swine flu”) public health emergency, FDA authorized the use of Tamiflu in children less than 1 year of age.
Q. Is Tamiflu a substitute for the flu vaccine?
A. No. Getting the flu vaccine is the best way to protect against getting the flu and controlling the spread of the flu.
More information on the Seasonal and 2009 H1N1 flu vaccines is available on the flu vaccination page on the Flu.gov website.
(see http://www.flu.gov/individualfamily/vaccination/index.html).
Q. What do the terms treatment of the flu and prevention (prophylaxis) of the flu mean?
A. Treatment is used when a person is given Tamiflu because they have the signs and symptoms of the flu or have been diagnosed with the flu. Tamiflu has been shown to lessen the amount of time people are sick with the flu.
Prevention (prophylaxis) is when someone who does not have flu symptoms is given Tamiflu to help stop them from getting the flu because they are exposed to or come into close contact with someone (for example live with or take care of someone) who has the flu.
Q. Do I take Tamiflu the same way for treatment and prevention (prophylaxis) of the flu?
A. No. The number of times a day (frequency) and the number of days (duration) that you take Tamiflu are different for treatment and prevention of the flu. Your healthcare provider will tell you how to take Tamiflu. Take it exactly as your healthcare provider prescribes.
Q. What should people do if they continue to have or start to develop flu symptoms while taking Tamiflu?
A. If flu symptoms do not go away, or if new symptoms develop while taking Tamiflu, people should contact their healthcare provider. Other illnesses cause people to have symptoms similar to the flu, or may occur at the same time as the flu, and they might need other treatment.
Q. Does Tamiflu come in a liquid as well as capsules?
A. Yes, Tamiflu is available as a liquid (oral suspension) and as oral capsules of different sizes. Your healthcare provider will prescribe the strength that is right for you.
Q. Do I need to make the Tamiflu liquid (oral suspension)?
A. No, a pharmacist should mix Tamiflu liquid before giving it to you. If you get a bottle with only powder in it, you should return the medication to the pharmacy so it can be mixed correctly.
Q. Is there enough Tamiflu suspension?
A. For the 2009-2010 flu season there is not enough of the liquid Tamiflu made by the manufacturer. Some pharmacies may need to make a liquid for patients. The strength of the liquid made by the pharmacy may be different than the liquid from the manufacturer. You should always follow the directions on the medicine label for how much and how often to give the medication. You should speak with your healthcare provider if you have any questions.
Q. Does the liquid (oral suspension) need to be refrigerated?
A. Yes, liquid Tamiflu (oral suspension) should be stored in the refrigerator. Ask the pharmacist how long to keep the medicine, and then throw away the unused medicine after that time. You should only use the medication for as long as your healthcare provider has directed.
Q. Does liquid Tamiflu (oral suspensions) need to be shaken?
A. Yes, shake liquid Tamiflu well each time before you give it.
Q. What do I use to give liquid Tamiflu (oral suspension)?
A. The pharmacist should give you a syringe to measure the dose of liquid Tamiflu. Some syringes for oral use have markings in milligrams (mg) and some have markings in milliliters (mL). You and your pharmacist should look at the syringe and compare it to the directions on the medicine label. The unit of measure (mg or mL) on the medicine label should match the unit of measure (mg or mL) on the syringe. You should be able to use the syringe to measure the right amount (mg or mL) that is written on the medicine label. If you can not measure the right amount with the syringe you were given, then you should ask the pharmacist to give you a different syringe with different markings.
Q. What type of syringe should I use to give my child Tamiflu orally?
A. Parents or caregivers of children younger than one year of age will always need to use a syringe marked in milliliters (mL). If you have questions about how to give the medicine you should speak with your healthcare provider.
Q. What should I do if I am given Tamiflu capsules but can not swallow them?
A. If you have trouble swallowing Tamiflu capsules, you should tell your healthcare provider. If liquid Tamiflu is not available and you have capsules that give the right dose (30 mg, 45 mg or 75 mg), you may pull open the Tamiflu capsules and mix the powder with a small amount of sweetened liquid such as regular or sugar-free chocolate syrup. You don’t have to use chocolate syrup but thick, sweet liquids work best at covering up the taste of the medicine.
Q. Should women who are pregnant or nursing take Tamiflu?
A. Tamiflu may be of benefit for some pregnant and nursing women with 2009 H1N1 influenza. At this time, the U.S. Centers for Disease Control and Prevention (CDC) recommends that pregnant women who are sick from 2009 H1N1 influenza may develop more serious illness and should be treated with a flu drug. Pregnant and nursing women are advised to talk with a healthcare professional before using Tamiflu.
More information is available at flu.gov
(see http://www.flu.gov/individualfamily/parents/pregnant5tips.html).
Q. What are the most common side effects of Tamiflu?
A. The most common side effects of Tamiflu are nausea and vomiting. Usually, nausea and vomiting are not severe and happen in the first 2 days of treatment. Taking Tamiflu with food may lessen the chance of getting these side effects. Other side effects include stomach (abdominal) pain, nosebleeds, headache, and feeling tired (fatigue).
Q. What are the serious side effects of Tamiflu?
A. Children and teenagers with the flu may be at a higher risk for seizures, confusion, or abnormal behavior early during their illness. These serious side effects may happen shortly after beginning Tamiflu or may happen in people when the flu is not treated. These serious side effects are not common but may result in accidental injury to the patient. People who take Tamiflu should be watched for signs of unusual behavior and a healthcare provider should be contacted right away if the patient shows any unusual behavior while taking Tamiflu.
Rare cases of allergic reactions, including serious skin rashes, have happened in people who take Tamiflu. If a rash develops, stop taking Tamiflu and contact a healthcare provider right away.
FDA encourages consumers to report any side effects and medication errors from
Tamiflu to FDA at 1-800-FDA-1088.
Q. Where can I get more information about Tamiflu and 2009 H1N1?
A. The following links provide additional information on Tamiflu:
FDA 2009 H1N1 webpage – http://www.fda.gov/NewsEvents/
PublicHealthFocus/ucm150305.htm
Flu.gov page – http://www.flu.gov
CDC 2009 H1N1 flu page – http://www.cdc.gov/h1n1flu/
Tamiflu website – http://www.tamiflu.com
Relenza: Consumer Questions and Answers
Q. What is Relenza and what is it approved for?
A. Relenza (zanamivir) is an antiviral drug. It works by attacking the flu virus to keep it from multiplying in your body and reducing the symptoms of the flu. It can sometimes keep you from getting the flu if you take it before you get sick.
The term “flu” refers to illness caused by the influenza virus. The flu is a respiratory infection that can cause symptoms such as fever, chills, aches and pains, cough, and sore throat. The flu can range from mild common cold symptoms, to the typical “flu” symptoms described above, to life-threatening pneumonia and other complications, including secondary bacterial infections.
Relenza is used to treat people 7 years of age and older who have the flu (influenza A and B viruses). Relenza is also used for prevention (prophylaxis) of the flu in people age 5 years or older.
Q. Is Relenza a substitute for the flu vaccine?
A. No. Getting the flu vaccine is the best way to protect against getting the flu and controlling the spread of the flu.
More information on the Seasonal and 2009 H1N1 flu vaccines is available on the flu vaccination page on the Flu.gov website.
(see http://www.flu.gov/individualfamily/vaccination/index.html ).
Q. What do the terms treatment of the flu and prevention (prophylaxis) of the flu mean?
A. Treatment is used when a person is given Relenza because they have the signs and symptoms of the flu or have been diagnosed with the flu. Relenza has been shown to lessen the amount of time people are sick with the flu.
Prevention (prophylaxis) is when someone who does not have flu symptoms is given Relenza to help stop them from getting the flu because they are exposed to or come into close contact with someone (for example live with or take care of someone) who has the flu.
Q. Do I take Relenza the same way for treatment and prevention (prophylaxis) of the flu?
A. No. The number of times a day (frequency) and the number of days (duration) that you take Relenza are different for treatment and prevention (prophylaxis) of the flu. Your healthcare providers will tell you how to take Relenza. Take it exactly as your healthcare provider prescribes.
Q. What should I do if I continue to have or start to develop flu symptoms while taking Relenza?
A. If your flu symptoms do not go away, or if you get new symptoms while taking Relenza, contact your healthcare provider. Other illnesses cause people to have symptoms similar to the flu, or may occur at the same time as the flu, and they might need other treatment.
Q. How is Relenza supplied?
A. Relenza is a powder that you inhale into your
mouth using a device called a Diskhaler. The powder is in a pouch called a
blister. There are 4 blisters on each circular medication pack (Rotadisks).
Each blister contains 5 mg of medicine. Each box of Relenza contains five Rotadisks.
Q. How many blisters are used for a dose?
A. Two (2) blisters are used for each dose. The 4 blisters on the Rotadisk
are enough medicine for 2 doses. Your doctor will tell you how many times a
day and for how many days you should take the medicine.
Q. Are there instructions for people who have never used an inhaler?
A. Yes, each box of Relenza has a Patient Instructions for Use leaflet
that explains how to take Relenza using the Diskhaler device. These instructions
are not a substitute for education and demonstration by your healthcare provider.
Your healthcare provider will tell you how to use Relenza. Use it exactly as
your healthcare provider prescribes. To help make sure Relenza is used the
right way by children, it should be used only under adult supervision. The
supervising adult must understand how to use the Diskhaler device.
To help you use Relenza the right way, the manufacturer, GlaxoSmithKline, also
created a video on their website that demonstrates the proper use of the Relenza
Diskhaler device, (see http://www.relenza.com/using-relenza-videos.html).
Q. Are there any other special instructions to remember?
A. Yes, it is important to remember to puncture both the top and bottom of
the blister using the Diskhaler before inhaling the medication into your mouth.
Relenza should never be used with any other device but the Diskhaler. The blisters
of medicine should never be opened and mixed into a liquid.
Q. Are there people who should not take Relenza?
A. Yes. Relenza is not for people who have chronic lung diseases such as asthma or chronic obstructive pulmonary disease (COPD). Also, since the Relenza powder contains lactose, people who have an allergy to lactose should not use Relenza.
Talk with your healthcare provider if you have concerns about using Relenza.
Q. Should women who are pregnant or nursing take Relenza?
A. Relenza may be of benefit for some pregnant and nursing women with 2009 H1N1 influenza. At this time, the U.S. Centers for Disease Control and Prevention (CDC) recommends that pregnant women who are sick from 2009 H1N1 influenza may develop more serious illness and should get be treated with a flu drug. Pregnant and nursing women are advised to talk with a healthcare professional before using Relenza.
More information is available at flu.gov (see http://www.flu.gov/individualfamily/
parents/pregnant5tips.html).
Q. What are the most common side effects of Relenza?
A. The most common side effects of Relenza are:
- diarrhea
- nausea
- vomiting
- headache
- dizziness
- nasal irritation
- cough
- ear, nose, and throat infections.
Q. What are the serious side effects of Relenza?
A. Some people have more trouble breathing while using Relenza, especially if you have chronic lung disease. If you have more trouble breathing after using Relenza, you should stop using Relenza and get medical help right away.
Children and teenagers with the flu may be at a higher risk for seizures, confusion, or abnormal behavior early during their illness. These serious side effects may happen shortly after beginning Relenza or may happen in people when the flu is not treated. These serious side effects are uncommon but may result in accidental injury to the patient. People who take Relenza should be watched for signs of unusual behavior and a healthcare provider should be contacted right away if a patient shows any unusual behavior while taking Relenza.
Rare cases of allergic reactions, including serious skin rashes, have happened in people who use Relenza. If a rash develops, stop Relenza and contact a healthcare provider right away.
Report any side effects and medication errors from Relenza to FDA at 1-800-FDA-1088.
Q. Where can I get more information about Relenza and 2009 H1N1?
A. The following links provide additional information on Relenza
FDA 2009 H1N1 webpage – http://www.fda.gov/NewsEvents/
PublicHealthFocus/ucm150305.htm
Flu.gov page – http://www.flu.gov
CDC 2009 H1N1 flu page – http://www.cdc.gov/h1n1flu/
Relenza website – http://www.relenza.com
Paul Rega is a board-certified physician in Emergency Medicine and is an Assistant Professor in the Department of Public Health & Disease Prevention and the Department of Emergency Medicine. A passion in Disaster Medicine has resulted, over the years, in multiple deployments, research and education both nationally and internationally. This has branched out into developing strategies associated with counter-terrorism and pandemics. Currently, Paul is assisting with H1N1 preparedness and response within UT and into the region.
November 6th, 2009at 8:19 pm
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