October 29, 2020
DRUG THERAPY for the FLU
Mechanism: keeps the virus from multiplying.
Indications for use: Influenza type A and B. Begin within 48 hours of symptoms. May reduce symptoms by 1 day.
Warnings/Precautions/ Adverse effects: Nausea, vomiting, dizziness, and insomnia. May cause behavior changes in children.
Start as soon as possible. Take two doses the first day.
Not a substitute for the vaccine
Tamiflu® 75mg capsules and powder for suspension 12mg/ml (available generically)
Adults: 75mg twice daily for 5 days. Get two doses in the first day. Start as soon as you pick up the prescription.
Baloxavir marboxil tablets (XOFLUZA® )
approved 2018 Cost: $180.00/dose
Mechanism of action: also keeps the virus from multiplying
Indications: for the treatment of acute uncomplicated influenza in patients 12 years of age
and older who have symptoms for less than 48 hours. Shortens flu symptoms versus placebo by about one day.
Dose: Take a single dose of XOFLUZA orally within 48 hours of symptom onset with or without food.
On average, patients recovered from flu symptoms in 2.3 days---(54 hours versus 80 hours) by about one day.
- Reduces viral load faster than oseltamivir, but not sure that reduces spread of flu.
CANDIDATES for PHARMACOLOGICAL TREATMENT
HIGH RISK PATIENTS: Clinicians should start antiviral treatment as soon as possible for adults and children with documented or suspected influenza, vaccinated or not, who meet the following criteria:
• Persons of any age who are hospitalized with influenza.
• Outpatients of any age with severe or progressive illness, regardless of illness duration.
• Outpatients who are at high risk of complications from influenza, including those with chronic medical conditions and immunocompromised patients. Think diabetes, obesity, chronic kidney disease, chronic heart disease, chronic lung disease (asthma, COPD)
• Children younger than 2 years and adults ≥65 years.
• Pregnant women and those within 2 weeks postpartum
LOW RISK PATIENTS: Outpatients with illness onset ≤2 days before presentation (C-I).
• Symptomatic outpatients who are household contacts of persons who are at high risk of developing complications from influenza, particularly those who are severely immunocompromised (C-III).
• Symptomatic healthcare providers who care for patients who are at high risk of developing complications from influenza, particularly those who are severely immunocompromised
NON-PHARMACOLOGICAL TREATMENT MEASURES
Of course, PREVENTION is the best approach:
- Vaccination: best if given in October and November
- Avoid close contact with sick people
- Stay home if you are sick
- Cover mouth and nose when coughing or sneezing
- Wash your hands---OFTEN! Viruses can survive on surfaces for 2-8 hours.
- Avoid touching eyes, nose, mouth
- Looks like we need to add masking and social distancing to this list given the low transmission rate in the Southern Hemisphere in 2020.
- Humidification of air
- cough suppressants, analgesic. Symptom management.
- Absolutely no Aspirin in patients under age 18.
YOUR NICKMAN’S PHARMACIST SAYS:
We’ve seen a significant decrease in the influenza spread in the southern hemisphere, most likely due to social distancing, masking, working from home and on-line learning.
All of the efforts made to decrease the spread of the COVID-19 virus are greatly impacting the spread of the seasonal influenza virus. Patients seem a lot more interested in getting their flu vaccinations this year. I’ve noticed a huge uptick in patient who were “first timers”. If you have not had your flu shot yet, stop by Nickman’s Drug. We want to keep you healthy!