Saturday, November 7, 2009
When to Take Tamiflu
With the H1N1 flu season hitting most communities, the question of when to give patients Tamiflu comes up for physicians. Tamiflu is the antiviral medication that can shorten the severity of flu symptoms by...drumroll...one day. To be effective it should be given within the first 48 hours of symptoms.
There are no medical guidelines for who should take Tamiflu. If patients have symptoms severe enough for hospitalization or have a chronic condition or asthma, Tamiflu should definitely be prescribed. Pregnant women and young children are at more risk for severe flu so they should be given Tamiflu when symptoms present, but what about everyone else?
Is shortening the illness by one day worth the $100 Tamiflu costs? Some doctors are concerned about creating resistant strains of influenza if Tamiflu is overused. And giving Tamiflu to "prevent" flu is not recommended because people who live in a household with a flu victim have only a 15-27% chance of catching flu anyway. That said, if a person with high risk factors is exposed to the flu, giving Tamiflu is likely to prevent illness.
As with any medication, adverse events can occur. With Tamiflu adverse event reports were primarily related to unusual neurologic or psychiatric events such as delirium, hallucinations, confusion, abnormal behavior, convulsions, and encephalitis. Most of the reports come from Japan.
I am not prescribing Tamiflu routinely for people with flu symptoms. If they ask for it, and understand how it works and the small risks of taking it, I will write the prescription. Tamiflu is not a substitute for the flu shot.
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