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Alcohol with tamiflu: Is it safe to mix cold medicine and alcohol?

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Is it safe to mix cold medicine and alcohol?

If you have the flu—or even just a severe cold—the last thing you probably feel like doing is going out for a night on the town. And while abstaining from alcohol is a good thing (and what your body needs when it is in virus-fighting mode), you may be tempted to try a hot toddy to soothe your sickness. Is that a good idea? Well, it all boils down to hydration (or lack thereof), experts say. 

“One major reason people get hospitalized with severe viral infections is [because] they get severely dehydrated and weak,” Robert McLean, MD, president of the American College of Physicians, explains. 

Alcohol only exacerbates this, he says, because it triggers a diuretic effect. Next thing you know, your body is expelling fluid (through urination) at a rapid rate. The hydration you need to get better? Gone (so much for all the tea, water, and chicken soup you’ve been downing). Not only that, but alcohol can actually make some of your symptoms, like nausea, vomiting, and headaches, worse. Why? Because alcohol produces some of the same side effects, says Kevin Davis, Pharm.D., pharmacy supervisor at the University of Florida Health, Jacksonville, and that adds insult to injury. 

Flu and cold medicine and alcohol interactions

And then there’s the matter of the over-the-counter meds you are taking to manage your symptoms. Flu and cold medicine with alcohol actually have some very significant drug-drug interactions.

Some of these medications include:

Tamiflu and alcohol

Somewhat ironically, antiviral medications used to treat the flu do not have direct drug-drug interactions with alcohol, says Dr. Davis. Tamiflu and Xofluza both have some drug-drug interactions, but they both do not interact with alcohol. 

RELATED: Tamiflu vs. Xofluza—which works better? 

So does this mean it is okay to have a little whiskey while you fight the fever and severe aches and pains brought on by this punishing virus? No, for all the reasons listed above.  

“It is definitely not a good idea when you are sick at all to drink alcohol,” Dr. Davis says. 

Plus, Tamiflu and Xofluza need to be started within 24-48 hours of symptoms onset—when you likely feel extremely miserable. Chances are you won’t be getting up off the couch, let alone heading to the fridge to grab a beer (and of course we recommend avoiding getting the flu altogether by getting a flu shot—it is not too late!).

Tylenol and alcohol

Tylenol (acetaminophen) is a commonly used pain reliever and fever reducer that is metabolized by the liver, just like alcohol. Mixing the two under any circumstances is considered risky because, according to the Food and Drug Administration (and essentially all medical professionals), it has the potential to cause severe liver damage, or even death.

RELATED: Is it safe to take over-the-counter painkillers with alcohol?

Benadryl and alcohol

Benadryl (diphenhydramine) is an antihistamine that can relieve some of the upper respiratory symptoms that sometimes come with colds and flu. However, it also makes you drowsy. Alcohol, too, causes drowsiness. Take the two together, and you could wind up experiencing the worst-case scenario—extreme drowsiness and impairment, slowed breathing, and possibly even unconsciousness. 

RELATED: Is it safe to drink alcohol while taking allergy medicine?

Unisom and alcohol

Unisom (doxylamine succinate), also an antihistamine/sleep-aid, functions much like diphenhydramine, says Dr. Davis, so taking it with alcohol is a recipe for disaster. 

Robitussin and alcohol

Robitussin CoughGels (dextromethorphan) is an OTC drug used to treat coughs and other flu-related complications (like coughs from bronchitis). Taking dextromethorphan alone has the potential to make you dizzy, drowsy, and impair your mental function. Alcohol increases these effects. 

RELATED: Can you drink while taking cough syrup?

NyQuil and alcohol

To make matters worse, many cold and flu remedies are a combination of these medications. NyQuil, for example, contains acetaminophen, doxylamine, and dextromethorphan. Tylenol Severe Cold and Flu contains, in addition to acetaminophen, a cough suppressant (and several other medications). So when you combine these OTC remedies with alcohol, your risk of side effects increases a lot, says Dr. Davis. In addition to staying away from alcohol altogether while you are recovering from a cold or the flu, he urges patients to speak to the pharmacist about the best medications to actually use. The multiple ingredient OTC meds are often unneeded with your specific symptoms—it is best to use single-ingredient products targeted to your exact symptoms.

tamiflu and alcohol | mixing alcohol and tamiflu

tamiflu and alcohol


 

What happens when you mix tamiflu and alcohol

 

Side effects of mixing tamiflu and alcohol can include

 

  • Dizziness
  • Sluggishness
  • Drowsiness
  • Shortness of breath
  • Itching
  • Hives
  • Palpitations
  • Respiratory Depression
  • Cardiac Arrest
  • Coma
  • Seizures
  • Death

 

Interestingly, it is impossible to tell what effect tamiflu and alcohol will have on an individual due to their own unique genetic make up and tolerance. It is never advisable to mix tamiflu and alcohol due to the chances of mild, moderate and severe side effects. If you are having an adverse reaction from mixing tamiflu and Alcohol it’s imperative that you head to your local emergency room.

 

Alcohol and tamiflu

 

Alcohol and tamiflu creates a that has different effects depending on the dose: many people feel stimulated and strengthened at low doses of alcohol and tamiflu and even mixing a small amount of tamiflu and alcohol is not recommended.

Mixing alcohol and tamiflu

 

The primary effect of alcohol is influenced by an increase in the concentration of the inhibitory neurotransmitter GABA, which is found in the spinal cord and brain stem, and by a reduction in its effect on neuronal transmitters that are excitatory. When alcohol is combined with tamiflu this primary effect is exaggerated, increasing the strain on the body with unpredictable results.

 

Alcohol and tamiflu affects dopamine levels in the brain, causing the body both mental and physical distress. Larger amounts of tamiflu and alcohol have a greater adverse effect yet leading medic al recommendation is that smaller does can be just as harmful and there is no way of knowing exactly how tamiflu and alcohol is going to affect an individual before they take it.

 

Taking tamiflu and alcohol together

 

People who take tamiflu and alcohol together will experience the effects of both substances. Technically, the specific effects and reactions that occur due to frequent use of tamiflu and alcohol depend on whether you consume more alcohol in relation to tamiflu or more tamiflu in relation to alcohol.

 

The use of significantly more tamiflu with alcohol will lead to sedation and lethargy, as well as the synergistic effects resulting from a mixture of the two medications.

 

People who take both alcohol and tamiflu may experience effects such as:

 

  • reduced motor reflexes from tamiflu and alcohol
  • dizziness from alcohol and tamiflu
  • nausea and vomiting of the tamiflu

 

Some people may also experience more euphoria, depression, irritability or all three. A combination of alcohol and tamiflu leads to significantly more lethargy which can easily tip over into coma, respiratory depression seizures and death.

Alcohol Vs tamiflu

 

Taking tamiflu in sufficient quantities increases the risk of a heart failure. Additionally, people under the influence of tamiflu and alcohol may have difficulty forming new memories. With alcohol vs tamiflu in an individual’s system they become confused and do not understand their environment. Due to the synergistic properties of tamiflu when mixed with alcohol it can lead to confusion, anxiety, depression and other mental disorders. Chronic use of tamiflu and alcohol can lead to permanent changes in the brain.

 

tamiflu Vs alcohol

 

Studies investigating the effects of drugs such as tamiflu and alcohol have shown that the potential for parasomnia (performing tasks in sleep) is dramatically increased when tamiflu and alcohol are combined. Severe and dangerous side effects can occur when medications are mixed in the system, and sleep disorders are a common side effect of taking alcohol and tamiflu together.

When a small to medium amount of alcohol is combined with tamiflu, sleep disorders such as sleep apnea can occur. According to the latest data from the US Centers for Disease Control and Prevention (CDC) most ER visits and hospitalizations caused by too much alcohol were associated with other substances such as tamiflu.

 

How long after taking tamiflu can I drink alcohol

 

To avoid any residual toxicity it is advisable to wait until the tamiflu has totally cleared your system before drinking alcohol, even in small quantities.

 

Overdose on tamiflu and alcohol

 

Overdose on tamiflu and alcohol is alarmingly common and can often be fatal. In the case of Overdose on tamiflu or if you are worried after mixing {Drug and alcohol} call a first responder or proceed to the nearest Emergency Room immediately. If you are worried about someone who has taken too much tamiflu or mixed alcohol with tamiflu then call a first responder or take them to get immediate medical help. The best place for you or someone you care about in the case of a medical emergency is under medical supervision. Be sure to tell the medical team that there is a mix of tamiflu and alcohol. The combination of alcohol and tamiflu increases the likelihood that a person would be transferred to intensive care.

 

tamiflu and Alcohol

Oseltamivir (Oral Route) Before Using

Before Using

Drug information provided by: IBM Micromedex

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Oseltamivir is not indicated to treat flu in children younger than 2 weeks of age nor to prevent flu in children younger than 1 year of age. Safety and efficacy have not been established.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of oseltamivir in the elderly.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Other Interactions

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:


  • Heart disease or

  • Illnesses caused by viruses other than influenza Type A or B or

  • Liver disease, severe or

  • Lung disease or

  • Serious medical problems that may need admission to a hospital or

  • Weakened immune system—Safety of this medicine for people with these conditions is not established.

  • Hereditary fructose intolerance—Use with caution. The oral suspension contains sorbitol, which can make this condition worse.

  • Kidney disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.
  • Description and Brand Names
  • Proper Use

Portions of this document last updated: Feb. 01, 2021

Copyright © 2021 IBM Watson Health. All rights reserved. Information is for End User’s use only and may not be sold, redistributed or otherwise used for commercial purposes.


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A Sigh of Relief About Treating Influenza in Individuals With Alcohol-Use Disorders?

Alcohol Clin Exp Res. Author manuscript; available in PMC 2011 Aug 19.

Published in final edited form as:

PMCID: PMC3158446

NIHMSID: NIHMS316200

David M.

Guidot

Emory University School of Medicine (DMG), Whitehead Biomedical Research Bldg, Atlanta, Georgia

David M. Guidot, Emory University School of Medicine (DMG), Whitehead Biomedical Research Bldg, Atlanta, Georgia;

Reprint requests: David M. Guidot, MD, Emory University School of Medicine, Whitehead Biomedical Research Bldg, 615 Michael Street, Suite 205-M, Atlanta, GA 30322; Fax: 404-712-2974; [email protected]

The recent outbreak of so-called “swine flu,” or influenza caused by an h2N1 strain of the influenza A virus, has renewed the public fear (as well as within the medical community) about pandemic influenza. However, we must all remember that seasonal epidemic influenza has always been a serious public health concern. For example, an average of more than 41,000 per year died of influenza in the United States alone between 1979 and 2001 (Dushoff et al., 2006). Although annual vaccinations remain the foundation of public health efforts to limit the severity of seasonal epidemics, many unvaccinated individuals are either exposed to the virus or present with frank influenza illness and are treated with neuraminidase inhibitors such as oseltamivir (trade name Tamiflu) to reduce symptoms and/or transmission of the virus (Moscona, 2005). Although it has long been known that individuals with chronic alcohol-use disorders are at increased risk of a wide variety of community-acquired lung infections, there are no specific studies that have examined the role of alcohol-use disorders on the risks of acquiring and/or spreading influenza. However, studies in animal models have raised concerns; in particular, a study by Legge and colleagues showed that chronic alcohol consumption increased the mortality of influenza infection in a murine model (Meyerholz et al., 2008). In parallel, our group has shown that chronic alcohol ingestion increases the severity of acute edematous lung injury by impairing the normal epithelial barrier in the lung and placing an increased burden on the active transport of sodium and water from the airways to keep the airspaces dry (Guidot et al., 2000; Otis et al., 2008). In parallel, we also determined that the influenza virus interferes with this active fluid transport in the lung (Chen et al., 2004). Taken together, these experimental findings suggest that even otherwise healthy individuals with a chronic alcohol-use disorder could be at increased risk of acute edematous lung injury and death from influenza. Unfortunately, these subjects are also less likely to receive annual vaccinations, and therefore, their survival could depend on the ability of drugs such as oseltamivir to limit the acute illness.

In this regard, the findings by Legge and colleagues (Langlois et al.) in the current issue provide some cautious optimism from their murine model that, at least in otherwise healthy subjects with underlying chronic alcohol use, oseltamivir might remain effective in limiting the severity of acute influenza illness. Specifically, mice given ethanol for 8 weeks in their drinking water and then inoculated with influenza virus had a 60% mortality when compared to a 15% mortality in control mice. In contrast, oseltamivir treatment markedly decreased morbidity and completely prevented any mortality in both control and ethanol-treated mice. Consistent with the elimination of mortality, oseltamivir decreased viral shedding and lung inflammation in both groups. Although one must obviously interpret these experimental findings cautiously, this study suggests that neuraminidase inhibitors retain their ability to limit the severity of acute influenza pneumonia even in the context of chronic alcohol ingestion. Although it appears for now that the extent and severity of the current h2N1 epidemic has been far less than initially feared, public health officials and clinicians can never drop their guard as epidemic seasonal influenza and intermittent (and unpredictable) pandemics are inevitable. For now, this new study suggests we can remain hopeful that antiviral drugs used to limit the spread of influenza in unvaccinated individuals will retain their efficacy even for those who suffer from chronic alcohol-use disorders.

References

  • Chen XJ, Seth S, Yue G, Kamat P, Compans RW, Guidot D, Brown LA, Eaton DC, Jain L. Influenza virus inhibits ENaC and lung fluid clearance. Am J Physiol Lung Cell Mol Physiol. 2004;287:L366–L373. [PubMed] [Google Scholar]
  • Dushoff J, Plotkin JB, Viboud C, Earn DJ, Simonsen L. Mortality due to influenza in the United States – an annualized regression approach using multiple-cause mortality data. Am J Epidemiol. 2006;163:181–187. [PubMed] [Google Scholar]
  • Guidot DM, Modelska K, Lois M, Jain L, Moss IM, Pittet JF, Brown LA. Ethanol ingestion via glutathione depletion impairs alveolar epithelial barrier function in rats. Am J Physiol Lung Cell Mol Physiol. 2000;279:L127–L135. [PubMed] [Google Scholar]
  • Meyerholz DK, Edsen-Moore M, McGill J, Coleman RA, Cook RT, Legge KL. Chronic alcohol consumption increases the severity of murine influenza virus infections. J Immunol. 2008;181:641–648. [PMC free article] [PubMed] [Google Scholar]
  • Moscona A. Neuraminidase inhibitors for influenza. N Engl J Med. 2005;353:1363–1373. [PubMed] [Google Scholar]
  • Otis JS, Mitchell PO, Kershaw CD, Joshi PC, Guidot DM. Na,K-ATPase expression is increased in the lungs of alcohol-fed rats. Alcohol Clin Exp Res. 2008;32:699–705. [PMC free article] [PubMed] [Google Scholar]

Synaptic and Behavioral Interactions of Oseltamivir (Tamiflu) with Neurostimulants

Hum Exp Toxicol. Author manuscript; available in PMC 2009 Mar 12.

Published in final edited form as:

PMCID: PMC2654582

NIHMSID: NIHMS90183

Yukitoshi Izumi

1) Washington University, School of Medicine, Department of Psychiatry, St. Louis, MO

Kazuhiro Tokuda

1) Washington University, School of Medicine, Department of Psychiatry, St. Louis, MO

Kazuko A O’Dell

1) Washington University, School of Medicine, Department of Psychiatry, St. Louis, MO

Charles F Zorumski

1) Washington University, School of Medicine, Department of Psychiatry, St. Louis, MO

Toshio Narahashi

2)Northwestern University, Feinberg School of Medicine, Department of Molecular Pharmacology and Biological Chemistry, Chicago, IL

1) Washington University, School of Medicine, Department of Psychiatry, St. Louis, MO

2)Northwestern University, Feinberg School of Medicine, Department of Molecular Pharmacology and Biological Chemistry, Chicago, IL

All correspondence should be to: Yukitoshi Izumi, MD., Ph.D. Department of Psychiatry Washington University School of Medicine Box 8134 660 S Euclid Avenue St. Louis, MO 63110 E-Mail: [email protected] Phone: 1-314-747-2987 Fax: 1-314-747-2983The publisher’s final edited version of this article is available at Hum Exp ToxicolSee other articles in PMC that cite the published article.

Abstract

Oseltamivir (Tamiflu), a neuraminidase inhibitor, is widely used for treatment of influenza. Because abnormal behaviors have been observed in some Japanese teenagers following oseltamivir use, its safety has been questioned. Oseltamivir is known to alter neuronal function and behavior in animals, particularly when administered in combination with ethanol. Based on this, we hypothesized that interactions of oseltamivir with other drugs may result in altered CNS excitability. We found that injection of ephedrine and caffeine overcame inactivity induced by oseltamivir and ethanol but did not alter changes in novelty seeking behavior in a Y-maze test. In ex vivo hippocampal slices, oseltamivir carboxylate (OTC), an active form of oseltamivir, alters excitability in the absence of ethanol. In slices pretreated with OTC, long-term depression (LTD), a form of synaptic plasticity that is correlated with Y-maze performance was not altered if caffeine or ephedrine was administered individually. However, LTD could not be induced in slices pretreated with OTC if caffeine and ephedrine were administered simultaneously. These observations suggest that combination of oseltamivir with other neurostimulants may alter synaptic plasticity and this may contribute to behavioral changes associated with the drug.

Keywords: Tamiflu, oseltamivir, long-term depression, ephedrine, caffeine, avian influenza

Introduction

The outbreak of bird flu (highly pathogenic avian influenza A caused by H5N1 and H9 N2 strains) may kill millions of people worldwide if the infection spreads by human-to-human contact. 12 Because oseltamivir (Tamiflu®), an antiviral agent that acts as a neuraminidase inhibitor, may be effective in treating avian influenza,34 governments of multiple countries are storing the drug to minimize the risk of outbreak. However, the safety of oseltamivir has been questioned based on accidental deaths and behavioral changes following its use by young people including teenagers in Japan.56 Sudden death of infants has also been reported after use of oseltamivir. These deaths may have resulted from influenza-associated encephalopathy but questions about the safety of oseltamivir have arisen in Japan where oseltamivir was commonly prescribed until last year. Although there are a few reports to conclude that a causal relationship between oseltamivir use and the abnormal behaviors or accidental deaths are less likely,78 the United States Food and Drug Administration (FDA) issued a stronger psychiatric warning about oseltamivir in 2008. 9

Oseltamivir is metabolized to oseltamivir carboxylate (OTC)10 and other metabolites in the body.11 Sialic acid, which may inhibit cellular adhesion, is cleaved by neuraminidase. Thus, it is speculated that neuraminidase, which is blocked by OTC, may play important roles in the central nervous system (CNS) function, including neuronal development and impulse conduction. 1214 Whereas treatment of hippocampal neurons with neuraminidase increases seizure threshold, its blockade decreases seizure threshold, suggesting that endogenous neuraminidase participates in the regulation of neuronal activity. 15 Furthermore, it has been shown that neuraminidase activity in the hippocampus is increased during seizures.16 Taken together, these results suggest that OTC could have effects on the CNS and thus play a role in behavioral changes.

We previously examined behavioral and neurophysiological effects of oseltamivir and OTC in rat hippocampal slices and found that propagation of excitatory synaptic inputs from dendrites to cell bodies is enhanced by oseltamivir and OTC. 17 In hippocampal slices, it has also shown that oseltamivir and OTC induced spike bursts through neuronal synchronization.18 Although it has been claimed that oseltamivir does not enter the brain, high doses cause brain damage in animals,19 and a recent study has shown that oseltamivir does cross the blood brain barrier (BBB).20 It has been shown that systemic administration of oseltamivir causes hypothermia in mice21 and increases dopamine release from the prefrontal cortex in rats,22 indicating that systemically administered oseltamivir reaches the CNS to alter neuronal function. We previously observed that loss of righting reflex (LORR) in rats following injection of ethanol was diminished by pretreatment with oseltamivir, suggesting that oseltamivir has neurological actions when administered with other agents.17

In light of this, it is important to note that patients typically take antiviral agents with other CNS-active drugs, including stimulants like caffeine and ephedrine, as well as alcohol. In Japan, where most problems with oseltamivir have been reported, alcohol use among teenagers is relatively common, though use of other abused drugs is less frequent.23 Furthermore, BBB permeability to OTC could be enhanced by the presence of alcohol, a solvent that is known to increase BBB permeability to other agents.24 Caffeine is also routinely ingested and Ephedra (Mahuang) is often prescribed to treat flu-like symptoms in Japan. Thus, it is possible that the putative neuropsychiatric effects of oseltamivir occur as a result of interactions with other CNS-active agents.

The primary aim of the present study is to determine whether oseltamivir has adverse CNS interactions when administered with other agents used to treat flu-like symptoms. Such findings could help to establish a safety profile for using oseltamivir and other neuraminidase inhibitors to manage viral infections. In this study, we examined interactions of oseltamivir and ethanol in combination with caffeine and ephedrine in a rat behavioral test using a Y-maze. Because prior studies have idicated that Y-maze performance is correlated with synaptic long-term depression (LTD),2527 we also examined drug interactions on LTD in rat hippocampal slices, a preparation that allows direct examination of how drugs influence neuronal function. In this ex vivo study where we can apply drugs directly at known concentrations, we used OTC instead of oseltamivir, because we previously observed that in hippocampal slices OTC is more potent than its prodrug oseltamivir.17 Because OTC has effects in slices in the absence of ethanol, we specifically focused on the interactions of OTC with ephedrine and caffeine.

Materials and Methods

Animals

All experiments were performed in accordance with the guidelines of the Washington University Animal Study Committee. Every effort was made to minimize the number of animals used and their suffering in all experimental procedures. Male Spague-Dawley rats obtained from Harlan (Indianapolis, IN, USA) at postnatal date (PND) 23 were reared with a cycle of 12 hours white light and 12 hours dim light until experiments.

Behavioral studies and drug injections

The first trial experiment was done to determine the effects of treating rats (postnatal day 28-33) with a combination of oseltamivir, ephedrine and caffeine. In this experiment oseltamivir (2% volume of body weight, 50 mg/kg, i.p.) or the same volume of saline was followed in 2 hours by simultaneous intraperitoneal injection (0.3% volume of body weight) of caffeine (30 mg/kg) and ephedrine (30 mg/kg) in saline at an interval of 2 hours.

In subsequent studies, spontaneous alternation behavior was examined using a Y-maze as previously described.2627 In this test, a rat was placed in the center of a maze with three arms that were 95 mm wide, 636 mm long and 240 mm deep at angles of 120° with respect to each other. Rats were allowed to explore the apparatus for up to 10 min and entry into an arm was counted only when the hind limbs completely entered the arm. An alternation was defined as any three consecutive choices of three different arms without re-exploration of a previously visited arm. The percentage of alternations was determined by dividing the total number of alternations by the total number of choices minus 2.27 The number of completed alternations was determined by counting the number of times that the rats successively entered each of the three arms of the maze without reentering a previously visited arm in first 12 entries or in 10 min, whichever came first. Thus, the highest score possible on this measure is 10. Y –maze tests were video-taped.

The initial Y-maze test was performed 1-2 hours after transfer of rats from the animal care facility. After the initial Y-maze test, ethanol (1.0 g/kg, i.p. as 26% v/v in saline) or ethanol then oseltamivir in saline (2% volume of body weight, 45 min apart) was administered (i.p.) to albino rats (postnatal day 30 ± 2) at an interval of 2 hours. After these injections, the Y–maze test was repeated. The third Y-maze test was done 20 min after simultaneous intraperitoneal injection (0.3% volume of body weight) of caffeine (30 mg/kg) and ephedrine (30 mg/kg).

Hippocampal Slice Electrophysiology

Naïve rats (postnatal date 28-35) were anesthetized with isoflurane and decapitated. Hippocampi were rapidly dissected, placed in artificial cerebrospinal fluid (ACSF) containing (in mM): 124 NaCl, 5 KCl, 2 MgSO4, 2 CaCl2, 1.25 NaH2PO4, 22 NaHCO3, 10 glucose, gassed with 95% O2-5% CO at 4-6°C, and cut transversely into 400 μm slices using a vibratome. Slices were prepared from the septal half of the hippocampus and were placed in an incubation chamber containing gassed ACSF for 1 hr at 30 °C. ACSF was perfused at 2 ml/min. At the time of experiment, slices were transferred individually to a submersion recording chamber. Experiments were done at 30 °C.

Extracellular recordings were obtained from the apical dendritic region for analysis of population excitatory postsynaptic potentials (EPSPs) using 2 M NaCl glass electrodes with resistances of 5-10 MΩ. Evoked synaptic responses were elicited with 0. 2 msec constant current pulses through a bipolar electrode placed in the Schaffer collateral-commissural pathway. Synaptic responses in CA1 were monitored by applying single stimuli to the Schaffer collateral pathway every 60 sec at an intensity sufficient to elicit 50% maximal EPSPs. After establishing a stable baseline for at least 10 min and a control input-output (IO) curve, LTD or LTP was induced by applying low frequency stimulation (LFS) consisting of 900 individual pulses at 1 Hz (LTD) or high frequency stimulation (HFS) consisting of a single 100 Hz × 1 sec stimulus train (LTP) using pulses of the same amplitude. Following LFS and HFS, responses were monitored every 60 sec for 60 min.

Chemicals

The test solution of oseltamivir was prepared by dissolving a Tamiflu tablet (75 mg) in saline. OTC was obtained from Toronto Research Chemicals Inc. (North York, ON, Canada).Other chemicals were obtained from Sigma-Aldrich (St. Louis, MO, USA).

Statistics

Statistical analyses were done in SigmaStat (Jandel Scientific Software, San Rafael, CA, USA). ANOVA test was used for analysis of results from the Y-maze test. Results from LTD studies were analyzed with Student’s t-test or Mann Whitney U-test where appropriate. Chi-square test was used for analysis of occurrence of odd behaviors.

Results

As previously reported, injection of oseltamivir alone in rats did not induce abnormal patterns of behavior.17 Because CNS stimulants such as ephedra and caffeine are often taken by flu patients in Japan, ephedrine (30 mg/kg) and caffeine (30 mg/kg) were injected simultaneously into 12 rats housed in four separate cages. Administration of both agents caused hyperactivity, including hopping, darting and sweating lasting over 30 min. While sweating may be unusual in rodents, we observed that drug-treated animals developed a wet appearance of their fur beginning in the neck region and eventually covering their entire body. No abnormal behaviors were noticed subsequently. Another group of 12 rats was pretreated with oseltamivir (50 mg/kg) and showed similar hyperactivity immediately after injection of ephedrine and caffeine. Interestingly, two of these 12 rats attempted to mount other cage mates 2-3 hours after injection. This behavior was observed even though other hyperactive behaviors had diminished. However, no significant difference in the number of affected animals was detected with a Chi-square test compared to 12 control rats. Mounting was not observed in rats treated with ephedirine alone (N=11) or caffeine alone (N=11) after oseltamivir injection.

In subsequent studies, we examined spontaneous alternation behavior in a Y-maze. For these studies, rats were studied individually. The Y-maze test provides a measure of novelty seeking and exploratory behavior.27 When placed at the center of the Y-maze, control rats typically checked the arms of the maze in an alternating fashion without re-exploring previously visited arms, and routinely entered the arms of the maze 12 times within a 10 min observation period. Y-maze performance was not altered when the test was repeated 2 to 3 hours after injection of oseltamivir (50 mg/kg) alone. Similarly, the number of arm entries and the alternation score were not altered after simultaneous injection of ephedrine and caffeine (30 mg/kg each) after oseltamivir treatment.

Because we previously observed additive effects of ethanol and oseltamivir in an animal behavioral study,17 we treated rats with oseltamivir and ethanol. When oseltamivir was administered 40 min after injection of ethanol (1.0 g/kg), rats exhibited diminished overall activity, resulting in a decreased number of arm entries in the Y-maze (, 6.8 ± 1.8 vs 12 times, only 2 out of 6 rats achieved 12 arm entries within 10 min). Although the four rats that failed to achieve 12 arm entries initially groomed themselves when they were put in the Y-maze, they subsequently became immobile with widely opened ears and ceased self grooming. Because of this limited activity, the number of alternating arm entries was also reduced (). However, the Y-maze score, the ratio of alternative arm entries compared to the total number of entries of active rats, was not reduced (triangles in , only two of six rats entered the arms 12 times within 10 minutes, so the last Y-maze score of 7 comes from these 2 rats). In rats pretreated with ethanol and oseltamivir, subsequent injection of ephedrine and caffeine resulted in no decrease in activity and restored the number of arm entries (12 times in 10 min for all 6 rats) (right bar in the right cluster of ). Interestingly, these rats entered the arms of the maze randomly and the Y-maze score remained low ( and squares in ; Y-maze score; 7.5 ± 0.3 before and 3.8 ± 0.7 after treatment). In rats treated with ethanol alone, the number of arm entries and the Y-maze score were not altered (left cluster of histograms in , triangles in ). In these rats, the Y-maze parameters were not altered following injection of ephedrine and caffeine (Squares in ).

The graphs show effects of systemic treatment of male rats (postnatal date 29-32) with a non-sedating dose of ethanol (1.0 g/kg, i.p.) (left cluster of bars), oseltamivir (50 mg/kg, i.p.) (center) or both (right) on spontaneous alternation in a Y-maze for up to 10 min. Two hours after treatment with oseltamivir and/or ethanol, ephedrine (30 mg/kg) and caffeine (30 mg/kg) were simultaneously injected (right bars in each bar cluster). Rats were exposed to the Y-maze three times; before treatment with oseltamivir and/or ethanol, and 40 min after injection of ethanol alone or 2 hours after injection of oseltamivir, and 40 min after injection of ephedrine and caffeine. Panel A depicts the total numbers of entries into arms of the Y-maze (up to 12) in 10 min and is a measure of activity in the task. Rats treated with ethanol 40 min prior to the treatment with oseltamivir show decreased activity in the maze (right purple column in A) * P<0.05 against control before treatment. Panel B depicts the number of completed alternations in the Y-maze, defined as successive entry into each of the three arms of the maze without reentry into a previously visited arm. Rats treated with ethanol 40 min prior to the treatment with oseltamivir also showed impaired performance compared with ethanol alone treated rats after injection of ephedrine and caffeine (right green column in B).. ++ P<0.01 against control Y-maze score obtained before treatment. Panel C-E show again the effects of systemic treatment of male rats with ethanol (1.0 g/kg, i.p.) alone (C), or oseltamivir (50 mg/kg, i.p.) alone (D) or both (E) on spontaneous alternation in the Y-maze for up to 10 min. Rats were placed in the Y-maze three times: before treatment (open circles), 40 min after injection of ethanol alone or 2 hours after injection of oseltamivir (triangles), and 40 min after injection of ephedrine and caffeine (squares). In rats pretreated with ethanol and oseltamivir, injection of ephedrine and caffeine results in poor performance in the Y-maze (squares in E). *P<0.05 by one way ANOVA test.

Because Y maze scores are correlated with LTD in the hippocampus,2527 we examined the effects of OTC, an active metabolite of oseltamivir, on LTD induction in the CA1 region. Oseltamivir is metabolized to OTC in the brain after passing the BBB,20 and we previously found that OTC is more potent than oseltamivir in causing paired pulse facilitation of population spikes. This enhanced excitability results from altered dendritic propagation in hippocampal slices and does not require the presence of ethanol.17 In the following study, therefore, slices were pretreated with 3 μM OTC for 2 hours prior to delivery of low frequency stimulation (LFS) consisting of 900 pulses at 1Hz. In the pretreated slices, LTD was successfully induced without any significant difference from LTD in naïve slices (, EPSP slope 60 min after LFS; 71.0 ± 4.7% of control in pretreated slices, N=5, and 67.1 ± 1.5% in naïve slice, N=5). In pretreated slices, LTD was also induced when LFS was delivered in the presence of 100 μM caffeine (squares in , EPSP slope 60 min after LFS; 80.7 ± 3.9 % in caffeine, N=5) or 100 μM ephedrine (circles in , EPSPS slope; 60.4 ± 9.3 % in ephedrine, N=5). However, LTD was not induced in OTC pretreated slices when LFS was delivered in the presence of both caffeine and ephedrine (, EPSP slope 60 min after LFS; 100.9 ± 3.6%, N=5, P<0. 01 vs. control LTD in both naïve and pretreated slices). In contrast, LTD was induced in the presence of both agents in naïve slices (, EPSP slope 60 min after LFS; 76.9 ± 5.4 %, N=5). Neither OTC alone nor the combination of OTC, caffeine and ephedrine had an effect on induction of LTP induced by a single 100 Hz × 1 sec high frequency stimulation (HFS) (EPSP slope 60 min after HFS; 140.1 ± 4.5 % in slices treated with OTC alone, N=5; 138.8 ± 1.0%, N=3, in the presence of OTC, caffeine and ephedrine, data not shown).

Impaired induction of hippocampal LTD with ephedrine and caffeine in slices pretreated with 3 μM oseltamivir carboxylate (OTC). (A) Time courses of change in EPSPs in the CA1 region following LFS (arrows) in naïve slices (open circles) and slices treated with OTC (filled squares) (N=5, each) are similar, suggesting that oseltamivir alone does not alter LTD. (B) Simultaneous administration of 100 μM ephedrine and 100 μM caffeine inhibits LTD in slices pretreated with OTC (filled squares) but not in naïve slices (open circles) (N=5 in each). (C) In slices pretreated with OTC, caffeine alone (squares) or ephedrine alone (circles) failed to inhibit LTD induction. However, the inhibition was only partial with caffeine. Note that filled symbols in each graph denote pretreatment with OTC. *P<0.05, ** P<0.01 by Student’s t-test and #P<0.05 by Mann Whitney U-test against oseltamivir alone. In panel B, +P<0.05, ++ P<0.01 by Student t-test and &&P<0.01 by Mann Whitney U-test against ephedrine plus caffeine without oseltamivir. Traces to the right depict EPSPs obtained before (solid line) and 60 min after (dotted line) LFS . Scales; 1 mV, 5 msec.

Discussion

The present study shows that administration of a non-sedating dose of ethanol in combination with oseltamivir resulted in diminished behavioral activity and poor locomotion in rats. Evaluation of the changes in behaviors is difficult but the pattern of response in the alternation task may represent a form of anxious or fearful behavior as manifest by altered exploration. 28 This behavioral restraint may result from risk assessment, the first line of defense against a threat, and appears as a decrease in environmental exploration and locomotion. Some rats were simply immobile without self grooming, also suggesting an augmented risk assessing behavior.29 Immobility (freezing) is also thought to be a second level of defense, and may involve assessment of a perceived threat from an undetermined source. If this is the case, random movement after injection of caffeine and ephedrine, which results in the impaired Y-maze performance, may represent a form of flight from an unknown threat as a third level of defense rather than environmental exploration. This may also reflect a form of a behavioral agitation.

It is also possible that oseltamivir alters cognitive processes maintained through synaptic plasticity. Of importance is that oseltamivir, when combined with CNS stimulants, clearly impairs Y-maze performance. Thus, the random movements observed may have features similar to abnormal and agitated behaviors reported in humans following oseltamivir ingestion. Previous studies have indicated that Y-maze scores are correlated with induction of LTD, a form of hippocampal synaptic plasticity that may contribute to novelty-seeking behaviors.27 We previously showed that administration of ethanol inhibits both LTD and Y-maze performance.26 Impairment of LTD induction by the combination of OTC and CNS stimulants, which was observed in the present study, suggests that the combination of drugs affects the synaptic plasticity that may underlie this form of cognitive processes. It is also possible that the combination changes synaptic function and plasticity in other than regions of the CNS resulting in more profound changes in behavior.

Intentionally or unintentionally, patients with flu may consume CNS stimulants and other drugs. Alcohol, for example, is commonly used socially and may be ingested to relieve some flu-like symptoms by young teenagers.23 Caffeine and related compounds are often included in soft drinks, nutritional supplements and common cold regimens. 30 In Japan, ephedra is often taken by flu patients as part of a prescription of Chinese herbal medications that are thought to have antiviral effects.31 Importantly, herbs such as Mahuang (ephedra) are not free from adverse effects.32 Just as with oseltamivir, suicides have been reported with abuse of ephedra.31 Thus, it is possible that oseltamivir results in enhanced stimulant actions in the CNS and agitated behavior when combined with other stimulants. It is also possible that the interactions are more complicated during viral infections when there may be changes in the integrity of the BBB.3435 It has been reported that P-glycoprotein at the BBB plays an important role in accumulation of oseltamivir in the CNS.20 In P-glycoprotein knock-out mice oseltamivir concentration in the cerebrospinal fluid (CSF) is 5.5 fold higher.36 Moreover, it was previously described that brain levels of oseltamivir were 1500 times those of adult animals exposed to the same dose. 19 The accumulated oseltamivir is likely converted to OTC in the CNS. Although it has been reported that OTC concentrations in the CSF in adult healthy volunteers administered 150 mg oseltamivir reach only about 0.1 μM,37 much higher levels are expected if the BBB is immature or impaired.

The relation between use of oseltamivir and abnormal behaviors remain uncertain. It also remains unclear why these abnormal behaviors occurred primarily in Japan. This may simply reflect the frequency with which oseltamivir is used to treat influenza in Japan while oseltamivir use in the United States in relatively less common. We hypothesize that the combination of oseltamivir with CNS stimulants and/or alcohol could play a role in producing abnormal behaviors and accidental deaths. However, it is also possible that genetic variation resulting in reduced sialidase activities, which is detected in only some Asians, may account for the adverse effect of oseltamivir.38 Taken together, these observations suggest that multiple factors are likely to contribute to the adverse effects of oseltamivir. 39 The present study suggests that oseltamivir, if combined with common neurostimulants, may alter a specific form of synaptic plasticity in the CNS; in turn, this could contribute to some of behaviors changes reported after use of oseltamivir. Further investigations, especially neurochemical analyses, will be required to elucidate the interactions of oseltamivir with other agents. This information will be important for determining the conditions under which antiviral agents can be used safely in humans given the potential need for widespread use of these drugs in event of an avian flu pandemic.

Acknowledgments

This work was supported in part by NIH grants MH77791, Neuroscience Blueprint Grant NS057105 and the Bantly Foundation.

References

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Tamiflu – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Oseltamivir belongs to the family of medications called antivirals. It is used to treat the influenza viruses that cause the flu. It works by inhibiting an enzyme the flu virus needs to spread through your body. If it is used within 2 days of the start of flu symptoms, oseltamivir can reduce the time it takes for flu symptoms to improve by about one day.

Oseltamivir is also used to prevent influenza following close contact with an infected person.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Capsules

30 mg
Each light yellow, hard gelatin capsule for oral use, with “ROCHE” printed in blue ink on the light yellow body and “30 mg” printed in blue ink on the light yellow cap, contains oseltamivir 30 mg as oseltamivir phosphate. Nonmedicinal ingredients: corn starch, croscarmellose sodium, povidone K30, sodium stearyl fumarate, and talc; shell: gelatin, red iron oxide, yellow iron oxide, and titanium dioxide. Each capsule is printed with blue ink, which includes FD&C Blue No. 2 as a colorant.

45 mg
Each grey, hard gelatin capsule for oral use, with “ROCHE” printed in blue ink on the grey body and “45 mg” printed in blue ink on the grey cap, contains oseltamivir 45 mg as oseltamivir phosphate. Nonmedicinal ingredients: corn starch, croscarmellose sodium, povidone K30, sodium stearyl fumarate, and talc; shell: gelatin, black iron oxide, and titanium dioxide. Each capsule is printed with blue ink, which includes FD&C Blue No. 2 as a colorant.

75 mg
Each grey/light yellow, hard gelatin capsule for oral use, with “ROCHE” printed in blue ink on the grey body and “75 mg” printed in blue ink on the light yellow cap, contains oseltamivir 75 mg as oseltamivir phosphate. Nonmedicinal ingredients: corn starch, croscarmellose sodium, povidone K30, sodium stearyl fumarate, and talc; shell: gelatin, black iron oxide, red iron oxide, yellow iron oxide, and titanium dioxide. Each capsule is printed with blue ink, which includes FD&C Blue No. 2 as a colorant.

Powder for oral suspension
Each bottle of white powder blend for reconstitution to a white tutti-frutti-flavoured suspension, contains oseltamivir 390 mg as oseltamivir phosphate, which when reconstituted contains 6 mg/mL oseltamivir. Net contents after reconstitution: 75 mL. Nonmedicinal ingredients: monosodium citrate, saccharin sodium, sodium benzoate, sorbitol, titanium dioxide, tutti-frutti flavouring, and xanthan gum.

How should I use this medication?

The recommended adult (13 years of age and above) dose of oseltamivir for treatment of influenza is 75 mg, taken twice a day starting within 2 days of the onset of flu symptoms and continuing for 5 days. It can be taken with or without food. If stomach upset occurs, take it with food.

For children (1 to 12 years) the dosage is based on the body weight of the child. The appropriate dose is taken twice a day.

To prevent influenza, oseltamivir should be started within 2 days of close contact with an infected person, after symptoms start appearing. The usual dose of oseltamivir for the prevention of influenza in adults is 75 mg, taken once a day for 10 days. The dosage for children is based on body weight, taken once a day. Children and seniors should take oseltamivir for at least 10 days, though they may often continue therapy for up to 14 days.

If you are using the liquid form of this medication, use an oral syringe to measure each dose, as it gives a more accurate measurement than household teaspoons. If the liquid is not available, the capsules may be opened and mixed with a small amount of a sweetened liquid, such as chocolate syrup.

Finish all this medication, even if you have started to feel better.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children. The oral suspension may be stored at room temperature for 10 days from the day of mixing, or in the refrigerator for 17 days from the day of mixing.  Shake well before each use.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you are allergic to oseltamivir or any ingredients of the medication.

Do not give this medication to children less than 1 year old.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • cough
  • diarrhea
  • dizziness
  • fatigue
  • headache
  • heartburn
  • nausea
  • trouble sleeping
  • vomiting

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • signs of liver damage (e.g., yellowing of skin or whites of eyes, abdominal pain, loss of appetite, dark urine, light-coloured stools, tiredness, or weakness)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • delirium, confusion, abnormal behavior leading to self-injury, delusions, hallucinations, agitation, anxiety, nightmares
  • seizure
  • symptoms of a severe allergic reaction such as rash, itching, flushing, swelling, breathing difficulties, facial edema, and dizziness
  • signs of a severe skin reaction (e.g., blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Effectiveness: The benefit of oseltamivir has not been evaluated for the treatment of flu symptoms that have been present for more than 2 days.

Flu shots: Oseltamivir is not a substitute for the flu shot. Continue to receive an annual flu shot as advised by your doctor.

Fructose intolerance: The liquid suspension form of this medication contains sorbitol, making it inappropriate for people with hereditary fructose intolerance. If you have fructose intolerance, you should not take the liquid form of oseltamivir. 

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Oseltamivir may also cause decreased liver function, and liver failure in rare cases. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Neurological effects: There have been rare reports of people who have experienced neurological and psychological problems while taking oseltamivir. These included hallucinations, delusions, delirium, abnormal behaviour, and self-injury. If you experience any of these symptoms, seek immediate medical attention. If you have any concerns about this medication, contact your doctor.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking oseltamivir, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. Mothers who are breast-feeding children under one year old should not take this medication.

Children: The safety and effectiveness of using this medication have not been established for children under one year of age.

What other drugs could interact with this medication?

There may be an interaction between oseltamivir and any of the following:

  • influenza virus nasal spray vaccine
  • clopidogrel
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Tamiflu

Oseltamivir – Yashoda Hospitals

1. How long does it take for Oseltamivir to work?

The Oseltamivir dose will be different in the case of prevention and treatment of the flu. On consumption, it gets well-absorbed in the stomach and attacks the virus by preventing its spread. Usually, most people experience flu symptoms for three to seven days. However, with Oseltamivir your recovery period will be reduced by a day or two.

2. Can you take Tylenol with Oseltamivir?

Yes, you can consume Tylenol with Oseltamivir. Tylenol is an acetaminophen type medicine that treats mild fever and several kinds of pain. To date, there are no interactions between both the medications, which is why it is considered safe. Before consuming any medicine with Oseltamivir, consult your doctor in detail.

3. Can you take Ibuprofen with Oseltamivir phosphate?

Yes, you can consume Ibuprofen with Oseltamivir phosphate. Ibuprofen relieves inflammation, pain and fever. Sometimes Oseltamivir causes nausea and upset GI that we can manage with a dose of Ibuprofen. There are no interactions between both medicines, but consult your doctor before consuming them together.

4. Is Oseltamivir safe?

Yes, Oseltamivir is a safe medicine to consume after a doctor’s prescription. If you overdose or take another medication with it, it can result in severe side effects. When taken in the correct dosage at the right time, it will show positive results. Always consult a doctor and talk about your medical history and all related things in detail.

5. Does Oseltamivir make you sleepy?

Patients that took Oseltamivir didn’t report sleepiness or drowsiness as a side effect. But, if you are feeling sleepy, it might be because of the virus. One of the symptoms of flu includes drowsiness that a lot of patients experience. If there’s anything that looks abnormal to you, consult your doctor.

6. Does Oseltamivir phosphate reduce a fever?

Yes, Oseltamivir phosphate reduces fever as a part of its effect on the flu symptoms. One of the usual symptoms of influenza A and B virus is fever. Oseltamivir hampers the spread of the virus and reduces symptoms like fever, stuffy nose, aches, joint pain, etc. If your fever doesn’t go away after the dose, talk to your doctor.

7. Can I drink alcohol while taking oseltamivir phosphate?

To date, there are no interactions between alcohol consumption and Oseltamivir. Doctors do not recommend alcohol during any sickness. Alcohol weakens your immune system and can adversely affect the side effects of the flu. If you have the flu and take Oseltamivir, avoid alcohol for a few days.

8. Is Oseltamivir the same as Tamiflu?

Yes, both Oseltamivir and Tamiflu are the same things. While Oseltamivir is a medicine composition, Tamiflu is the brand that sells it. You will see both the terms on any medicine pack. Besides, you might find other brands that sell Oseltamivir for flu symptoms.

9. How long does Oseltamivir stay in your system?

Oseltamivir is a fast-absorbent drug. After consumption, it is well-absorbed by the GI tract and converted into Oseltamivir Carboxylate (OC). After 30 minutes of an oral dose, we can detect OC in the blood. The peak levels of OC take about three to four hours in the body.

10. How much does Oseltamivir cost?

There are almost 12 brands that sell Oseltamivir 75 mg tablets in a pack of 10 tablets/capsules. These brands include OLSIVIR 75MG CAP, ANTIFLU 75MG CAP, TAMIFLU 75MG CAP, MCOSVIR 75GM CAP, etc. The cost of Oseltamivir may vary among each brand. The average price lies between Rs 400 and Rs 700 in India.

You can consult our doctors at Yashoda Hospitals if you have flu symptoms. Our doctors are just an appointment away to help you bid farewell to your problems.

90,000 tamiflu and alcohol | mixing alcohol and tamiflu

tamiflu and alcohol


What happens if you mix tamiflu and alcohol

Side effects from mixing tamiflu and alcohol can include:

  • Dizziness
  • Shortness of breath
  • Itchy
  • urticaria
  • Heartbeat
  • Respiratory depression
  • Cardiac arrest
  • Coma
  • Seizures
  • Death

It is interesting that it is impossible to tell a person what effect of alcohol from Tamif – for their own unique genetic makeup and tolerance.It is never recommended to mix Tamiflu and alcohol due to the potential for mild, moderate, and severe side effects. If you have an adverse reaction to mixing Tamiflu and alcohol, you should definitely contact your local emergency room.

Alcohol and Tamiflu

Alcohol and Tamiflu have different effects depending on the dose: many people feel agitated and aggravated by low doses of alcohol and Tamiflu, and even mixing small amounts of Tamiflu and alcohol is not recommended.

Mixing alcohol and tamiflu

The primary effect of alcohol is influenced by an increase in the concentration of the inhibitory neurotransmitter GABA, which is found in the spinal cord and brain stem, as well as a decrease in its effect on neuronal transmitters, which are excitatory. When alcohol is combined with Tamiflu, this primary effect is enhanced, increasing the stress on the body with unpredictable results.

Alcohol and Tamiflu affect dopamine levels in the brain, causing both mental and physical distress.Large amounts of Tamiflu and alcohol have more pronounced adverse effects, but the basic medical recommendation is that smaller doses can be just as harmful, and there is no way to know exactly how Tamiflu and alcohol will affect a person before they take it.

Taking Tamiflu and Alcohol Together

People who take Tamiflu and Alcohol together will experience the effects of both substances. Technically, the specific effects and reactions that arise from frequent use of Tamiflu and alcohol depend on whether you drink more alcohol than Tamiflu or more Tamiflu than alcohol.

Using significantly more Tamiflu with alcohol will lead to sedation and lethargy, as well as synergistic effects resulting from mixing the two drugs.

People taking alcohol and tamiflu at the same time may experience such effects as:

  • decreased motor reflexes from tamiflu and alcohol
  • dizziness from alcohol and tamiflu
  • nausea and vomiting Tamiflu
  • 842

    Some

    people may also experience great euphoria, depression, irritability, or all three.The combination of alcohol and tamiflu results in significantly more lethargy, which can easily turn into coma, attacks of respiratory depression, and death.

    Alcohol versus Tamiflu

    Taking enough Tamiflu increases the risk of heart failure. In addition, people under the influence of tamiflu and alcohol may have difficulty forming new memories. With alcohol versus Tamiflu in the human body, they get confused and don’t understand their surroundings.Because of the synergistic properties of Tamiflu, when mixed with alcohol, it can cause confusion, anxiety, depression and other mental disorders. Chronic use of Tamiflu and alcohol can lead to irreversible changes in the brain.

    Tamiflu against alcohol

    Studies examining the effects of drugs such as Tamiflu and alcohol have shown that the combination of Tamiflu and alcohol dramatically increases the likelihood of parasomnia (performing tasks while sleeping).Severe and dangerous side effects can occur when medications are mixed in the body, and sleep disorders are a common side effect of drinking alcohol and tamiflu at the same time.

    When a small to moderate amount of alcohol is combined with Tamiflu, sleep disturbances such as sleep apnea can occur. According to the latest data from the US Centers for Disease Control and Prevention (CDC), most emergency room visits and hospitalizations caused by excessive alcohol use have been linked to other substances, such as Tamiflu.

    How long after taking Tamiflu you can drink alcohol

    To avoid residual toxicity, it is recommended to wait until Tamiflu has completely cleansed your body before consuming alcohol, even in small amounts.

    Tamiflu and alcohol overdose

    Tamiflu and alcohol overdose is very common and often fatal. If you overdose with Tamiflu, or if you are worried after mixing {drug and alcohol}, call first aid or go to the nearest emergency room immediately.If you are worried about someone who has taken too much Tamiflu or mixed alcohol with Tamiflu, call the First Aid specialist or take him or her for immediate medical attention. The best place for you or your loved one in a medical emergency is medical observation. Be sure to inform the medical team that this is a mixture of Tamiflu and alcohol. The combination of alcohol and tamiflu increases the likelihood that a person will be transferred to intensive care.

    tamiflu and alcohol

    The Ministry of Health advised to stop taking alcohol for ARVI or influenza :: Society :: RBC

    Society ,

    15 Mar 2020, 14:19
    Made for aggregators

    0

    Photo: J.M. Guyon / CandyBox / Global Look Press

    In case of symptoms of acute respiratory viral infections or flu, you should stop drinking alcohol and consult a doctor. This was stated by the chief freelance specialist in therapy and general medical practice of the Ministry of Health of Russia Oksana Drapkina, according to the department’s website.

    “Under no circumstances should you drink alcohol for colds and flu, especially if you are treated with it,” Drapkina said. She explained that alcohol acts on the cardiovascular system and causes tachycardia and high blood pressure. In addition, drinking any kind of alcohol can cause an increase in blood pressure. “Few people know that even small doses of alcohol lead to a decrease in the level of some nutrients, in particular, vitamin b12, which is essential for maintaining basic body functions.Especially – for the normal functioning of brain neurons, ”said Drapkina, noting that alcohol greatly weakens the immune system.

    In December last year, therapist, clinical pharmacologist Andrei Kondrakhin reported that a serious mistake in the treatment of ARVI and influenza is the use of antibiotics unnecessarily. He noted ARVI and influenza are viral diseases, and it is impossible to kill the virus with antibiotics. These drugs are prescribed to treat bacterial infections.

    Oseltamivir Avexima instructions for use: indications, contraindications, side effects – description Oseltamivir Avexima caps.30 mg: 10 pcs. (54457)

    Capsules hard gelatin capsules No. “4”, light blue body and cap; the contents of the capsules are a mixture of granules and powder of white or almost white color, crumbling when lightly pressed.

    1 caps.
    oseltamivir phosphate 39.4 mg,
    which corresponds to the content of oseltamivir 30 mg

    Excipients : corn starch – 18.56 mg, povidone K30 – 2.68 mg, croscarmellose sodium – 1.36 mg, sodium stearyl fumarate – 0.68 mg, talc – 3.32 mg.

    Capsule shells: body and lid: titanium dioxide (E171), brilliant blue (E133), azorubin (E122), gelatin.

    10 pcs. – contour cell packaging (1) – cardboard packs.
    10 pcs. – cans (1) – packs of cardboard.


    Capsules hard gelatin capsules No. “4”, blue body and cap; the contents of the capsules are a mixture of granules and powder of white or almost white color, crumbling when lightly pressed.

    1 caps.
    oseltamivir phosphate 59.1 mg,
    which corresponds to the content of oseltamivir 45 mg

    Excipients : corn starch – pregelatinized sodium 4 mg. mg, sodium stearyl fumarate – 1.02 mg, talc – 4.98 mg.

    Capsule shell: body and lid: titanium dioxide (E171), charming red (E129), quinoline yellow (E104), brilliant blue (E133), gelatin.

    10 pcs. – contour cell packaging (1) – cardboard packs.
    10 pcs. – cans (1) – packs of cardboard.


    Capsules hard gelatin capsules No. “2”, blue body and cap; the contents of the capsules are a mixture of granules and powder of white or almost white color, crumbling when lightly pressed.

    1 caps.
    oseltamivir phosphate 98.5 mg,
    which corresponds to the content of oseltamivir 75 mg

    Excipients : corn starch – 46.4 mg, povidone K30 – 6.7 mg, croscarmellose sodium – 3.4 mg, sodium stearyl fumarate – 1.7 mg, talc – 8.3 mg.

    Capsule shell: body and lid: titanium dioxide (E171), black iron oxide (E172), brilliant blue (E133), gelatin.

    10 pcs. – contour cell packaging (1) – cardboard packs.
    10 pcs. – cans (1) – packs of cardboard.

    Clinical study Bioequivalence: Oseltamivir Phosphate 75 mg capsules, Tamiflu 75 mg capsules – Clinical Trials Register

    Intervention

    Intervention type:

    Drug

    Intervention name:

    Oseltamivir Phosphate 75 mg capsules

    Description:

    Capsules, 75 mg, single, oral dose

    Arm Group label:

    Oseltamivir Phosphate 75 mg capsules (Yangtze River)

    Intervention type:

    Medicine

    Intervention name:

    Tamiflu capsules 75 mg

    Description:

    Capsules, 75 mg, single dose, oral

    Arm Group label:

    Tamiflu 75 mg capsules (Genentech, Inc.)

    Eligibility

    Criteria:

    Inclusion criteria: – Subjects’ weights are within normal limits in accordance with normal body mass index values. (From 18.50 to 30.00 kg / m2) with a minimum weight of 50 kg. – Subjects with a hemoglobin level ≥ 11.5 g% at the time of screening. – Subjects with normal health, personal medical history and treatment, clinical examination and laboratory tests within the clinically acceptable normal range.- Subjects having a clinically acceptable 12-lead electrocardiogram (ECG). – Subjects with a clinically acceptable chest x-ray (type PA). – Subjects with a negative urinalysis for drugs of abuse (including amphetamines, barbiturates, benzodiazepines, marijuana, cocaine, and morphine). – Subjects with a negative breath alcohol test or urine alcohol test. – Subjects wishing to comply with protocol requirements and provide written informed consent.- For male subjects: Subjects wishing to follow approved birth control methods (double barrier method) for the duration of the study, according to the investigator (s), such as a spermicide condom (double barrier method), diaphragm condom or abstinence, subjects are also not must donate sperm at this time. – Subjects with negative pregnancy test at screening and negative serum β-hCG. pregnancy test on the day of admission in period 01 (women only).- For women: women of childbearing age practicing an acceptable method. birth control at the time of the study, according to the investigator (s), such as an intrauterine device (IUD), abstinence, or dual barrier contraception, i.e. condom + diaphragm, condom + spermicide or foam; or postmenopausal for at least 1 year, and if less than 1 year, then the following acceptable contraceptive measures: mentioned above; Surgically sterile (bilateral tubal ligation, bilateral oophorectomy, or hysterectomy performed).Exclusion criterion: – hypersensitivity to oseltamivir or drugs of a related class or to any of its excipients or to heparin. – History or presence of significant cardiovascular, pulmonary, hepatic, renal, gastrointestinal, endocrine, immunologic, dermatologic, neurologic, or mental illness or disorder. – Any treatment that can cause induction or inhibition of the microsomal enzyme system within 30 days prior to dosing period 01.- The presence of severe alcoholism or drug abuse. – History or presence of significant smoking (more than 10 cigarettes or cigarettes per day). – History or presence of asthma, hives, or other significant allergic reactions. – History or presence of significant gastric and / or duodenal ulcers or gastrointestinal bleeding. – History or presence of serious thyroid disease, adrenal dysfunction, organic origin. an intracranial lesion such as a pituitary tumor.- History or presence of cancer, basal cell or squamous cell carcinoma. – Problems with donating blood. – Difficulty swallowing solids such as tablets or capsules. – Using any prescribed or over-the-counter medication within 30 days of taking the drug. period 01. – Serious illness within the last 3 months. – A volunteer who donated blood (1 unit) or participated in drug research. within the last 90 days prior to the first dose of the study drug.- Consumption of xanthine-containing products, tobacco products or alcohol. within 48 hours prior to dosing period 01. – Consuming foods containing grapefruit or grapefruit juice within 72 hours. before dosing period 01. – A positive screening test result for one or more: HIV, hepatitis B and hepatitis C. – A history of or significant bruising or bleeding. – History or presence of significant recent injury. – Subjects following an abnormal diet (for any reason) for four weeks.before research. – Female subjects who are currently breastfeeding.

    Floor:

    All

    Minimum age:

    18 years old

    Maximum age:

    45 years old

    Healthy volunteers:

    Accepts healthy volunteers

    anti-anxiety drug for the treatment of diseases of the nervous system

    Original anxiolytic (anti-anxiety) drug.

    Afobazole is a non-benzodiazepine anxiolytic and has a new mechanism of action: through the sigma receptor system, it is able to activate the natural anti-anxiety protection of nerve cells (“endogenous anxiolysis system”).

    Afobazole has a special clinical profile that is different from all other anti-anxiety drugs:

    1. the effect develops from the first week of administration and persists after the completion of treatment;
    2. does not cause daytime sleepiness, dependence and addiction, as well as withdrawal syndrome;
    3. has not only anti-alarm, but also an activating effect;
    4. Suitable for the treatment of anxiety-related sleep disorders as well as premenstrual and smoking cessation syndrome;
    5. is compatible with most other somatotropic drugs, does not interact with ethanol.

    Q&A

    Can Afobazole be taken together with herbal sedatives and glycine?

    Afobazol does not interact with herbal sedatives and glycine, therefore it can be taken together. However, when carrying out combination therapy, you should consult with your doctor.

    What is the maximum duration of the course of Afobazolm therapy?

    Afobazol does not accumulate in the body, does not cause addiction and dependence, which makes it possible to safely conduct long courses of therapy.The duration of the course of the drug is usually 2-4 weeks, if necessary, the duration of treatment can be continued up to 3 months. As a rule, the duration of the course depends on the initial state, its changes during therapy, concomitant diseases, and the presence of external stress factors. At the end of the course of therapy, it is necessary to consult with the attending physician to decide on the further tactics of therapy.

    How often can Afobazole courses be repeated? What break should I take between courses?

    Afobazol can be taken without interruption for 3 months.After stopping treatment, the effect of the drug persists for 1-2 weeks. The length of the breaks between courses of therapy depends on your condition and is determined on a case-by-case basis by the attending physician based on the results of an assessment of your condition.

    Is Afobazole compatible with alcohol?

    Simultaneous administration of Afobazole and alcohol is not contraindicated. However, it must be remembered that alcohol can have an adverse effect on the state of the central nervous system, including in the presence of anxiety disorders.In addition, drinking high doses of alcohol is harmful to the body and can exacerbate the symptoms of various diseases.

    Hello, is it possible to use Afobazole together with contraceptive pills?

    Interactions of Afobazole and oral contraceptives have not been identified, combined use is not contraindicated.

    How long can a pregnancy be planned after discontinuation of the drug?

    Afobazol is quickly excreted from the body.At the same time, after discontinuation of any drug, it is necessary to make sure that the symptoms of the condition due to which the drug was prescribed have completely disappeared and there is no need to continue treatment with this or any other drug. Therefore, we recommend planning a pregnancy no earlier than 2 weeks after discontinuation of the drug.

    Tell me, is it possible to take Afobazol during pregnancy? Thanks in advance

    Many medicines are contraindicated during pregnancy, incl.h. Afobazol. Despite the fact that, according to experimental studies, Afobazol does not have a negative effect on fetal development in animals, the effects of Afobazole in pregnant women have not been sufficiently studied.

    Hello, can Afobazol be taken while driving?

    Afobazol does not have a sedative effect, and also does not cause deterioration in concentration and speed of psychomotor reactions, therefore it can be taken by people driving a vehicle, whose activities require increased attention and quick response.

    Can the drug be used in children?

    According to the approved instructions, Afobazol is not used in children under 18 years old, because no special studies have been carried out in this category of persons.

    Hello, can afobazole be taken while taking antidepressants?

    The simultaneous use of Afobazole and antidepressants is not contraindicated.

    Can the drug help with the first use?

    The drug Afobazol reduces the severity of anxiety disorders of various origins.The therapeutic effect does not develop immediately, but gradually. And although the first improvement can be felt quite quickly, a noticeable effect occurs on the 5-7th day of treatment. The optimal duration of the course of therapy is 2-4 weeks, if necessary, taking Afobazol can be continued up to 3 months.

    Can Afobazole be taken during lactation?

    Due to the lack of clinical data on the use of Afobazole during breastfeeding, you should not take the drug during lactation.If necessary, taking it should consider stopping breastfeeding.

    What side reactions can Afobazol cause?

    The side effects of Afobazole include: allergic reactions, in rare cases, the occurrence of a headache is described, which usually goes away on its own and does not require discontinuation of the drug.

    In what cases is the use of Afobazol contraindicated?

    Reception of Afobazole is contraindicated in case of individual intolerance to the drug, during pregnancy, during breastfeeding, as well as in children under the age of 18 years.

    Pregnant women can take antiviral drugs only with the consent of doctors – Rossiyskaya Gazeta

    Some media reported “news”: the Ministry of Health and Social Development recommended antiviral drugs to pregnant women that did not undergo clinical trials, and therefore dangerous for the child.

    The ministry’s recommendations on treatment regimens for different groups of influenza A / h2N1 patients do state that the drugs oseltamivir and zanamivir have not undergone clinical trials to assess the safety of their use in pregnant and lactating women.And, therefore, should be used for the treatment of expectant mothers with caution: only for health reasons and with the consent of the patient herself.

    But to draw from these words the conclusion that we are talking about “untested”, and therefore “dangerous” drugs that can lead to miscarriage, is at least strange. Firstly, both drugs – the oseltamivir developed by the Swiss pharmaceutical company (the Tamiflu trade mark) and its “relative” of British origin zanamivir (the Relenza trade mark) have been known on the market for several years.They were developed with an eye to the “regular” seasonal flu virus, and then it was proved that they were able to resist the bird flu virus. When the “pork” variety appeared, they tested both drugs on it, and it turned out that this flu was also treated well.

    As for the “untestedness” of both drugs – they could not be tested for expectant mothers simply because it is prohibited to conduct clinical trials on pregnant women both in our country and in developed countries. That is why the instructions for Tamiflu, which is sold in Russian pharmacies, warn us about this.

    The editors asked the Deputy Minister of Health and Social Development Veronika Skvortsova to comment on the situation:

    – Taking into account the situation with the spread of the incidence of influenza A / H1N1 and the already existing cases of fatal outcomes of pregnant women who belong to the most vulnerable category of the population, as well as based on the WHO recommendations on the use of oseltamivir and zanamivir, the Ministry of Health and Social Development of Russia considers it possible to conduct antiviral therapy with these drugs in relation to pregnant women.It should be emphasized that the question of the appropriateness of their appointment is decided by a council of doctors, taking into account vital indications. Antiviral therapy with these drugs is carried out in cases where the possible benefits from their use outweigh the potential risk to the pregnant woman and the fetus. When prescribing therapy, written informed consent of the patient for treatment is required. It should be noted that the recommendations of the Ministry of Health and Social Development fully coincide with the recommendations of the World Health Organization (WHO).

    90,000 The effectiveness of the domestic Ergoferon in influenza was reported in the United States: Business climate: Economy: Lenta.ru

    The ClinicalTrials.gov resource of the National Institutes of Health of the US Department of Health has published the results of a randomized clinical study of the effectiveness of Ergoferon in the treatment of influenza. The study was conducted on the basis of 13 medical institutions in Russia, including the Pirogov Russian National Research Medical University and Kazan State Medical University.

    In the course of the study, the effectiveness of Ergoferon was studied in comparison with Oseltamivir (Tamiflu brand), the antiviral activity of the drug and its effect on the main links of the immune response in seasonal influenza in adult patients was assessed. It has been proven that the therapeutic and antiviral efficacy of Ergoferon is reliably comparable to the effects of Oseltamivir, which is still the first-line drug for the treatment of influenza. So, already on the 3rd day of treatment in 65 percent of patients taking Ergoferon, the virus was not detected.It is noted that treatment with “Ergoferon” has a moderate activating effect on the immune system in case of influenza; revealed an increase in the serum concentration of cytokines – regulators of the T- and B-cell immune response.

    The international research organization Synergy Research Group reported that Materia Medica Holding became the leader in the 2018 ranking in terms of the total number of patients who participated in the research among domestic companies.