What You Should Know About Flu Antiviral Drugs

Can flu be treated?

Yes. There are prescription medications called “antiviral drugs” that can be used to treat flu illness. CDC recommends prompt treatment for people who have flu or suspected flu and who are at higher risk of serious flu complications, such as people with asthma, diabetes (including gestational diabetes), or heart disease.

What are flu antiviral drugs?

Flu antiviral drugs are prescription medicines (pills, liquid, an inhaled powder, or an intravenous solution) that fight against flu viruses in your body. Antiviral drugs are not sold over the counter. You can only get them if you have a prescription from a health care provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections. Antiviral drugs for flu only work to treat flu. Flu antiviral drugs are different than antiviral drugs used to treat other infectious diseases such as COVID-19. Antiviral drugs prescribed to treat COVID-19 are not approved or authorized to treat flu.

What should I do if I think I am sick with flu?

If you get sick with flu, antiviral drugs are a treatment option. Check with your doctor promptly if you are at higher risk of serious flu complications (full list of higher risk factors) and you develop flu symptoms. Flu signs and symptoms can include feeling feverish or having a fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. However, not everyone with the flu has a fever. Your doctor may prescribe antiviral drugs to treat your flu illness.

Should I still get a flu vaccine?

Yes. Antiviral drugs are not a substitute for getting a flu vaccine. While flu vaccine can vary in how well it works, a flu vaccine is best way to help prevent seasonal flu and its potentially serious complications. Everyone 6 months and older should receive a flu vaccine every year. Antiviral drugs are a second line of defense that can be used to treat flu (including seasonal flu and variant flu viruses) if you get sick.

What are the benefits of antiviral drugs?

When treatment is started within two days of becoming sick with flu symptoms, antiviral drugs can lessen fever and flu symptoms and shorten the time you are sick by about one day. They also may reduce the risk of complications such as ear infections in children, respiratory complications requiring antibiotics, and hospitalization in adults. For people at higher risk of serious flu complications, early treatment with an antiviral drug can mean having milder illness instead of more severe illness that might require a hospital stay. For adults hospitalized with flu illness, some studies have reported that early antiviral treatment can reduce their risk of death.

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When should antiviral drugs be taken for treatment?

Antiviral treatment provides the greatest benefit when started soon after flu illness begins. Studies show that flu antiviral drugs work best for treatment when they are started within two days of getting sick. However, starting them later can still be beneficial, especially if the sick person is at higher risk of serious flu complications or is in the hospital with more severe illness.  Follow instructions for taking these drugs. Follow your doctor’s instructions and the dose, frequency, and duration listed on the label instructions for taking these drugs.

What antiviral drugs are recommended this flu season?

There are four FDA-approved antiviral drugs recommended by CDC to treat flu this season.

• oseltamivir phosphate (available as a generic version or under the trade name Tamiflu®),
• zanamivir (trade name Relenza®)
• peramivir (trade name Rapivab®), and
• baloxavir marboxil (trade name Xofluza®).

Generic oseltamivir and Tamiflu® are available as a pill or liquid suspension and are FDA approved for early treatment of flu in people 14 days and older.

Zanamivir is a powdered medication that is inhaled and approved for early treatment of flu in people 7 years and older. (Note: Zanamivir (trade name Relenza®) is administered using an inhaler device and is not recommended for people with breathing problems like asthma or COPD.) Oseltamivir and zanamivir are given twice a day for five days.

Peramivir is given once intravenously by a health care provider and is approved for early treatment of flu in people 6 months and older.

Baloxavir is a pill given as a single dose by mouth and is approved for early treatment of flu in children aged 5 years to less than 12 years who do not have any chronic medical conditions, and for all people aged 12 years and older. (Note: Baloxavir (trade name Xofluza®) is not recommended for treatment of flu in pregnant people, lactating  people, or in outpatients with complicated or progressive illness because there is no information about use of baloxavir in these patients. Baloxavir is also not recommended for treatment of flu in hospitalized patients due to limited data.)

How long should antiviral drugs be taken?

To treat flu, oseltamivir or inhaled zanamivir are usually prescribed for five days, while one dose of intravenous peramivir or one dose of oral Baloxavir are usually prescribed.  Oseltamivir treatment is given to hospitalized patients, and some patients might be treated for more than five days.

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What are the possible side effects of antiviral drugs?

Side effects vary for each medication. The most common side effects for oseltamivir are nausea and vomiting. Zanamivir can cause bronchospasm, and peramivir can cause diarrhea. Other less common side effects also have been reported. Your health care provider can give you more information about these drugs or you can check the Food and Drug Administration (FDA) website for specific information about antiviral drugs, including the manufacturer’s package insert.

Can children take antiviral drugs?

Yes, though this varies by medication. Oseltamivir is recommended by CDC for treatment of flu in children beginning from birth and the American Academy of Pediatrics (AAP) recommends oseltamivir for treatment of flu in children 2 weeks old or older.

• Oseltamivir is available as an oral suspension for children.
• Zanamivir is approved for early treatment of flu in people 7 years and older, though it is not recommended for use in children with underlying respiratory disease, including asthma and other chronic lung diseases.
• Peramivir is approved for early treatment in people 6 months and older.
• Baloxavir is available in a single dose tablet for children aged 5 years and older. While an oral Baloxavir suspension (liquid) medication is approved by FDA, this product is not available for the 2022-2023 flu season.

If your child’s health care provider prescribes oseltamivir capsules for your child and your child cannot swallow capsules, the prescribed capsules may be opened, mixed with a thick sweetened liquid, and given that way. Learn more here.

Can pregnant people take antiviral drugs?

Yes. Oral oseltamivir is recommended for treatment of pregnant people with flu because compared to other recommended antiviral medications, it has the most studies available to suggest that it is safe and beneficial during pregnancy. Baloxavir is not recommended for pregnant people or while breastfeeding, as there are no available efficacy or safety data.

Who should take antiviral drugs?

It’s very important that flu antiviral drugs are started as soon as possible to treat patients who are hospitalized with flu, people who are very sick with flu but who do not need to be hospitalized, and people who are at higher risk of serious flu complications based on their age or health, if they develop flu symptoms. Although other people with mild illness who are not at higher risk of flu complications may also be treated early with antiviral drugs by their doctor, most people who are otherwise healthy and not at higher risk for flu complications do not need to be treated with antiviral drugs.

Treating Flu With Antiviral Medicines: Relenza & Tamiflu

Written by WebMD Editorial Contributors

• What Are Antiviral Drugs?
• When Are Antiviral Drugs Recommended?
• How Are Antivirals Used in Preventing Flu?
• Which Antiviral Drugs Are Recommended for Both Treatment and Prevention of the Flu?
• Do Antiviral Drugs for Flu Have Side Effects?
• When Do I Call the Doctor About Flu Antiviral Drugs?
• More

Antiviral drugs are prescription medications that may help prevent flu complications or shorten the severity and duration of flu once you have it. Here are the latest antiviral drug recommendations. After you read this, talk to your doctor to see if antiviral drugs can help you feel better.

Antiviral drugs are medicines that decrease the ability of flu viruses to reproduce. When used as directed, antiviral drugs may help reduce the duration of flu symptoms in otherwise healthy children and adults and may reduce the severity of common flu symptoms.

Antiviral drugs are recommended for both treatment and prevention of flu. Antiviral drugs work best when taken within 48 hours of onset of flu symptoms, but they may still offer benefits when taken later. These medications may reduce the duration of flu by one to two days and prevent severe flu complications.

Your doctor may prescribe an antiviral if you come in close contact with family members or others who have the flu and you want to try to avoid getting sick. However, the CDC discourages this as a routine practice, as it can lead to drug-resistant strains of the virus. Instead, the CDC recommends that people at risk of severe flu — such as pregnant women or people with asthma, diabetes, or heart disease — begin antiviral treatment as soon as flu symptoms appear. Others at high risk for complications from the flu include infants, the elderly, those with chronic illness, Native Americans and Alaskan Natives

It’s important, however, to remember that vaccination is the most effective way to prevent flu.

The CDC recommends the antiviral drugs baloxavir marboxil (Xofluza), oseltamivir (Tamiflu), and zanamivir (Relenza) for both flu prevention and treatment..

Baloxavir marboxil is taken orally and is approved for use in treatment of children 12 years of age and older.

Oseltamivir, which is taken by mouth, is approved for treating flu in those over 2 weeks of age and preventing flu in people one year of age and older.

Peramivir, given in one intravenous dose, is approved for people over the age of 2 for treatment only.

Zanamivir (Relenza) is approved for treating flu in people 7 years and older and for preventing flu in people 5 years and older. Relenza is inhaled through the mouth.

All four antivirals are most effective when given within 48 hours of the onset of flu symptoms, although they may still prevent severe flu complications when given more than 48 hours after symptoms appear.

For in-depth information, see WebMD’s Flu Prevention Strategies.

Side effects of antivirals may include nausea, vomiting, runny nose, stuffy nose, cough, diarrhea, and behavioral changes. Zanamivir is not recommended for individuals who have asthma, chronic obstructive pulmonary disease (COPD), or other lung disease. Based on your individual health status, your doctor will prescribe the antiviral drug that’s safest for you.

Ideally, you should talk to your doctor about the flu vaccine and antiviral drugs, including side effects, before the flu season begins.

When you do get flu symptoms, it’s important to call your doctor soon after symptoms appear. Flu drugs are most effective when taken within the first 48 hours of flu symptoms, although they may help prevent severe disease when taken later.

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what is it, what measures should be taken to prevent respiratory viral infection

Acute respiratory viral infections (ARVI) – can occur not only in a mild form of a cold and runny nose, but also cause severe forms of illness and complications that can lead to death ¹ . Therefore, during seasonal outbreaks of colds, it is worth following safety rules in order to protect yourself from the disease. But if you have been in contact with a sick person, you will need urgent measures, which doctors call emergency prevention.

In general, the prevention of viral infections is divided into specific – directed against a specific pathogen, and non-specific – aimed at protecting the body from viruses as a whole. Specific prevention includes vaccination – this method is not suitable for emergency care for acute respiratory viral infections and influenza, when contact with a sick person has already occurred. In addition, vaccinations do not exist for all ARVI pathogens.

Therefore, as emergency measures, only non-specific methods of preventing respiratory infections, which include taking drugs or non-drug methods, can be used.

Emergency prophylaxis after contact with a sick person

It will not be possible to completely protect yourself from contacts with other people – you have to go to work, go to shops, use public transport.

In such cases, emergency prophylaxis will protect against colds and flu. It is of two types – medicinal and non-drug.

Need emergency prophylaxis:

● frail or chronically ill adults and children;

● people who have not received a flu shot;

● workers who often come into contact with other people on duty: doctors, teachers, salespeople.

Now let’s talk in more detail about each type of prevention.

Medicinal

The use of drugs is the most effective way to prevent SARS and influenza. If you start drinking antiviral drugs immediately after contact with a sick person or a carrier of an infection, the medicine will prevent the virus from multiplying in the respiratory tract and infecting healthy cells, increase the readiness of the immune system, help protect the body from the development of the disease, recover faster or reduce the risk of complications.

It is necessary to start taking antiviral drugs in the emergency prevention mode when an outbreak of SARS is declared in your area, even if there were no contacts with obviously sick people. Many asymptomatic virus carriers appear in the focus of infection, in which the signs of the disease have not yet manifested themselves or the disease proceeds without manifestations.

What medicines to drink? Due to the frequent use of antiviral drugs, pathogens acquire resistance to them – resistance. Therefore, substances with a direct effect on viruses, such as oseltamivir, were excluded from nonspecific prevention of influenza and SARS. These drugs are prescribed only for the treatment of an infection with an identified pathogen ² . And to protect against the disease after contact with an infected person, it is recommended to take interferon preparations, interferon inducers or herbal preparations.

Interferon preparations

Interferons are substances of a protein nature with an antiviral effect. They protect cells from the penetration of viruses and suppress the reproduction of infectious agents – the reproduction of viral RNA or DNA ¹ . These substances also enhance the activity of immune cells – macrophages and lymphocytes ² .

The body produces interferons on its own. Some viruses, including the influenza virus, inhibit the production of interferons, which makes the immune system react weaker and the disease progresses rapidly.

Scientists have learned how to synthesize artificial interferons and create drugs based on them. Usually use interferon α-2b, less often interferon γ. They make up for the lack of their own interferons due to synthetic ones, which increases the body’s natural defense against viruses. It serves as a non-specific prevention of influenza and SARS, including COVID-19 ³ .

If you take artificial interferons for a long time, the body begins to produce antigen interferon antibodies. That is, human immunity destroys them in the same way as other foreign substances. In addition, drugs based on interferons have side effects ¹ .

Medicines with interferons are also used topically – in the form of drops, spray, ointment. So they begin to act at the site of the introduction of viruses, that is, on the nasal mucosa ² . But studies in recent years have shown that the use of intranasal interferons causes side effects on the nasal mucosa and does not prevent the virus from entering the trachea ³ . Therefore, they are recommended to use when other forms of drugs are not suitable, for example, during pregnancy.

Interferon inductors

Interferon inductors are substances that stimulate the body to produce its own interferons. They can be divided into two groups: classical – tilorone, meglumine acridone-acetate, and with polyvalent effects, for example, sodium deoxyribonucleate. According to the peak time of interferon production, drugs are divided into two groups: early interferon – after 4-8 hours, and late – after 18-24 hours.

The effect of taking classical interferon inducers does not occur immediately. At the same time, it stimulates the production of all types of interferons at once, including β-interferon, which suppresses immunity, and does not stimulate it ⁸ . That is, classic interferon inducers are not suitable for emergency prevention of SARS and influenza.

For emergency prophylaxis, combined preparations based on modern interferon inducers, for example, enisamia iodide 9, are better suited. 0003 4 (Nobasite). They act only on interferons α and γ and contain additional substances that enhance the antiviral effect. At the same time, a high concentration of interferons in the blood is maintained even 2.5 months after the end of the medication ⁸ . Against the background of their intake, the risk of becoming infected after contact with a sick person is reduced by 63% ⁹ , and ARVI develops 2 times less often ¹⁰ .

Even with a long course of administration, the effectiveness of drugs in this group does not decrease, because they trigger the synthesis of their own interferon. Antigens to them are not produced, side effects do not occur, virus resistance to these drugs does not develop ¹¹ .

Herbal medicines

Some plant oils contain natural substances with antiviral and immunomodulatory effects ¹² . On their basis, drops and ointments were created, which are applied to the lower part of the wings of the nose. A person inhales vapors of oils, they act on the nasal mucosa and prevent the virus from multiplying.

Phytopreparations can be taken orally, but this should be done with caution. Before buying, you should clarify the composition: many tinctures contain alcohol, which is contraindicated for children and pregnant women. Natural extracts can also cause allergies, which should be taken into account for people with high sensitivity.

Plants with antiviral activity ¹³ :

● eucalyptus;

● garlic;

● Eleutherococcus;

● ginseng;

● Echinacea.

Phytopreparations are recommended to be used simultaneously with other drugs as an additional method ¹⁴ .

Non-drug

If the causative agent of SARS has entered the body, drinking plenty of water will help reduce the risk of developing the disease. It increases the volume of circulating blood, which increases the number of lymphocytes – immunity cells. So it is easier for the body to cope with the number of pathogens that have penetrated inside.

Another way to prevent is to rinse the nose with isotonic saline. To do this, use sprays or a syringe without a needle. Studies have shown that this method reduces the risk of getting sick after contact with an infected person by 4.8 times ¹⁵ .

Post-vaccination prophylaxis

The vaccine trains our immune system, “trains” its cells to fight foreign agents. To do this, weakened or modified viruses that are not capable of causing disease are introduced into the body. The immune system recognizes them and begins to produce antiviral antibodies.

However, immunity to the pathogen is not formed immediately after vaccination. The immune system needs time to initiate the formation of lymphocytes – cells that synthesize immunoglobulins (antibodies). This will take about a week. Then it is necessary to wait until the lymphocytes produce a sufficient amount of immunoglobulins – proteins that will protect our respiratory tract from infection.

It takes about a month and a half to form a reliable immune defense, for example, against the flu. During this time, immunity increases, but the likelihood of getting sick is still high. Therefore, doctors strongly recommend getting vaccinated long before the onset of seasonal flu outbreaks. If you did not manage to get vaccinated in time, start drinking non-specific antiviral agents after vaccination. They will protect against infection until post-vaccination immunity is formed.

What to do in case of illness

Unfortunately, the disease is not always avoidable. Preventive measures significantly reduce the risk of infection, and in case of illness, they will help to transfer the infection as easily as possible. But they cannot protect against infections by 100%.

If you are sick:

● Take antiviral drugs in a therapeutic (treatment) mode;

● if necessary, start symptomatic treatment: drink cough medicines and cold complexes, drip nasal congestion relievers;

● Don’t forget about non-pharmacological methods of supporting the body: do not leave the house, drink more fluids, avoid physical and mental stress, ventilate the room and humidify the air.

These measures will improve well-being, help avoid complications, and bring recovery closer. However, before using any medication, you should consult your doctor.

If you feel very unwell, the temperature persists for too long, the disease drags on, you must consult a doctor.

Briefly about the main

➢ In general, the prevention of influenza and SARS is divided into specific – directed against a specific pathogen, and non-specific – aimed at protecting the body from viruses as a whole. As an emergency measure, it is non-specific that is suitable.

➢ Emergency prevention of SARS and influenza helps not to get sick after contact with an infected person. For this, drugs with interferon and interferon inducers are used.

➢ Preparations with interferon contain ready-made artificial interferon: it allows you to quickly achieve an antiviral effect, but loses its effectiveness with prolonged use.

➢ Classic interferon inducers stimulate the production of their own interferons: they can be taken for a long time, but they also increase the production of β-interferons, which suppress the immune system.

➢ Modern combined interferon inducers stimulate the production of only those interferons that have antiviral activity, and continue to act after the end of the course.

➢ In addition to medicines, you can use herbal remedies, plenty of warm drink and irrigation of the nasal cavity with isotonic solution.

Bibliography:

¹ Karpova AS, Kochkina Yu. V., Kedik SA Study of the antiviral activity of a complex preparation with aminocaproic acid for the prevention of influenza and SARS. Development and registration of medicines. 2019; 8(2): 22–26.

² G. N. Karetkina. Influenza and SARS: treatment and prevention in the coming epidemic season. Attending physician, 2015; eleven

³ Erofeeva M.K., Pozdnyakova M.G., Maksakova V.L. Topical issues of prevention of influenza and other acute respiratory viral infections. RMJ, 2011; 32:2091–2095.

⁴ Erofeeva M. K., Pozdnyakova M.G., Maksakova V.L. The possibility of using new drugs for the prevention of influenza and other acute respiratory viral infections. RMJ, 2010; 18(30): 1824-1828.

⁵ Posiseeva L.V., Kuksa D.S. SARS and pregnancy: prevention options. Issues of gynecology, obstetrics and perinatology. 2020; 19(6): 145–152.

⁶ Romantsov MG, Melnikova I. Yu., Ershov FI International scientific journal “Symbol of Science”. 2016; 4.

⁷ Mikhailova E.V., Malyugina T.N., Levin D.Yu., Serdyukov A.Yu., Matveeva M.A., Zheleznikov P.A., Malinina N.V. Experience in the use of recombinant interferon alfa-2b for the prevention of acute respiratory viral infections during the seasonal rise in incidence. Questions of practical pediatrics. 2019; 14(6): 78–82.

⁸ Denisova A.R., Maksimov M.L. Acute respiratory viral infections: etiology, diagnosis, modern view on treatment. breast cancer. 2018; 1(1).

⁹ Shuldyakov A. A., Lyapina E.P., Kuznetsov V.I. Modern principles of chemoprophylaxis of acute respiratory viral infections. Therapeutic archive. 2013; 11:27-33.

¹⁰ Paevskaya O.A., Zuevskaya S.N., Nikiforov V.V. Possibilities of etiotropic therapy in reducing the risks of developing severe or complicated course of acute respiratory viral infections and influenza. breast cancer. 2019;1(II):77–80.

¹¹ Vikulov G.Kh. New and re-emerging respiratory viral infections: diagnostic algorithms, methods of therapy and prevention. Medicine (Almaty). 2019; 7-8 (205-206): 53-64.

¹² Petrushina A.D., Nikoghosyan A.S., Kaib I.D., Malchenko L.A., Ushakova S.A. The use of inhalations with essential oils in complex therapy and for the prevention of acute respiratory viral infections in children. Polyclinic. 2013; 4.

¹³ Maksakova V.L., Erofeeva M.K. Topical issues of prevention of influenza and SARS. Pharmateka. 2013; 15:73-78.

¹⁴ Karpova E.P., Vagina E.E. Possibilities of therapy and prevention of acute respiratory viral infections in children. Pharmateka. 2015; 1:49-52.

¹⁵ Garashchenko M.V. Prevention of influenza and ARVI by irrigation therapy. Children’s otorhinolaryngology. 2013; 1:36-38.

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10: The best drugs for the prevention and treatment of influenza and SARS, 2020!

May 6, 2020

News

During the cold and flu season, it’s time to find out which antiviral drugs available on the Russian market are popular among pulmonologists and general practitioners.

The Center for the Study of Doctors’ Opinion decided to find out what doctors most often recommend for patients with mild to moderate SARS, with flu symptoms, as well as what drugs or measures to use to prevent viral infections.
April 2020
Reading time – 2.5 minutes

Research company Webka Marketing and its division “Center for the Study of Doctors’ Opinion, Moscow” conducted an independent study through a telephone and online survey in real time among 1000 pulmonologists and therapists throughout Russia, the results are also available at this link

The main goal of the study is to find out the popular brands of antiviral drugs, which drugs doctors would prefer for themselves and what preventive measures are the most effective, especially during the spread of a strain of a new infection caused by SARS-Cov-2; #COVID-19

We publish the study in the public domain, we do not collect or process personal data of respondents, as well as other data of study participants, participation in the study by doctors was voluntary and reflects the real opinion of specialists in the indicated specializations in Russia.

The study was conducted in accordance with the Marketing Research Code of the International Association of Researchers – Esomar, of which Webka Marketing is a member;

The study is honest and open, and we did not collaborate with any pharmaceutical company on the study.

Research geography: all of Russia

Among the studied drugs in the list of 25 trade names in the segment “Antiviral agents for the treatment and prevention of acute respiratory viral infections and influenza”, we analyzed the recommendations of doctors based on the experience of previous waves of the project and evaluation of sales in pharmacies.

Full list here:

SARS: Patient flow per week:

• 24 patients seek medical help with SARS accompanied by cold symptoms;

• Approximately 3 patients per week come to the doctor with more serious illness – severe acute respiratory infection, with viral and bacterial pneumonia.

The drug with maximum efficiency according to doctors:

• Approximately every second doctor considers the drug under the trade name “Ingavirin” as the most effective drug for the treatment of acute respiratory viral infection of the lung and middle course with symptoms of a cold. The opinions of therapists and pulmonologists in this matter do not differ significantly.

A big plus, doctors note the frequency of taking , only 1 time per day.

In second place in terms of popularity is the drug Tamiflu, manufacturer Roche, the characteristics by which the doctor preferred this drug – the manufacturing company, the proven effectiveness and bioavailability of the drug.

In third place is the drug Broncho-Munal, the manufacturer Sandoz, its advantages were noted by the convenience of administration and the quality of raw materials.

The drug with the maximum effectiveness according to doctors

• Important arguments when choosing a drug – proven efficacy and personal experience of treatment

More than 700 respondents preferred the drug under the trade name “Ingavirin”, manufactured by Valenta Pharm, again because of its proven effectiveness, doctors personally tested the effect of this drug, clinical studies are just as important.