Prevention and Control of Influenza, Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Nicole M. Smith, PhD; Joseph S. Bresee, MD; David K. Shay, MD; Timothy M. Uyeki, MD; Nancy J. Cox, PhD; Raymond A. Strikas, MD

Disclosures

Morbidity and Mortality Weekly Report. 2006;55(27):1-41. 

In This Article

Dosage

Dosage recommendations vary by age group and medical conditions ( Table 6 ).

Zanamivir. Zanamivir is approved for treatment of influenza among children aged ≥7 years. The recommended dosage of zanamivir for treatment of influenza is two inhalations (one 5-mg blister per inhalation for a total dose of 10 mg) twice daily (approximately 12 hours apart); the chemoprophylaxis dosage of zanamivir for children aged ≥5 years is 10 mg (two inhalations) once a day.[317]

Oseltamivir. Oseltamivir is approved for treatment and chemoprophylaxis among persons aged ≥1 year. Recommended treatment and chemoprophylaxis dosages of oseltamivir for children vary by the weight of the child. The treatment dosage recommendation of oseltamivir for children who weigh ≤15 kg is 30 mg twice a day; for children weighing >15-23 kg, 45 mg twice a day; for those weighing >23-40 kg, 60 mg twice a day; and for children weighing >40 kg, 75 mg twice a day.[310] The chemoprophylaxis recommended dosage of oseltamivir for children weighing ≤15 kg is 30 mg once a day; for those weighing >15-23 kg, 45 mg once a day; for those weighing >23-40 kg, 60 mg once a day; and for those weighing >40 kg, 75 mg once a day.

Zanamivir and Oseltamivir. No reduction in dosage is recommended on the basis of age alone.

Zanamivir. Limited data are available regarding the safety and efficacy of zanamivir for patients with impaired renal function. Among patients with renal failure who were administered a single intravenous dose of zanamivir, decreases in renal clearance, increases in half-life, and increased systemic exposure to zanamivir were observed.[317,368] However, a limited number of healthy volunteers who received high doses of zanamivir intravenously tolerated systemic levels of zanamivir that were substantially higher than those resulting from administration of zanamivir by oral inhalation at the recommended dose.[369,370] On the basis of these considerations, the manufacturer recommends no dose adjustment for inhaled zanamivir for a 5-day course of treatment for patients with either mild-to-moderate or severe impairment in renal function.[317]

Oseltamivir. Serum concentrations of oseltamivir carboxylate, the active metabolite of oseltamivir, increase with declining renal function.[310,371] For patients with creatinine clearance of 10-30 mL/min,[310] a reduction of the treatment dosage of oseltamivir to 75 mg once daily and in the chemoprophylaxis dosage to 75 mg every other day is recommended. No treatment or chemoprophylaxis dosing recommendations are available for patients undergoing routine renal dialysis treatment.

Zanamivir and Oseltamivir. Neither of these medications has been studied among persons with hepatic dysfunction.

Zanamivir and Oseltamivir. Seizure events have been reported during postmarketing use of zanamivir and oseltamivir, although no epidemiologic studies have reported any increased risk for seizures with either zanamivir or oseltamivir use.

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