Oseltamivir - description of the drug, instructions for use, reviews. Tamiflu (oseltamivir) and its analogues - instructions, release forms (capsules and powder for suspensions), use during pregnancy and in children, description and evidence base of the drug

There are contraindications. Consult your doctor.

For several years now, during the peak flu season (February-March), Moscow has remained without Tamiflu. This is not surprising, since the distribution of the drug in Russia is handled (suddenly...) by the manufacturer Arbidol (stormy applause...). Based on the experience of past years, the drug appears in pharmacies again when the flu is practically gone. Stock up early!

Preparations containing Oseltamivir or Oseltamivir (Oseltamivir, ATC code J05AH02):

Commercial names abroad (abroad) - Agucort, Antiflu, Fluvir, Fluhalt, GPO-A-Flu, Omiflu, Rimivat, Virobin.

Nomides: doctor's review

The first generic Tamiflu in Russia. We type in the search “pharmasynthesis reviews”.

Antijob website (http://antijob.net/black_list/oao_lauo_farmasintezrauo_/):

"The production is only packaging. The equipment is Indian, it cannot work stably, it constantly breaks down, breaks down, gets upset, and as a result is replaced by manual labor. The attitude towards workers is disgusting. One can only guess about the quality of the product... The director is Indian. At the lower levels there is staff , to put it mildly, is not very adequate (alcoholics, mentally inadequate people, etc.)."

Out of interest, I looked at the same Antijob website for reviews of the company I work for (a federal network of clinics with hundreds of employees): negative feedback ONE. And there are dozens of bad reviews for a small Irkutsk company.

In general, I believe that tablets are made from Indian substances in Irkutsk under the wise leadership of an Indian using poor equipment. In my humble opinion, the drug is “Indian”, only worse, due to the usual Russian mess.

Tamiflu and Russian flu drugs - a doctor's review

I'll start from afar.

In America there is an organization called the FDA (Food and Drug Administration). food products and medications). Led to its creation high level legal literacy of the American population. Frequent consumer lawsuits against food and drug manufacturers and huge amounts of fines and compensation forced the country's leadership to create a body that regulates the sale of food and drugs in the United States.

If a manufacturer has received FDA approval for sale in the United States, at the time the approval is valid, he is virtually insured against lawsuits regarding his products.

To get approval, you need to spend a lot of money to study the product on real patients over a long period of time, so-called randomized, double-blind, placebo-controlled studies. This is also why the cost of developing and registering a new drug in the United States is very high - about a billion dollars.

I am not idealizing the FDA; only those who do nothing make mistakes, and the amount of work of this agency is very large. However, this organization, for example, stopped sales in the United States of more than a dozen drugs that, after the start of commercial sales, were found to have dangerous properties.

Unfortunately, there is no similar body in Russia. And Russian drug manufacturers don’t have that kind of money. And many international pharmaceutical companies stopped drug research in Russian clinics due to high cost and unreliability (in other words, due to corruption, non-compliance with research requirements and falsification of results).

Therefore, in Russia it is possible to register a drug without any placebo-controlled randomized trials (that is, without strict proof of effectiveness and safety).

And - lo and behold - you already see this drug on pharmacy shelves.

And from the TV screen a hundred times a day they broadcast about its wonderful properties.

And now you are a fully mature buyer of a miracle drug.

This concludes the introduction and moves on to the drugs for the treatment of respiratory viral infections.

Most of them - Russian production(see the manufacturer in the corresponding column of the table), no FDA registered them, no one conducted any long-term studies on thousands of patients. However, they all cost hundreds of rubles per package.

Honestly speaking, when you start treatment with these drugs, you take full responsibility on yourself and actually conduct experiments on yourself. Serious side effects There seem to be no Russian drugs noted, but their effectiveness has not been proven, and, as it was said in a television advertisement for Arbidol, “the drug can help.” I'm speculating - maybe it won't help...

There is such a concept - the placebo effect (pacifiers). That is, taking any useful substance tablets can in a certain percentage of cases lead to an improvement in the condition. But not every Russian family can afford a placebo for hundreds of rubles. Choose a cheaper placebo, gentlemen.

I will especially say about homeopathic preparations. The annotation for Anaferon states that it contains “antibodies to human interferon containing no more than 10 to the minus 15 degree Nanograms." I’m sorry, but, firstly, this is much less weight one molecule, secondly, interferon is a protective substance, and antibodies are a product of the body’s fight against harmful foreign molecules. Therefore, “antibodies to interferon” are a product of the body killing its own protective molecules. Let's shake the noodles out of our ears, gentlemen.

Anaferon for adults and Anaferon for children have exactly the same dosage (read the instructions). And the “adult” instructions say that the adult drug is contraindicated for children. This is called pluralism in a single head and an undisguised desire to make money on the love of children.

And in the instructions for Anaferon, the duration of the course of treatment is pleasing - up to 6 months!!! That is, an ordinary citizen “to prevent the flu” should buy 9 packs wonderful remedy average price 150 rubles each!!! Tamiflu is already cheaper.

Here is such a wonderful drug Anaferon.

A little touch to Russian drugs. If you read the annotation for Tamiflu, right in the instructions you will see a description of studies on thousands of patients, detailed mode dosing for all categories of patients.

I have not found any descriptions of studies on thousands of patients in any Russian abstract.

And, for example, the instructions for Russian Remantadine say the following:

Dosage regimen:

Individual, depending on the indications, the patient’s age and the treatment regimen used.

DOT!!! THAT'S ALL, THERE IS NOTHING MORE ABOUT DOSES!!! That is, I, a doctor, cannot find out from the above official instructions How to use this miracle medicine. This is probably a sign of great respect Russian company to doctors and patients and proof high efficiency drug.

Therefore, when I or my relatives start to get sick, we still buy Tamiflu, registered with the “bourgeois” organization FDA.

Tamiflu (Oseltamivir) - instructions for use. The drug is a prescription, the information is intended only for healthcare professionals!

Clinical and pharmacological group:

Antiviral drug

pharmachologic effect

Antiviral drug. Oseltamivir phosphate is a prodrug, its active metabolite oseltamivir carboxylate (OC) is effective and selective inhibitor neuraminidase of influenza viruses type A and B - an enzyme that catalyzes the process of releasing newly formed viral particles from infected cells, their penetration into epithelial cells respiratory tract And further dissemination virus in the body.

Inhibits the growth of the influenza virus in vitro and suppresses the replication of the virus and its pathogenicity in vivo, reduces the release of influenza A and B viruses from the body. Studies of clinical isolates of influenza virus have shown that the concentration of OC required to inhibit neuraminidase by 50% (IC50) is 0.1-1.3 nM for influenza A virus and 2.6 nM for influenza B virus. According to published studies, the median IC50 values ​​for influenza B virus slightly higher and amounts to 8.5 nM.

Clinical effectiveness

The clinical efficacy of Tamiflu® has been demonstrated in studies of experimental influenza in humans and in phase III studies of influenza infections arising in natural conditions. In the studies conducted, Tamiflu® did not affect the formation of anti-influenza antibodies, including the production of antibodies in response to administration inactivated vaccine against the flu.

Natural research influenza infection

In phase III clinical studies conducted in the Northern Hemisphere in 1997-1998 during seasonal influenza infection, patients began receiving Tamiflu no later than 40 hours after the first symptoms of influenza infection appeared. 97% of patients were infected with influenza A virus and 3% of patients with influenza B virus. Tamiflu® significantly shortened the period clinical manifestations influenza infection (for 32 hours). In patients with confirmed influenza who took Tamiflu®, disease severity, expressed as the area under the curve for the total symptom index, was 38% less than in patients who received placebo. Moreover, in young patients without concomitant diseases Tamiflu® reduced by approximately 50% the incidence of influenza complications requiring the use of antibiotics (bronchitis, pneumonia, sinusitis, otitis media). These phase III clinical trials provided clear evidence of the drug's effectiveness in terms of secondary efficacy endpoints related to antiviral activity: Tamiflu caused both a shorter time to virus clearance and a decrease in the area under the viral titer-time curve.

Data obtained in a study on Tamiflu® therapy in elderly and old age, show that taking Tamiflu® at a dose of 75 mg 2 times a day for 5 days was accompanied by a clinically significant decrease in the median period of clinical manifestations of influenza infection, similar to that in adult patients more than young, however, the differences did not reach statistical significance. In another study, influenza patients over 13 years of age who had concomitant chronic diseases of the cardiovascular and/or respiratory systems received Tamiflu® in the same dosage regimen or placebo. There were no differences in the median period until clinical manifestations of influenza infection decreased in the Tamiflu® and placebo groups, however, the period of fever when taking Tamiflu® was reduced by approximately 1 day. The proportion of patients shedding virus on days 2 and 4 became significantly smaller. The safety profile of Tamiflu® in patients at risk did not differ from that in the general population of adult patients.

Treatment of influenza in children

In children aged 1-12 years ( average age 5.3 years) who had fever (more than 37.8°C) and one of the symptoms respiratory system(cough or rhinitis) during the period of circulation of the influenza virus among the population, a double-blind, placebo-controlled study was conducted. 67% of patients were infected with influenza A virus and 33% of patients with influenza B virus. Tamiflu® (when taken no later than 48 hours after the onset of the first symptoms of influenza infection) significantly reduced the duration of the disease (by 35.8 hours) compared with placebo. The duration of the disease was defined as the time until cough, nasal congestion, resolution of fever, and return to normal activity were resolved. In the group of children receiving Tamiflu®, the incidence of acute otitis media was reduced by 40% compared to the placebo group. Recovery and return to normal activity occurred almost 2 days earlier in children receiving Tamiflu® compared to the placebo group.

Another study involved children aged 6-12 years suffering from bronchial asthma; 53.6% of patients had influenza infection confirmed by serology and/or culture. The median duration of the disease in the group of patients receiving Tamiflu® did not decrease significantly. But by the last 6 days of Tamiflu® therapy, forced expiratory volume in 1 second (FEV1) increased by 10.8% compared to 4.7% in patients receiving placebo (p = 0.0148).

Preventing influenza in adults and adolescents

The preventive effectiveness of Tamiflu® against natural influenza A and B infections was proven in 3 separate phase III clinical studies.

In a phase III study, adults and adolescents who were in contact with an ill family member began taking Tamiflu® within two days of the onset of influenza symptoms in family members and continued it for 7 days, which significantly reduced the incidence of influenza in contacts by 92%.

In a double-blind, placebo-controlled study in unvaccinated and otherwise healthy adults aged 18-65 years, taking Tamiflu® during an influenza epidemic significantly reduced the incidence of influenza (by 76%). Participants in this study took the drug for 42 days.

In a double-blind, placebo-controlled study of elderly and senile residents of nursing homes, 80% of whom were vaccinated before the season in which the study was conducted, Tamiflu® significantly reduced the incidence of influenza by 92%. In the same study, Tamiflu® significantly (by 86%) reduced the incidence of influenza complications: bronchitis, pneumonia, sinusitis. Participants this study took the drug for 42 days.

In all three clinical studies, about 1% of patients fell ill with the flu while taking Tamiflu®.

In these clinical studies, Tamiflu® also significantly reduced the frequency of viral shedding and prevented transmission of the virus from one family member to another.

Prevention of influenza in children

The preventive effectiveness of Tamiflu® against natural influenza infection was demonstrated in a study in children from 1 to 12 years of age after contact with an ill family member or someone from their immediate environment. The primary efficacy parameter in this study was the incidence of laboratory-confirmed influenza infection. In a study of children who received Tamiflu® (powder for oral suspension) at a dose of 30-75 mg 1 time per day for 10 days, and did not shed the virus initially, the frequency of laboratory-confirmed influenza decreased to 4% (2/47 ) compared to 21% (15/70) in the placebo group.

Resistance

When taking Tamiflu® for the purpose of post-exposure prophylaxis (7 days), prophylaxis of family contacts (10 days) and seasonal prophylaxis (42 days), no cases of drug resistance were observed.

The risk of drug resistance when used to treat influenza has been extensively studied. According to all Roche sponsored clinical trials for the treatment of influenza infection when taking Tamiflu® in adult patients/adolescents, resistance to oseltamivir was found in 0.32% of cases (4/1245) using phenotyping and in 0.4% of cases (5/1245) using phenotyping and genotyping, and in children from 1 year to 12 years in 4.1% (19/464) and 5.4% (25/464) of cases, respectively. All patients had temporary carriage of OK-resistant virus. This did not affect viral clearance and did not cause clinical deterioration.

Several different subtype-specific viral neuraminidase mutations have been identified in in vitro studies or in the literature. The degree of sensitivity reduction depended on the type of mutation; for example, with the I222V mutation in N1, the sensitivity decreased by 2 times, and with the R292K mutation in N2, by 30,000 times. No mutations were found that reduce the sensitivity of influenza B virus neuraminidase in vitro.

In patients treated with oseltamivir, reported neuraminidase N1 mutations (including H5N1 viruses) leading to resistance/reduced sensitivity to OCs were H274Y, N294S (1 case), E119V (1 case), R292K (1 case), and neuraminidase mutations N2 - N294S (1 case) and SASG245-248del (1 case). In one case, the G402S mutation of the influenza B virus was discovered, which resulted in a 4-fold decrease in sensitivity, and in one case, the D198N mutation with a 10-fold decrease in sensitivity in a child with immunodeficiency.

Viruses with a resistant neuraminidase genotype differ in resistance to varying degrees from the natural strain. Viruses with the R292K mutation in N2 in animals (mice and ferrets) are significantly inferior in infectivity, pathogenicity and contagiousness to viruses with the E119V mutation in N2 and D198N in B and differ slightly from the “wild” strain. Viruses with the H274Y mutation in N1 and N294S in N2 occupy an intermediate position.

In patients who did not receive oseltamivir, occurring natural conditions mutations of the influenza A/H1N1 virus, which had reduced sensitivity to the drug in vitro. The degree of reduction in sensitivity to oseltamivir and the frequency of occurrence of similar viruses may vary depending on the season and region.

Results of preclinical studies

Preclinical data based on standard pharmacological safety, genotoxicity and chronic toxicity studies do not indicate any particular hazard to humans.

Carcinogenicity: Results from three studies assessing carcinogenic potential (two 2-year studies in rats and mice for oseltamivir and one 6-month study in Tg:AC transgenic mice for the active metabolite) were negative.

Mutagenicity: Standard genotoxicity tests for oseltamivir and the active metabolite were negative.

Effect on fertility: oseltamivir at a dose of 1500 mg/kg/day did not affect the reproductive function in male and female rats.

Teratogenicity: in studies studying the teratogenicity of oseltamivir at a dose of up to 1500 mg/kg/day (in rats) and up to 500 mg/kg/day (in rabbits), no effect on embryo-fetal development was found. In antenatal and postnatal developmental studies in rats, oseltamivir administered at a dose of 1500 mg/kg/day was observed to increase the period of labor: the safety limit between human exposure and the maximum non-effective dose in rats (500 mg/kg/day) for oseltamivir is 480 times higher, and for its active metabolite - 44 times higher. Exposure in the fetus was 15-20% of that in the mother.

Other: Oseltamivir and the active metabolite are excreted into the milk of lactating rats.

Approximately 50% of those tested guinea pigs when the active substance oseltamivir is administered into maximum doses Skin sensitization in the form of erythema was observed. Reversible eye irritation in rabbits has also been identified.

While oseltamivir phosphate at very high single oral doses (657 mg/kg and above) had no effect in adult rats, these doses did toxic effect on immature 7-day-old rat pups, incl. led to the death of animals. No undesirable effects were observed with chronic administration at a dose of 500 mg/kg/day from 7 to 21 days of the postnatal period.

Pharmacokinetics

Suction

Oseltamivir phosphate is easily absorbed from the gastrointestinal tract and into high degree turns into an active metabolite under the action of hepatic and intestinal esterases. Concentrations of the active metabolite in plasma are determined within 30 minutes, the time to reach Cmax is 2-3 hours, and are more than 20 times higher than the concentrations of the prodrug. At least 75% of the dose taken orally enters the systemic circulation in the form of an active metabolite, less than 5% in the form of the parent drug. Plasma concentrations of both the prodrug and the active metabolite are dose proportional and independent of food intake.

Distribution

Vss active metabolite - 23 l.

According to studies conducted on animals, after oral administration of oseltamivir phosphate, its active metabolite was detected in all main foci of infection (lungs, bronchial lavage, nasal mucosa, middle ear and trachea) in concentrations providing an antiviral effect.

The binding of the metabolite to plasma proteins is 3%. The binding of the prodrug to plasma proteins is 42%, which is not enough to cause a significant drug interaction.

Metabolism

Oseltamivir phosphate is highly converted into an active metabolite under the action of esterases located primarily in the liver. Neither oseltamivir phosphate nor the active metabolite are substrates or inhibitors of cytochrome P450 isoenzymes.

Removal

It is excreted (>90%) as an active metabolite mainly by the kidneys. The active metabolite does not undergo further transformation and is excreted by the kidneys (>99%) by glomerular filtration and tubular secretion. Renal clearance (18.8 l/h) exceeds the glomerular filtration rate (7.5 l/h), indicating that the drug is also eliminated by tubular secretion. Less than 20% is excreted through the intestines taken drug. T1/2 of the active metabolite is 6-10 hours.

Pharmacokinetics in special clinical situations

Patients with kidney damage

When using Tamiflu® (100 mg 2 times a day for 5 days) in patients with varying degrees kidney damage AUC is inversely proportional to decreased renal function.

Treatment. Patients with CC more than 30 ml/min do not require dose adjustment. In patients with CC from 10 to 30 ml/min, the dose of Tamiflu® should be reduced to 75 mg once a day for 5 days. Dosing recommendations for patients on chronic hemodialysis or chronic peritoneal dialysis for terminal stage chronic renal failure, and for patients with CC less than 10 ml/min are absent.

Prevention. Patients with CC more than 30 ml/min do not require dose adjustment. In patients with CC from 10 to 30 ml/min, it is recommended to reduce the dose of Tamiflu to 75 mg every other day; or 30 mg capsules daily or 30 mg suspension daily. There are no dosing recommendations for patients on chronic hemodialysis or chronic peritoneal dialysis for end-stage chronic renal failure, and for patients with creatinine clearance less than 10 ml/min.

Patients with liver damage

Data obtained in vitro and in animal studies indicate that there is no significant increase in the AUC of oseltamivir phosphate in patients with impaired liver function, mild and medium degree severity was also confirmed in clinical studies. The safety and pharmacokinetics of oseltamivir phosphate have not been studied in patients with severe hepatic impairment.

In elderly and senile patients (65-78 years), the exposure of the active metabolite at steady state is 25-35% higher than in younger patients when similar doses of Tamiflu are prescribed. T1/2 of the drug in elderly and senile patients did not differ significantly from that in younger patients. Taking into account the data on the exposure of the drug and its tolerability in elderly and senile patients, dose adjustment is not required for the treatment and prevention of influenza.

The pharmacokinetics of Tamiflu® were studied in children aged 1 to 16 years in a single-dose pharmacokinetic study and in a multiple-dose clinical study in a small number of children aged 3-12 years. In children younger age elimination of the prodrug and active metabolite occurs more rapidly than in adults, resulting in lower AUCs relative to a specific dose. Taking the drug at a dose of 2 mg/kg provides the same AUC of oseltamivir carboxylate as is achieved in adults after a single dose of a capsule with 75 mg of the drug (equivalent to approximately 1 mg/kg). The pharmacokinetics of oseltamivir in children over 12 years of age is the same as in adults.

Indications for use of TAMIFLU®

• treatment of influenza in adults and children over 1 year of age;
• prevention of influenza in adults and adolescents over 12 years of age in groups increased risk infection with the virus (in military units and large production teams, in weakened patients);
• prevention of influenza in children over 1 year of age

Dosage regimen

The drug is taken orally, with meals or regardless of meals. Tolerability of the drug can be improved if taken with food.

Adults, teenagers, or children who are unable to swallow the capsule may also be treated with Tamiflu® in powder form for oral suspension.

In cases where Tamiflu® is not available in powder form for oral suspension, or if the capsules show signs of aging, open the capsule and pour its contents into a small amount (maximum 1 teaspoon) of a suitable sweetened food product (chocolate syrup with normal content sugar or unsweetened, honey, light brown sugar or table sugar dissolved in water, sweet dessert, sweetened condensed milk, applesauce or yogurt) to cover up the bitter taste. The mixture must be mixed thoroughly and given to the patient as a whole. The mixture should be swallowed immediately after preparation.

Standard dosage regimen

The drug should be taken no later than 2 days after the onset of flu symptoms.

For adults and adolescents aged 12 years and older, the drug is prescribed 75 mg (1 capsule 75 mg, or 1 capsule 30 mg + 1 capsule 45 mg, or suspension) 2 times a day for 5 days. Increasing the dose to more than 150 mg per day does not increase the effect.

Children aged 8 years and older or weighing more than 40 kg who can swallow capsules can also be prescribed Tamiflu® in the form of 75 mg capsules (1 capsule 75 mg, or 1 capsule 30 mg + 1 capsule 45 mg) 2 times per day.

Prevention

The drug should be taken no later than 2 days after contact with the patient.

For adults and adolescents aged 12 years and older, Tamiflu® is prescribed 75 mg (1 capsule 75 mg, or 1 capsule 30 mg + 1 capsule 45 mg, or suspension) 1 time per day orally for at least 10 days after contact with the patient. . During a seasonal flu epidemic - 75 mg 1 time per day for 6 weeks. Preventive action lasts as long as the drug is taken.

For children aged 8 years and older or weighing more than 40 kg who can swallow capsules, the drug can also be prescribed for prophylaxis at 75 mg (1 capsule 75 mg, or 1 capsule 30 mg + 1 capsule 45 mg) 1 time per day.

For children aged 1 year and older, the drug in the form of a suspension or capsules of 30 mg and 45 mg is prescribed for prophylaxis in the following doses.

To dose the suspension, use the supplied syringe marked 30 mg, 45 mg and 60 mg. The required amount of suspension is taken from the bottle with a dosing syringe, transferred to a measuring cup and taken orally.

Dosage regimen in special cases

Patients with kidney damage

Treatment. When using Tamiflu® in patients with impaired renal function with CC more than 30 ml/min, no dose adjustment is required. For CC values ​​from 10 to 30 ml/min, the dose should be reduced to 75 mg once a day for 5 days. There are no dosing recommendations for patients on chronic hemodialysis or chronic peritoneal dialysis for end-stage chronic renal failure and for patients with creatinine clearance less than 10 ml/min.

Prevention. When using Tamiflu® in patients with CC more than 30 ml/min, no dose adjustment is required. For CC values ​​from 10 ml/min to 30 ml/min, it is recommended to reduce the dose of Tamiflu® to 75 mg every other day, or 30 mg suspension daily.

Dosing recommendations for patients undergoing chronic hemodialysis or chronic peritoneal dialysis for end-stage renal disease and for patients with CC? 10 ml/min are not available.

Patients with liver damage

Elderly and senile patients

Elderly patients do not require dose adjustment when treating and preventing influenza.

The safety and effectiveness of Tamiflu® in children under 1 year of age have not been established.

Preparation of Tamiflu® suspension from powder

1. Gently tap the closed bottle with your finger several times so that the powder is distributed at the bottom of the bottle.

2. Measure 52 ml of water using a measuring cup, filling it to the indicated level.

3. Add 52 ml of water to the bottle, cap and shake well for 15 seconds.

4. Remove the cap and insert the adapter into the neck of the bottle.

5. Screw the cap onto the bottle tightly to ensure correct positioning of the adapter.

The expiration date of the prepared suspension should be indicated on the bottle label. Before use, the bottle with the prepared suspension must be shaken. To dispense the suspension, a dosing syringe is provided with labels indicating dose levels of 30 mg, 45 mg and 60 mg.

Extemporaneous preparation of Tamiflu® suspension from capsules

In cases where adults, adolescents and children have a problem with swallowing capsules, and Tamiflu® in powder form for the preparation of an oral suspension is not available or if there are signs of “aging” of the capsules, it is necessary to open the capsule and pour out its contents in a small amount (maximum 1 teaspoon) of a suitable sweetened food item (as above) to cover the bitter taste. The mixture must be mixed thoroughly and given to the patient as a whole. The mixture should be swallowed immediately after preparation.

75 mg capsules:

If patients require a dose of 75 mg, the following instructions should be followed:

2. Add a small amount (no more than 1 teaspoon) of a suitable sweetened food (to cover the bitter taste) and mix well.

3. Mix the mixture thoroughly and drink it immediately after preparation. If there is a small amount of mixture left in the container, you should rinse the container with a small amount of water and drink the remaining mixture.

If patients require doses of 30-60 mg, the following instructions should be followed for proper dosing:

1. Holding one Tamiflu® 75 mg capsule over a small container, carefully open the capsule and pour the powder into the container.

2. Add 5 ml of water to the powder using a syringe with marks indicating the amount of liquid collected. Mix thoroughly for 2 minutes.

3. Draw the required amount of mixture into the syringe from the container according to the following table.

There is no need to collect undissolved white powder as it is an inactive filler. By pressing the plunger of the syringe, inject all its contents into the second container. Any remaining unused mixture should be discarded.

4. In a second container, add a small amount (no more than 1 teaspoon) of a suitable sweetened food to cover the bitter taste and mix well.

5. Mix the mixture thoroughly and drink it immediately after preparation. If there is a small amount of mixture left in the container, you should rinse the container with a small amount of water and drink the remaining mixture.

This procedure should be repeated before each dose of the drug.

Capsules 30 mg and 45 mg:

1. Determine the required number of Tamiflu capsules required to prepare the mixture:

*In children weighing >40 kg and adults, Tamiflu® can be used to prepare a mixture of 1 capsule 45 mg + 1 capsule 30 mg 2 times a day for treatment or 1 time a day for prevention.

2. Make sure that it is used correct dose drug (according to the table above). Holding 1 or more Tamiflu® capsules over a small container, carefully open 1 or more capsules and pour the powder into the container.

3. Add a small amount (no more than 1 teaspoon) of a suitable sweetened food to cover the bitter taste and mix well.

4. Mix the mixture thoroughly and drink it immediately after preparation. If there is a small amount of mixture left in the container, you should rinse the container with a small amount of water and drink the remaining mixture.

Repeat this procedure before each dose of the drug.

Side effect

Clinical trials for the treatment of influenza in adults

The most common adverse events in 2107 patients (including patients receiving Tamiflu 75 mg twice daily and 150 mg twice daily, placebo) in phase III studies were nausea and vomiting. They were transient in nature, arose, as a rule, after taking the first dose and in most cases did not require discontinuation of the drug. When taken at the recommended dose (75 mg 2 times a day), the reason for withdrawal from the study was nausea in 3 patients and vomiting in 3 patients.

In phase III studies in adults, the incidence of some adverse events was higher with Tamiflu than with placebo. Adverse events that occurred most often when taking the recommended dose during treatment or prophylaxis are presented in Table 1. It includes young adult patients without concomitant pathology and patients at risk, i.e. patients with high risk development of complications of influenza (elderly and senile patients, patients with chronic diseases heart or respiratory organs). When treating with Tamiflu®, nausea, vomiting, abdominal pain and headache were observed (regardless of the causal relationship with the study drug) with a frequency of 1% or more than when taking placebo.

Table 1. Most common adverse events reported in studies of treatment and prevention of natural influenza infection.

* - Adverse events most frequently reported in studies of treatment with oseltamivir (75 mg twice daily) are included; reactions are arranged in descending order depending on the frequency of occurrence in a given group.

In influenza treatment studies, the profile of adverse events in patients at risk for developing influenza complications was generally the same as in young adults without comorbidities.

Clinical trials on prevention

A total of 3,434 volunteers (adolescents, adults without comorbidities, and elderly and senile adults) participated in phase III influenza prevention studies, 1,480 of whom received the recommended dose of the drug (75 mg once daily) for 6 weeks. Despite longer duration administration of the drug, the adverse event profile was very similar to that in the treatment studies (Table 1). Patients taking Tamiflu® for prophylaxis experienced pain slightly more often than in the placebo group and more often than in treatment studies various localizations, rhinorrhea, dyspepsia and upper respiratory tract infections. However, the differences in the incidence of these adverse events between the Tamiflu® and placebo groups were less than 1%. The safety profile in 942 elderly and senile patients receiving Tamiflu® and placebo was clinically no different from that in younger patients.

Treatment studies in children

A total of 1032 children aged 1–12 years (including 698 children without comorbidities aged 1–12 years and 334 patients with asthma aged 6–12 years) were enrolled in the phase III influenza treatment trials. 515 patients were treated with Tamiflu® suspension.

Adverse events that occurred in more than 1% of children are presented in Table 2. The most commonly observed were vomiting, as well as abdominal pain, nose bleed, hearing impairment, conjunctivitis. These phenomena occurred suddenly, stopped on their own, despite continued treatment, and in the vast majority of cases did not serve as a reason for discontinuation of treatment.

Table 2. The most common adverse events noted in studies of the treatment and prevention of natural influenza infection in children aged 1-12 years. Adverse events that occurred in >1% of children treated for natural acquired influenza infection in phase III studies.

a - Pooled data from phase III clinical trials of Tamiflu® treatment of natural influenza infection.

b - Uncontrolled studies comparing Tamiflu® treatment in dosing regimen 2 for 5 days and Tamiflu® prophylaxis once daily for 10 days.

c - Standard dose - dose depending on age.

All adverse events recorded in studies of treatment with oseltamivir (75 mg twice daily) with an incidence of ≤1% were included.

Prevention Research in Children

Children aged 1-12 years (222 and 134 patients, respectively) took part in the study after contact with a sick family member or someone from their immediate environment. The most common adverse events were gastrointestinal symptoms, especially vomiting. Tamiflu® was well tolerated in this study, and the reported symptoms were consistent with those previously encountered (Table 2).

Post-marketing surveillance

Frequency determination unwanted effects: very often (?1/10); often (?1/100,<1/10); нечасто (?1/1000, <1/100); редко (?1/10 000, <1/1000); очень редко (<1/10 000), частота не известна (по имеющимся данным частоту определить нельзя).

Dermatological reactions: rarely - dermatitis, skin rash, eczema; very rarely - exudative erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis.

Allergic reactions: rarely - urticaria, anaphylactic and anaphylactoid reactions, Quincke's edema.

From the digestive system: rarely - gastrointestinal bleeding after taking Tamiflu® (in particular, a connection between the phenomena of hemorrhagic colitis and taking Tamiflu® cannot be ruled out, since these phenomena disappeared both after the patient recovered from the flu and after discontinuation of the drug).

From the liver: very rarely - hepatitis, increased activity of liver enzymes in patients with flu-like symptoms receiving Tamiflu®.

From the side of the central nervous system: in patients (mainly children and adolescents) taking Tamiflu® for the treatment of influenza, convulsions and delirium (including symptoms such as impaired consciousness, disorientation in time and space, abnormal behavior, delusions, hallucinations, agitation, anxiety, nightmares). These cases rarely involved life-threatening actions. The role of Tamiflu® in the development of these phenomena is unknown. Similar neuropsychiatric disorders were also observed in patients with influenza who did not receive Tamiflu®.

From the organ of vision: visual impairment (frequency unknown).

From the cardiovascular system: arrhythmia (frequency unknown).

Contraindications to the use of TAMIFLU®

• chronic renal failure (continuous hemodialysis, chronic peritoneal dialysis, CC less than 10 ml/min);
• hypersensitivity to the components of the drug.

The drug should be prescribed with caution during pregnancy and lactation (breastfeeding).

Use of TAMIFLU® during pregnancy and breastfeeding

In animal reproductive toxicity studies (rats, rabbits), no teratogenic effect was observed. Studies in rats did not show any negative effects of oseltamivir on fertility. Exposure in the fetus was 15-20% of that in the mother.

During preclinical studies, oseltamivir and the active metabolite were excreted into the milk of lactating rats. Whether oseltamivir or the active metabolite is excreted in human milk is unknown, but their amounts in breast milk may be 0.01 mg/day and 0.3 mg/day, respectively.

Because There is insufficient data on the use of the drug in pregnant women; Tamiflu should be prescribed during pregnancy or nursing mothers only if the possible benefits of its use for the mother outweigh the potential risk to the fetus or infant.

Use for liver dysfunction

Patients with mild to moderate liver dysfunction do not require dose adjustment during the treatment and prevention of influenza. The safety and pharmacokinetics of Tamiflu® in patients with severe hepatic impairment have not been studied.

Use for renal impairment

Patients with impaired renal function and CC above 30 ml/min do not need to adjust the dose. For CC values ​​from 10 to 30 ml/min, it is recommended to reduce the dose of Tamiflu to 75 mg once a day for 5 days. Dosing recommendations for patients undergoing chronic hemodialysis or chronic peritoneal dialysis for end-stage renal disease and for patients with CC< 10 мл/мин отсутствуют. Поэтому препарат противопоказан при хронической почечной недостаточности (постоянный гемодиализ, хронический перитонеальный диализ, КК менее 10 мл/мин).

special instructions

Seizures and delirium-like neuropsychiatric disorders have been reported in patients (mainly children and adolescents) taking Tamiflu® for the treatment of influenza. These cases rarely involved life-threatening actions. The role of Tamiflu® in the development of these phenomena is unknown. Similar neuropsychiatric disorders were also observed in patients with influenza who did not receive Tamiflu®.

There is no data on the effectiveness of Tamiflu® for any diseases caused by pathogens other than influenza A and B viruses.

When treating and preventing influenza in patients with CC from 10 to 30 ml/min, a dose adjustment of Tamiflu® is required. There are no recommendations for dose adjustment in patients receiving hemodialysis, peritoneal dialysis and in patients with creatinine clearance less than 10 ml/min.

One bottle of Tamiflu® (30 g of powder for oral suspension) contains 25.713 g of sorbitol. When taking Tamiflu® at a dose of 45 mg 2 times a day, 2.6 g of sorbitol enters the body. In patients with congenital fructose intolerance, this amount exceeds the daily norm of sorbitol.

Use in pediatrics

Tamiflu® should not be prescribed to children under 1 year of age.

Overdose

Currently, no cases of overdose have been described.

When taking Tamiflu® in single doses up to 1000 mg, nausea and vomiting were observed. Therefore, nausea and/or vomiting may be expected symptoms of acute overdose. Dizziness may also occur.

Drug interactions

According to pharmacological and pharmacokinetic studies, a clinically significant drug interaction is unlikely.

Oseltamivir phosphate is highly converted into an active metabolite by esterases, mainly located in the liver. Drug interactions due to competition and binding to the active sites of esterases that convert oseltamivir phosphate into the active substance are not presented. The low degree of binding of oseltamivir and the active metabolite to proteins does not give reason to assume the presence of an interaction associated with the displacement of drugs from binding with proteins.

In vitro, oseltamivir phosphate and the active metabolite are not the preferred substrate for polyfunctional cytochrome P450 oxidases or glucuronyltransferases. There are no reasons for interaction with oral contraceptives.

Cimetidine, a nonspecific inhibitor of isoenzymes of the cytochrome P450 system and competing in the process of tubular secretion with alkaline drugs and cations, does not affect the plasma concentrations of oseltamivir and its active metabolite.

A clinically significant drug interaction due to competition for tubular secretion is unlikely, given the safety margin for most similar drugs, the routes of elimination of the active metabolite of oseltamivir (glomerular filtration and anionic tubular secretion), and the excretory capacity of each route.

Probenecid leads to an approximately 2-fold increase in the AUC of the active metabolite oseltamivir (due to a decrease in active tubular secretion in the kidneys). However, dose adjustment is not required when used concomitantly with probenecid, given the safety margin of the active metabolite.

Co-administration with amoxicillin does not affect plasma concentrations of oseltamivir and its components, demonstrating weak competition for elimination by anionic tubular secretion.

Concomitant use with paracetamol does not affect plasma concentrations of oseltamivir and its active metabolite or paracetamol.

No pharmacokinetic interaction between oseltamivir and its main metabolite was detected when taken simultaneously with paracetamol, acetylsalicylic acid, cimetidine or antacids (magnesium and aluminum hydroxide, calcium carbonate).

In phase III clinical studies, Tamiflu® was prescribed with commonly used drugs such as ACE inhibitors (enalapril, captopril), thiazide diuretics (bendroflumethiazide), antibiotics (penicillin, cephalosporins, azithromycin, erythromycin and doxycycline), histamine H2 receptor blockers (ranitidine, cimetidine), beta-blockers (propranolol), xanthines (theophylline), sympathomimetics (pseudoephedrine), opioid agonists (codeine), corticosteroids, inhaled bronchodilators, acetylsalicylic acid, ibuprofen, paracetamol. No changes in the nature or frequency of adverse events were observed.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

Storage conditions and periods

Capsules should be stored at a temperature not exceeding 25°C. Shelf life - 7 years. After 5 years of storage of the drug, signs of “aging” of the capsules may be observed, which can lead to their increased fragility or other physical impairments that do not affect the effectiveness and safety of the drug.

The powder for preparing the suspension should be stored at a temperature not exceeding 25°C. Shelf life - 2 years.

After preparation, store the suspension at a temperature of 2° to 8°C for 17 days or at a temperature not exceeding 25°C for 10 days and do not use after the expiration date.

The drug should be stored out of the reach of children.

Oseltamivir (Oseltamivir) is an antiviral drug recommended for infection of the body with two types of influenza viruses - type A and type B. Available by prescription.

Instructions for use Oseltamivir

Release form

The drug is produced in the form of gelatin capsules in a hard shell (No. 2). The color of the capsule body is brown, the cap is cream. On the lid there is the inscription "OR", on the body - "75". Both are black. The mixture inside is a white powder.

Capsules in a blister of 10 pcs. There is 1 blister in the box.

Storage conditions

Store the drug in a cool, dark, dry place. This should be done no longer than 2 years from the date indicated on the box. Acceptable temperature is positive up to 25°C. Hide from children.

Compound

Each Oseltamivir capsule contains oseltamivir phosphate – 98.5 mg; additional components: sodium stearyl fumarate, croscarmellose sodium, corn starch, talc, povidone.

Pharmacodynamics

Oseltamivir carboxylate exhibits an antiviral effect. It is a selective inhibitor of influenza virus neuraminidase.

Oseltamivir carboxylate stops neuraminidase activity. This leads to inhibition of the growth of influenza A and B viruses outside the body. The use of the drug reduces their excretion from the body.

Method of use of the antiviral drug

The drug Oseltamivir is prescribed as an antiviral drug for patients over 13 years of age. It is advisable to drink it during meals.

Flu therapy

The instructions for the antiviral drug advise you to start using the drug no later than two days after the first signs of the disease so that the effectiveness of the drug is visible.

Use of medication as a prophylactic agent

To prevent influenza infection during an epidemic or after contact with an infected person (once you learn about it, start treatment immediately), it is recommended to take 75 mg of the drug once a day for 10 days. The doctor may extend the use of an antiviral drug for prophylaxis for up to 6 weeks.

For adults, the maximum dose is 150 mg per day. Exceeding the dosage will not increase the effect.

Side effects

* Insomnia;
* Dizziness;
* Headache;
* Severe weakness;
* Increased fatigue;

* Nausea, vomiting (at the beginning of therapy and in case of overdose);
* Abdominal pain;
* Loose stools;

Respiratory system:

* Problems with nasal breathing;
* Sore throat;
* Bronchitis;
* Cough;

Dermatology:

Hypersensitivity reactions are possible, expressed as:

* rash;
* dermatitis;
* eczema;
* swelling of the skin of the face and tongue;
* erythematous rashes;

Contraindications

The use of the product by children under 13 years of age is prohibited, as well as in cases of individual intolerance to any component in the composition of the drug.

Pregnancy

Research continues.

Taking the drug during lactation is prohibited.

Overdose

In case of severe overdose, vomiting and nausea are possible. Treatment consists of gastric lavage and symptomatic therapy.

Additionally

The effectiveness of the drug when exposed to other influenzas has not been determined.

The drug is not effective if you start using it 40 hours after the moment of infection.

There is no information about the effectiveness of the drug in patients with chronic cardiopathologies and damage to the respiratory system, as well as in patients with other severe diseases and conditions in the patient for which he needs inpatient therapy.

When Oseltamivir is reused as a prophylactic and therapeutic agent, its safety and effectiveness have not been confirmed.

Before using the drug, you need to check the bacterial etiology of the disease (based on the similarity of signs at the onset of the disease) and confirm infection with both types of influenza virus, since the drug is ineffective for diseases of bacterial origin.

The experiment did not confirm depression of the central nervous system (which could have an impact on the speed of attentiveness and psychomotor skills) under the influence of the drug. But, nevertheless, before you get behind the wheel of a vehicle or engage in other types of at least somewhat dangerous activities during treatment, you need to keep in mind the dizziness from taking the medicine, as well as the danger that is caused by the signs of the initial illness (for example, severe hyperthermia ).

The onset of the first cold weather always alarms us with the appearance of respiratory viral infections. Panic on the radio, television, among friends is instantly stored in the mind, and a person begins to listen to his body in anticipation of a “terrible” virus.

In this article, we will look at cheap analogues of the drug Tamiflu and compare their effectiveness.

Are viral infections really that dangerous? Among doctors working in infectious diseases departments, there is an opinion that the greater the fear of the disease, the sooner you will get it. Doctors and nurses have been working for years in dangerous hospitals (for example, tuberculosis hospitals, without wearing a protective mask), and do not suffer from these infections. The percentage of infected personnel in infectious diseases departments is very low.

If we remember Soviet times, viruses were not widely trumpeted, and there was no such panic among the population. People went to skating rinks, rolled around in the snow, actively attended New Year's performances and were not so afraid of ARVI. Fear is the main culprit of many diseases, even common ARVI. In addition, the low immunity of our citizens wants to be the best.

Of course, one cannot completely dismiss “trifling” viruses, because... Still, there is a large group of people with immunodeficiencies who require auxiliary antiviral therapy for influenza, and sometimes serious medications, such as the drug Tamiflu.

It is also necessary to note the inappropriateness of prescribing antiviral drugs in cases where the body copes completely independently using only traditional methods, producing protective persistent antibodies.

In our article we will talk about the sensational, expensive antiviral drug Tamiflu, which was spoken of during the swine flu epidemic as almost a panacea. Let's get acquainted with analogues of Tamiflu, which are much cheaper and more accessible to the general population.

Tamiflu - instructions

To compile a list of Tamiflu analogues and select worthy products that will not only therapeutically satisfy the patient, but also cost less, let’s consider its main parameters.

Release form, price, composition, storage

The drug is available in the form of capsules (75 mg No. 10) and powder for suspension (12 mg/1 ml) - 30 grams of active substance in a bottle. Today, the average price for capsules is 1,200 rubles.

The availability of the powder and its price should be checked at a specific pharmacy, because Recently, Internet search engines have not provided information about this form of the drug. Usually the powder costs 150 rubles more.

The active ingredient in Tamiflu is oseltamivir.. The shelf life of the drug is 5 years.

Indications

The drug is used for the prevention and treatment of influenza (types A and B), as well as parainfluenza. Tamiflu is prescribed to children as early as 12 months. In practice, the remedy is used earlier, starting from six months.

Contraindications

It is not recommended to use Tamiflu in case of severe renal pathologies and non-susceptibility to the main or auxiliary composition. A relative contraindication is pregnancy and lactation, but at the discretion of the doctor, Tamiflu can be used during this period.

Adverse reactions

Sometimes the following side effects may occur:

• dizziness;
• nausea (sometimes vomiting);
• epigastric pain;
• upset stomach (diarrhea, or feeling the urge to stool);
• weakness;
• hallucinatory manifestations;
• sleep disturbance;
• allergic reactions;
• cough;
• laryngitis;
• conjunctivitis;
• other.

Dosage

When the first symptoms of influenza appear, the drug should be used no later than 48 hours.

For babies, a suspension is used, because the child cannot swallow capsules. If the powder is not available for sale, you can use the contents of the capsules to prepare the suspension. The calculation of the required dose is carried out by the pediatrician, taking into account the age and weight of the child.

Patients weighing at least 40 kg take capsules twice a day (morning and evening). After 12 years, it is also recommended to take Tamiflu twice for 5 days, i.e. A blister of 10 tablets is used.

For the purpose of prevention, dosages should be as follows:

• For patients weighing more than 40 kg, as well as for children over 12 years of age, Tamiflu is prescribed for 10 days, 1 capsule per day;
• For children, preventive doses are determined only by a pediatrician.

After reading the instructions, it is easy to notice that Tamiflu is used only for the flu, has a high price and a large list of potential adverse reactions. A positive point is the possibility of treating influenza in young children.

Of course, not all patients are ready to pay 1200 rubles for 10 tablets of Tamiflu, yet “our patient” is always looking for a cheaper alternative so that the price does not hit his pocket. Do such analogues exist? Let's try to figure it out.

Doctor Komarovsky about the drug Tamiflu

List of cheap analogues

Almost all antiviral drugs are cheaper than Tamiflu, so the list of analogues will be long. But we will not list information from pharmacological reference books, but will present a list of drugs that, according to statistics, are most often used for the flu, as an alternative to Tamiflu:

• ingavirin 60 mg (7 capsules) – 370 rubles;
• arbidol 100 mg (10 caps.) – 230 rubles;
• Relenza 20 mg (5 rotadiscs) – 1100 rubles;
• kagocel 12 mg (12 tablets) – 270 rubles;
• amiksin 60 mg (10 tablets) – 600 rubles;
• cycloferon 150 mg (10 tablets) – 190 rubles;
• Anaferon (20 tablets) – 230 rubles.

Tamiflu or Ingavirin – which is better?

The cheap Russian analogue Ingavirin is considered an excellent replacement for Tamiflu, not only in price, but also in therapeutic effect. Therefore, high sales of this drug have been noticed recently.

Ingavirin has broader indications than Tamiflu. It is prescribed for acute respiratory viral infections, adenoviruses and other respiratory infections. Tamiflu is used only for the flu.

Unlike Tamiflu, ingavirin suppresses not only viruses, but also relieves inflammation, eliminates toxins, activates the production of its own interferon, and eliminates catarrhal phenomena. The drugs under consideration have completely different compositions, so they are not structural analogues.

Lack of ingavirin - the drug is used only from 18 years of age(dosage 90 mg) and from 7 years (60 mg). Tamiflu is recommended for use starting from 12 months of a child’s life. The advantage of Ingavirin is that it does not have a toxic effect, like Tamiflu.

According to clinical trials, there is evidence of a more pronounced antiviral effect of ingavirin compared to Tamiflu.

The price of ingavirin is 3.5 times cheaper.

Relenza or Tamiflu – what to choose

Unlike Tamiflu, amixin is used only from the age of seven, and its price is half the price. The area of ​​use is not limited to influenza. Amiksin is a frequently prescribed drug for respiratory infections, which has not only antiviral activity, but also a pronounced immunomodulating property.

Amiksin shows effectiveness against herpes, cytomegalovirus, viral hepatitis, and other pathologies of viral origin. Amiksin is non-toxic compared to Tamiflu, and side effects are so rare that they are practically reduced to zero. Most often this is an individual intolerance to the composition of the drug.

Amiksin or Tamiflu - which is better? It is impossible to answer unequivocally. It is necessary to consider a specific clinical case, taking into account the symptoms, age, allergy history and immune status of the patient. Only a set of this information about the patient will help you choose one of these remedies.

Cycloferon or Tamiflu - which is better?

Despite its inexpensive cost, the drug shows high effectiveness against many diseases: influenza, ARVI, viral hepatitis, HIV, neuroinfections, and others. This effect is achieved through a combination of three properties of the drug: antiviral, anti-inflammatory and immunomodulating. A successful combination of active ingredients allows you to quickly eliminate the symptoms of influenza and ARVI.

Unlike Tamiflu, the drug is only in tablet form and is used in children only from 4 years of age. Cycloferon has no side effects, with the exception of possible allergic reactions. Therefore, long-term courses of taking this drug are safe, which allows treatment in patients with immunodeficiencies, such as HIV infection.

The price of Cycloferon is 5 times less, it is not surprising that patients quite often prefer it to Tamiflu.

Anaferon or Tamiflu – what to choose

This drug is classified as homeopathy, the composition of which includes affinity-purified antibodies to human interferon gamma. Anaferon has two tablet forms: adult and children's. The second form allows you to use the product from the age of one month onwards. For the youngest patients, the tablets are turned into powder and dissolved in water according to the prescribed dose.

There are more indications for the use of Anaferon than Tamiflu. They include: herpes virus, infectious mononucleosis, acute respiratory viral infections, immunodeficiencies, bacterial lesions, and other pathologies. Homeopathy acts gradually, forcing the body to “get out” on its own using its own reserves and self-healing. In the future, this helps reduce the number of relapses of respiratory infections.

Anaferon activates antiviral immunity and acts more slowly than Tamiflu for the flu. For aggressive acute respiratory viral infections and influenza, anaferon is more suitable as a complex therapy for these diseases than separately, but if the patient has good immunity, even with influenza infection, it can also be used as monotherapy.

We can conclude that Tamiflu is an antiviral agent, and Anaferon is an activator of antiviral immunity.

The price of Anaferon is significantly lower than that of Tamiflu, approximately 5 times.

Issue on the effectiveness of Tamiflu

Conclusion

Selecting analogues is not always easy. Of course, if the replacement is made only taking into account the price, then there is no problem, we compared the cost and took the drug cheaper. But this approach, to put it mildly, is philistine, and has nothing in common with professionalism. It’s good if the drug is suitable and has the expected effect of treatment.

Unfortunately, often pharmacies, seeing the buyer’s desire to buy a cheap antiviral drug, offer remedies, taking into account only the price, but not the patient’s complaints. Although in principle they are not obliged to advise patients at all.

It is a pity when patients in the first days of influenza and ARVI do not receive professional help, and then Tamiflu or its analogues purchased at a high price will no longer bring the expected result by at least 50%. The money is wasted, and there remains disappointment about the drug and the entire course of treatment.

Remember, antiviral drugs are selected exclusively by the doctor, because The doctor always adjusts the dosage according to the instructions, according to the ongoing flu or acute respiratory viral infection. Sometimes the course of treatment lasts only three days, and in some cases it is recommended to extend anti-influenza therapy longer than even indicated in the instructions. Be healthy!

Attention, TODAY only!

Among people who are faced with painful conditions, drugs with an antiviral effect are in greatest demand in pharmacies. Regardless of whether a person is sick or not, he turns to a pharmacist in order to buy a drug that has this effect. Many people use medications of this type to eliminate the illness that has arisen, and some people take the medication for preventive purposes to avoid the development of the disease. To combat the most common viral disease, influenza, many people use Tamiflu or its analogues.

Effect of the drug

Contains Tamiflu The main component is oseltamivir. In addition to it, there are also additional components. Their composition may vary depending on the form of release of the drug.

When treating viral diseases with this medicine, its main component selectively inhibits neuraminidase of the influenza A and B viruses. This helps prevent the release of new viruses from cells that have already been infected. Thanks to this action, this drug prevents the further development of the viral disease. Thanks to oseltamivir, the pathogenicity of viral cells is reduced and their replication is also reduced.

If you take this medicine within two days from the moment signs of a viral disease are detected, you can ensure a reduction in the duration of the disease, as well as reduce the risk of complications after recovery from illness. When treating Tamiflu, the main component of the drug does not affect the process of the formation of antibodies to viruses. When carrying out seasonal prophylaxis using this drug, resistance to the active component does not occur in people taking Tamiflu.

The route of administration of Oseltamivir is oral. After entering the body, it is absorbed in the intestines. The effect of hepatic esterases on the drug leads to the formation of the active form of oseltamivir. In the blood of a person who is being treated with Tamiflu, it is detected in the blood plasma after half an hour has passed from the moment of taking the drug. The active substance reaches its maximum concentration three hours after administration.

The substance is removed from the body by the kidneys after 6 hours. The intestine provides the excretion of no more than 20% of the main drug. Time of withdrawal of the main component in people who suffer from kidney failure, occurring in a severe form, increases noticeably. People who suffer from liver dysfunction do not experience any negative effects when removing the components of this medicine from the body.

When is Tamiflu prescribed?

The instructions for this pharmacological agent indicate that the indication for the use of Oseltamivir is therapy and prevention of viral infections that were caused by influenza. Doctors can prescribe this medicine for children starting from 1 year old, and also prescribe it for the treatment of adult patients. If there is an urgent need, then this remedy can be prescribed to children from 6 months.

The flu has a certain set of typical symptoms, the onset of which occurs suddenly. These include the following:

If adults or children are constantly in contact with possible carriers of the virus, then Oseltamivir is often prescribed as a preventive measure.

Tamiflu: instructions for use

The versatility of this drug lies in the fact that it can be used to treat diseases of viral etiology in children and adults. The only thing that may vary is the dosage of the drug, as well as the release form.

In powder form

Ready-to-use suspension used in the treatment of viral diseases by taking Tamiflu orally. Before taking the medicine directly, you need to shake the bottle several times and keep it tightly closed. After this, measure out 52 g of purified water and add the liquid to the bottle. Next, you need to close the bottle with a lid and shake it for 20 seconds. As a result a uniform suspension should form. When the suspension is ready, remove the cap and replace the adapter. The date on which the solution was prepared should be immediately marked on the bottle.

• The drug in the form of a suspension is prescribed to adults and children at a dosage of 75 mg twice a day;
• when treating children weighing more than 40 kg, the drug is prescribed in the same amount, but taken once a day.

According to reviews, the duration of treatment with Oseltamivir should be 10 days. When treating viral diseases on your own, it is prohibited to increase the dosage without consulting a doctor, even if you are taking Zanamivir. In this case, the patient will not be able to provide the necessary healing effect. Moreover, he may experience adverse reactions when taking Oseltamivir.

When preventing diseases of viral etiology, Oseltamivir is prescribed to children in the following dosages:

In capsule form

Oseltamivir or its analogues prescribed in this form must be taken orally with clean water. There is no need to chew the product in your mouth. Taking medication not tied to meals. The dosage of the drug in the form of a suspension and in the form of capsules is the same.

Side effects

The instructions for use of this remedy note that the most common side effect that occurs in people using this remedy to treat viral illnesses is feeling nauseous, vomit. The appearance of these effects can occur at the initial stage of treatment of the disease. As a rule, they go away on their own, and there is no need to refuse Oseltamivir therapy.

Along with these side effects, there are others that cause more serious character and if these occur, the patient must stop taking the medication and visit the attending physician:

• respiratory system: cough, bronchitis and laryngitis;
• Gastrointestinal tract: stool disorders, pain in the abdomen, as well as nausea and vomiting;
• Allergic conditions: the appearance of dermatitis, as well as the occurrence of eczema, urticaria.

Contraindications

People who have intolerance to oseltamivir, it is not prescribed for the treatment of viral diseases. It is also not prescribed to people with intolerance to additional components present in this medicine. Oseltamivir is not prescribed for people who have end-stage renal failure.

People whose work involves driving a car are also not prescribed this medicine. In addition, people should be careful when taking this drug. who operate complex equipment.

Tamiflu: cheaper analogues and cost

When you go to a pharmacy to purchase Oseltamivir, many will probably be surprised at the high price tag. It is impossible to find this medicine for less than 1000 rubles. The maximum cost of the medicine is 1300 rubles. The issue of the price of a medicine depends largely on the pharmacy chain in which it is offered, as well as the manufacturer of the drug. For people who want to get rid of a viral disease, this is an expensive product it is too expensive.

Therefore, in order to get rid of the painful condition, they try to find Tamiflu analogues that are more affordable in terms of price.

It is worth saying that if used as the main therapeutic agent analogue of this drug, then the treatment process will be no less effective. However, it should be noted that it will not be possible to save on therapy using analogues, since they cost only slightly less than Tamiflu.

• Relenza is offered in pharmacies at prices ranging from 950 to 1200 rubles.
• Patients can purchase Flustop at prices ranging from 1050 to 1300 rubles.
• Arbidol works well for the treatment of viral diseases, for which you will have to pay from 500 to 800 rubles at the pharmacy.
• Oseltamivir is offered at prices ranging from 904 to 1250 rubles
• Amiksin can be purchased at a price of 905 rubles.

Oseltamivir (oseltamivir) is a drug recommended by the World Health Organization for the treatment and prevention of influenza types A and B. This antiviral drug prevents the reproduction and spread of viruses in the body.

Indications and dosage:

Influenza type A and B (treatment and prevention).

The drug should be taken no later than 2 days from the onset of flu symptoms; adults and children over 12 years old - at a dose of 75 mg 2 times a day for 5 days; increasing the dose to more than 150 mg/day does not increase the effect. Children from 1 year to 12 years - depending on body weight.

Prevention: adults and children over 12 years old - 75 mg once a day for 6 weeks (during a flu epidemic).

In patients with creatinine Cl less than 30 ml/min, dose adjustment is necessary (75 mg 1 time per day for 5 days); when creatinine Cl is less than 10 ml/min, there is no data on use.

Overdose:

Currently, no cases of overdose have been described. Single doses of oseltamivir phosphate have caused nausea and/or vomiting.

Treatment: symptomatic therapy. There is no specific antidote.

Side effects:

• Insomnia

  Dizziness

  Cough, bronchitis

• Lethargy, weakness

  Headache

  Sore throat

  Stomach ache

Contraindications:

Drug intolerance

Kidney failure.

Due to the lack of studies, Oseltamivir is used with caution:

For liver failure.

In childhood up to 1 year.

There is also information that the degree of effectiveness and safety of using the drug to prevent influenza in children under the age of 13 years has not been determined.

During pregnancy and breastfeeding, the drug can be used only in cases where the expected effect of treatment exceeds the possible risk to the fetus or child (also due to the lack of research).

Interaction with other drugs and alcohol:

Information obtained from pharmacological and pharmacokinetic studies of oseltamivir suggests that clinically significant drug interactions are unlikely.

Drug interactions caused by competition with esterases, under the influence of which oseltamivir phosphate is converted into an active substance, are not covered in detail in the literature. The low degree of binding of oseltamivir carboxylate to proteins suggests that an interaction caused by displacement of the drug from protein binding is unlikely.

Cimetidine, which is a nonspecific inhibitor of isoenzymes of the cytochrome P450 system and a competitor for the renal tubular secretion of bases and cationic drugs, does not affect the plasma levels of oseltamivir and oseltamivir carboxylate.

Concomitant use with probenecid leads to an approximately 2-fold increase in the AUC of the active metabolite (due to a decrease in active anionic tubular secretion in the kidneys), but no dose adjustment is required.

No pharmacokinetic interaction was detected when oseltamivir was taken simultaneously with amoxicillin, paracetamol, antacids (magnesium and aluminum hydroxide, calcium carbonate).

Composition and properties:

Active ingredient: 1 capsule contains 98.5 mg of oseltamivir phosphate, which is equivalent to 75 mg of oseltamivir.

Excipients: pregelatinized starch, croscarmellose sodium, povidone, talc, sodium stearyl fumarate.

Release form:

Pharmachologic effect:

Oseltamivir is the international name of the drug; this active substance is also included in the preparations Tamiflu (capsules and powder for suspension), Tamigripp (capsules).

Storage conditions:

Diazepam should be given at temperatures up to 25 degrees Celsius.