When the flu strikes, it will possibly really feel relentless: rising fever, hacking cough, stuffy nostril and sore throat. For many individuals, aid can come within the type of Tamiflu, a prescription antiviral remedy used to deal with and even forestall the sickness.
But some folks could not understand that Tamiflu isn’t the one possibility.
Other flu treatments can be found within the United States. These alternate options generally fly below the radar, in part because some are targeted for specific populations. But Xofluza, a one-dose tablet, is authorised for folks 5 years and older – and generally is a sturdy different for some individuals who could in any other case be prescribed Tamiflu.
Antiviral drugs are inclined to work finest when began inside two days after signs start, so having quick access to therapy choices is vital for treating the flu most successfully.
To deal with flu this season, there are four antiviral drugs recommended by the US Centers for Disease Control and Prevention: Tamiflu or oseltamivir, Xofluza or baloxavir, Relenza or zanamivir, and Rapivab or peramivir.
Tamiflu is used to deal with flu in folks ages 2 weeks and older, and to reduce the chance of getting the flu in folks 1 12 months and older. The medication is run in liquid kind or capsules, and sometimes have to be taken twice day by day for 5 days when used for flu therapy. When used for prevention after publicity, it’s sometimes taken as soon as day by day for 10 days. Available as a generic or below the commerce identify Tamiflu, it may cost about $50 or less with out insurance coverage. The commonest negative effects embrace nausea and vomiting.
As an alternative choice, Xofluza is run as a single-dose pill and authorised for ages 5 and older. It can be utilized to treat or prevent the flu, and it may cost nearly $200 with out insurance coverage, however eligible sufferers can use coupons to minimize prices. The commonest negative effects embrace diarrhea and vomiting.
“The most common complaint I hear about is vomiting from Tamiflu,” Dr. Ari Brown, a pediatrician based mostly in Texas and creator of the Baby 411 e book sequence, mentioned in an electronic mail. She referenced a 2023 study that confirmed about 18% of individuals expertise vomiting with Tamiflu versus 5% with Xofluza.
The research additionally discovered that about 5% of individuals get diarrhea with Xofluza in contrast with none taking Tamiflu. “I’ve also had a few pediatric patients experience moodiness with Tamiflu, which is reported in the literature,” she mentioned.
The “biggest difference” between Tamiflu and Xofluza is that Xofluza can cease viral shedding in sooner or later whereas Tamiflu could take about three days, Brown mentioned.
That means the remainder of the family could have much less publicity to the flu and fewer folks could come down with it, however “both antivirals will help reduce the duration of the misery by a couple of days,” Brown mentioned. For occasion, with therapy, some folks could expertise 5 days of flu signs as a substitute of seven.
Rapivab is likely one of the other prescription drugs authorised to deal with flu. The drug is authorised for ages 6 months and older, given once as an intravenous infusion by a well being care supplier. It may cost up to about $1,000 with out insurance coverage, and the most typical hostile response in adults tends to be diarrhea.
Lastly, Relenza is the other recommended flu remedy. It is inhaled in powder form, and sometimes administered utilizing an inhaler gadget twice a day for 5 days. The prescription drug is authorised to deal with flu in ages 7 and older, and for preventive use in ages 5 and older. It may cost up to about $90 with out insurance coverage. Side effects embrace allergic response, dizziness or irritation of the nostril, and it’s not recommended for folks with respiratory issues, similar to bronchial asthma.
Among the recommended flu treatments, Tamiflu tends to be the go-to flu remedy for many sufferers. But Xofluza is turning into extra broadly used, Brown mentioned.
However, it might not at all times be out there in pharmacies, recommended by suppliers or lined by insurance coverage.
“I suspect it is region-dependent,” Brown mentioned about entry to therapy.
“When one part of the country has surging flu cases, there is higher demand. We have not encountered this issue in Austin,” she mentioned. For occasion, this flu season, she has solely had one Xofluza prescription that she wanted to ship to a unique pharmacy as a result of the primary pharmacy was out of inventory.
But total, “Xofluza is rising in popularity over Tamiflu,” Brown mentioned.
“One dose. Fewer side effects. More insurances are covering the cost of it now and manufacturer coupon makes it less expensive than in previous years,” she mentioned, including that she prefers it for her sufferers. “But all of the factors above–cost, ability to swallow a pill, availability can impact that decision.”
Another issue which will affect choices: There is a rising concern in regards to the influenza virus growing resistance to Xofluza.
“This is more in the minds of the practitioner – and I think it has been one of the reasons it hasn’t been used more frequently – the influenza virus can develop resistance to baloxavir, to Xofluza, during the course of treatment,” mentioned Dr. William Schaffner, an infectious illness skilled at Vanderbilt University Medical Center.
“That happens sometimes around 10% of the time, so it’s not trivial. And that’s why I think the longer-term Tamiflu continues to be favored – that and the side effect of diarrhea,” he mentioned. “So, Tamiflu tends to be recommended more frequently, despite the fact that you do have to take it for five days.”
Xofluza resistance has appeared to happen much more incessantly in youthful youngsters, Dr. Tim Uyeki, chief medical officer of the influenza division on the CDC’s National Center for Immunization and Respiratory Diseases, mentioned throughout a name earlier this month of the CDC’s Clinician Outreach and Communication Activity (COCA).
“This emergence of baloxavir resistance is associated with a longer duration of symptoms,” Uyeki said during the call. “Fortunately, transmission of a baloxavir-resistant virus from person to person has been very, very limited. It’s been reported, but it appears to be very uncommon and there’s no circulation of baloxavir-resistant viruses or oseltamivir-resistant viruses in the general population.”
National influenza specialists mentioned on the COCA name that Tamiflu or oseltamivir is most popular for treating hospitalized sufferers and folks with progressive sickness.
Xofluza shouldn’t be recommended throughout being pregnant, whereas breastfeeding, for outpatients with sophisticated or progressive sickness, severely immunosuppressed folks or hospitalized sufferers, due to the lack of understanding on its use for these teams.
But there are conditions for which Xofluza could also be most popular.
“For a patient with known or suspected influenza B, baloxavir has much greater efficacy against influenza B compared to oseltamivir,” Uyeki mentioned in the course of the name, including that the remedy is “generally well tolerated.”
“A single dose of baloxavir is not associated with many side effects and fewer side effects compared to oseltamivir,” he mentioned. “For patients, I think every patient would prefer a single oral dose of baloxavir versus five days, twice-daily of oseltamivir treatment.”
At the top of the decision, Uyeki added that researchers ought to proceed finding out the potential advantages of treating flu sufferers with a mix of antiviral drugs, particularly these with extreme illness.
“I think we need more data for treatment of influenza in hospitalized influenza patients, so severe influenza,” he mentioned. “And for that we need more data for a combination antiviral treatment, for example oseltamivir-plus-baloxavir.”