Flu: doctors recommend Tamiflu. But is evidence-based medicine evidence-based?

Tamiflu antibiotic or not

Tamiflu is not an antimicrobial agent.
Some people believe that the antiviral agent Tamiflu is an antibiotic that can be used to get rid of the worst infection. But if you carefully read our article, you probably remembered that this is just an antiviral agent that helps the body itself begin to produce antibodies that will begin to suppress pathogenic bacteria.

Yes, initially it blocks them itself, but unlike antibiotics it does not kill them completely, but only weakens them, thereby enabling the body’s defenses to repel the attack as quickly as possible. Antibacterial agents affect the body a little differently. They simply kill the infection without worrying about the immune system. In view of all this, we can definitely say that Tamiflu categorically cannot be classified as a group of antibacterial drugs that are used to treat pneumonia, bronchitis and purulent tonsillitis.

Action of Oseltamivir

Oseltamyvir is released in an inactive form. It acquires medicinal properties in the human body, under the influence of enzymes. In the liver it takes on the carboxylate form. More than 70% of the drug enters the blood after passing the liver barrier. About 5% of the drug remains unchanged and circulates in the blood in an inactive form. The drug is excreted from the body in the urine.

The product blocks viral neiraminidazy, which is necessary for their reproduction. Without this enzyme, the pathogen cannot enter the cell, nor can it exit an already infected cell. Thanks to this, the virus cannot replicate and invade new tissue. Oseltamyvir affects the 2 most common types of infection - A, B.

Directions for use and dosage

Tamiflu is taken orally. The drug can be used regardless of meals, but its tolerability improves if it is taken with food.

To prepare the suspension, you need to distribute the powder at the bottom of the bottle, for which you should carefully tap the closed bottle with your finger several times, measure 52 ml of water using a measuring cup and add it to the bottle. After this, close the bottle tightly with a cap and shake well for 15 seconds.

Then remove the cap, insert the adapter into the neck of the bottle, and screw the cap onto the bottle tightly to ensure the adapter is positioned correctly. Before use, the bottle with the prepared suspension must be shaken.

If there are problems with swallowing capsules, it is not possible to use the powder to prepare a suspension, or if there are signs of “aging” of the capsules (after 5 years of storage of the drug, increased fragility of the shell or other problems may occur that do not affect the safety and effectiveness of the drug), it can be used granulate To do this, open the capsule and pour its contents into a small amount (maximum 1 teaspoon) of a suitable sweetened food product to mask the bitter taste. You can use chocolate syrup (normal or sugar-free), honey, table or light brown sugar dissolved in water, sweetened condensed milk, sweet dessert, yogurt or applesauce. The mixture must be mixed thoroughly and swallowed in full immediately after preparation.

To treat influenza, Tamiflu should be taken no later than 48 hours after the onset of symptoms of the disease. As a rule, adults and children over 12 years of age are prescribed the drug 2 times a day, 75 mg (capsules or suspension), the duration of therapy is 5 days. Increasing the recommended dose does not increase the effect.

Children over 1 year of age are recommended to take the drug in the form of a suspension. A single dose is determined by weight:

• Less than 15 kg – 30 mg;
• 15-23 kg – 45 mg;
• 23-40 kg – 60 mg;
• More than 40 kg – 75 mg.

The drug is taken 2 times a day for 5 days. For correct dosing, use the included syringe marked 30, 45 and 60 mg. If necessary, children over 8 years old or weighing more than 40 kg can take Tamiflu in capsule form.

To prevent influenza, adults and children over 12 years of age are prescribed the drug once a day, 75 mg for at least 10 days after contact with an infected person. Taking Tamiflu should be started no later than in the first 2 days after contact. During a seasonal flu epidemic, the drug is taken in the same dose for 6 weeks. As long as you take the drug, the preventive effect of Tamiflu continues.

For children, the drug for the prevention of influenza is prescribed in the same single dose as for treatment. Children weighing more than 40 kg can take capsules. The frequency of taking Tamiflu is 1 time per day, the duration of therapy is 10 days.

Patients with creatinine clearance more than 30 ml per minute do not require dose adjustment. If the creatinine clearance is 10-30 ml per minute during treatment, the daily dose should be reduced to 75 mg. For prophylaxis, the daily dose should be reduced to 30 mg when taken daily or to 75 mg when taken every other day.

Patients with moderate and mild liver functional disorders, as well as elderly patients, do not require dosage adjustment.

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.

pharmachologic effect

The pharmacological action of oseltamivir is based on its ability to inactivate viral neuraminidase, an enzyme that contributes to the damage of healthy cells by viral agents, as well as their spread. The enzyme neuraminidase was first discovered during the study of pathogenic microorganisms that cause gas gangrene (Clostridium perfringens).

Under the influence of the enzyme, newly formed viral particles are easily separated from the outer shell of infected cells, which contributes to the further movement of viruses throughout the patient’s body. Oseltamivir has a pharmacological effect outside cells, circulating in the blood plasma and intercellular fluid. The concentration of active substance sufficient for therapeutic effectiveness is fifty percent of the lower limit of the nanomolar range.

Oseltamivir helps reduce the release of viruses from the body when coughing and sneezing, reducing the likelihood of developing the disease in contacted people, which is especially important for preventing the spread of infection. Isolation of a patient with influenza infection is desirable, but not always possible. The patient can spread pathogens to family members and work colleagues.

The properties of the drug to limit the spread of viral agents may help improve the epidemiological situation. Reduction of symptoms of intoxication during treatment with Tamiflu occurs due to a decrease in the concentration of toxins in the blood plasma. The symptoms of intoxication during influenza infection can be so pronounced that the patient experiences confusion, loss of orientation, hallucinations, severe muscle and joint pain...

The maximum effectiveness of oseltamivir is observed within 40 hours from the onset of influenza infection. Resistance to the effects of the drug, according to serological studies, is observed in no more than one percent of viral strains. After oral administration, Tamiflu is absorbed in the small intestine, the maximum concentration in the blood plasma and intercellular fluid is observed after two hours. Metabolism occurs under the influence of liver enzymes, resulting in the appearance of an active metabolite - oseltamivir carboxylate.

Its content is twenty times higher than the concentration of the original pro-drug. More than seventy percent of the dose taken is converted into an active metabolite and enters the blood plasma, where it is partially bound to proteins. The active metabolite is excreted from the body primarily by the kidneys; the half-life of Tamiflu is eight to ten hours.

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!

During a period when the incidence of influenza is very high, many people are trying to stock up on the popular antiviral drug Tamiflu. This may be why it is not always available in pharmacies. However, you may be offered a Russian drug called Nomides. What kind of medicine is this, and how can it replace the Tamiflu you are looking for? Let's take a closer look at the properties of both drugs, and also find out how effective they are in treating the flu.

At what age can Tamiflu be given to children?

Tamiflu - recommendations for use
Despite the fact that some parents decide to use Tamiflu to treat children under one year old, official medicine allows it to be given only to those children who are already 1 year old. Also, in addition to age, the weight of a small patient must be taken into account. It is believed that the body can easily cope with the active substance only if the child weighs at least 15 kg.

If the baby weighs less, the single dose is reduced and is only 25 mg. But all this does not mean that using Tamiflu to treat infants is strictly prohibited. If a viral infection threatens the baby’s life, the doctor may decide to use just such anti-influenza therapy.

True, in this case he will have to independently select the daily dose of the medicine and give it to the child under strict supervision. For this reason, such children are admitted to the hospital and are examined by the attending physician several times a day while they are taking the drug. If after 3 days of taking the medicine there is no improvement, another therapy is selected for the small patient.

Oseltamivir - instructions for use and price

The cost of drugs depends on the manufacturer, the number of capsules in the package, and the region. Product under the trade name Nomides:

• 75 mg – 700 rubles.
• 45 mg – 400 rubles.
• 30 mg – 300 rubles.

Tamiflu:

1. 75 mg – 1100 rubles.
2. Suspension – 900 rubles.

The price of Influcein 75 mg varies between 600-700 rubles. Instructions for use and price of Oseltamivir and Zanamivir are similar.

Directions for use and dosage

The drug can be taken with meals or regardless of meals. Some patients absorb the medicine better if they take it with food.

The standard dosage of 75 mg per day can be divided into 2 parts, one 30 mg capsule and one 45 mg capsule.

It is better to start treatment in the first days of the disease, immediately after the first symptoms appear.

Instructions for use of Tamiflu in the form of capsules for the treatment of influenza

Adults and children over 13 years of age take 75 mg 2 times a day. The course of treatment is 5 days.

Tamiflu for children from 1 to 12 years of age is recommended to be prescribed in an amount of 60 to 150 mg per day, divided into 2 doses. The course of treatment is 5 days.

The dosage depends significantly on the child’s weight:

• for weight up to 15 kg – 60 mg per day;
• with a weight from 15 to 23 kg – 90 mg;
• children weighing from 23 to 40 – 120 mg per day;
• with a weight above 40 mg – 150 mg.

For children aged six months to one year, 3 mg per kg of weight is prescribed, 2 times a day. The course of treatment is the same as for other age categories.

Instructions for capsules for prevention

It is recommended to take the medicine as a prophylactic within 2 days after contact with the patient.

As a rule, take one 75 mg capsule once a day for 10 days.

During an epidemic, you can drink 75 mg, once a day for 1.5 months.

Tamiflu for children under 12 years of age is prescribed as a prophylaxis depending on weight:

• up to 15 kg – 30 mg per day;
• from 15 to 23 kg – 45 mg per day;
• from 23 to 40 kg – 60 mg;
• more than 40 mg – 75 mg per day.

The duration of treatment is 10 days.

If the patient has problems swallowing the capsule or it appears unsuitable for consumption, the contents of the tablet can be poured into a teaspoon. Then add chocolate syrup, sugar, honey, condensed milk or another product that can hide the unpleasant taste of the powder. The prepared product must be consumed immediately after mixing.

Indications for use

This antiviral drug is intended to treat influenza types A and B. It is suitable for adults and children from 6 months. Tamiflu is also prescribed for the prevention of infectious diseases caused by these pathogens. If there is no reliable data on a specific virus, then this medicine may not have the expected effect, since the effect of Tamiflu does not apply to other viruses.

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Side effects and contraindications

When treated with Tamiflu, side effects are observed in the gastrointestinal tract: nausea, vomiting, diarrhea, epigastric pain that goes away on its own and does not require discontinuation of treatment.

Side effects from the nervous system, especially when treating children under twelve years of age, according to clinical studies, may be accompanied by psychopathic reactions.

An in-depth study of Tamiflu was conducted by Japanese scientists in 2004, which resulted in the identification of the psychotropic effect of oseltamivir on the children's body. The description of the drug Tamiflu, presented in the instructions for use, does not contain this information.

The World Health Organization (WHO), in connection with the threat of the spread of bird flu, recommended the administration of Tamiflu to children starting from birth, which caused fierce controversy among the medical community. There is still no consensus on this issue among scientists.

Contraindications to the use of Tamiflu are:

• Intolerance to one of the components of the drug;
• Diseases of the liver and kidneys, accompanied by severe functional disorders;
• Tamiflu is not recommended for children under twelve years of age due to significant side effects on the nervous system and gastrointestinal tract.

Self-medication with Tamiflu is not recommended. Indications for use, dosage and timing of treatment should be determined by the attending physician.

Reviews

Ivan

“During the swine flu epidemic in 2010, I was hospitalized with viral pneumonia due to the flu, I spent a long time in intensive care and was put on a ventilator, in a word, I was already in the grave with one foot, how they pulled me out is still not clear. Now every breeze immediately turns into bronchitis, at best, and surviving a flu epidemic is generally a problem. So last year, Tamiflu helped to bring down the incipient infection very well. I took it according to the regimen as recommended by the therapist and the flu was gone. Became my lifesaver"

“My son is 10 years old. Pain in the joints began and there was a sharp rise in temperature. We started taking Tamiflu. At the first appointment I complained of nausea, but at the second appointment there was no more nausea. The child recovered from his flu-like state a few hours later.”

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Instructions for use for treatment

Tamiflu can be prescribed to people who are already sick, or as a preventive measure. In the latter case, the drug is usually prescribed in an amount of 75 ml twice a day. The course of treatment at this dosage is most often 5 days. This medicine can be taken at any time of the day - both before and after meals. However, it is believed that the drug is best absorbed during meals.

The instructions for use prescribe the drug Tamiflu in the first two days after the first symptoms of influenza appear. The price (the reviews of analogues of this drug are not so good, since they are not as effective) for this medicine is high, but it begins to help immediately. Most symptoms subside within the first day of use.

It is also possible to take Tamiflu from capsules with signs of “aging”. In this case, the powder should be poured into a small amount of a sweetened food product (honey, syrup, condensed milk). Increasing the dose of the drug to more than 150 mg/day does not increase the effectiveness of its action.

The effectiveness of oseltamivir in the treatment of influenza

Since oseltamivir has been used for more than 15 years, its effectiveness has been proven in randomized, placebo-controlled trials. For example, one such project involved 374 people with influenza. The study found that compared to placebo, treatment with Tamiflu:

• the duration of the disease is reduced by more than 30%,
• the severity of the disease is reduced by 38%,
• the duration of fever decreases by 2–3 days,
• the number of complications in the form of bronchitis and sinusitis is reduced by 8%.

In this study, two dosages of the drug were used: 75 or 150 mg of oseltamivir per day. Interestingly, there were no significant differences in treatment outcomes between patients taking one or two capsules of the drug per day.

special instructions

Undesirable side effects when using Tamiflu are unlikely, and come down more to individual intolerance to the components of the drug. Since the medicine must be prescribed by a doctor, he usually takes into account all the characteristics of the patient’s body, which minimizes the occurrence of adverse reactions.

The most common side effect when using Tamiflu is nausea (less commonly, vomiting). Such manifestations may appear at the beginning of treatment and usually go away on their own, without requiring discontinuation of the drug.

Other side effects that may require you to stop using the medication:

There is evidence that children experienced symptoms such as disturbances of consciousness, delusions, hallucinations, and overexcitation while taking the drug. But experts say that the occurrence of such reactions may not be associated with taking Tamiflu, because the same symptoms often appear against the background of severe intoxication and high temperature, regardless of the use of certain medications.

Tamiflu has no absolute contraindications. Relative contraindications are:

• Individual intolerance to components;
• Age up to one year;
• Severe pathologies of the liver, kidneys and metabolic disorders.

There is no information regarding the tolerability of the drug in patients suffering from severe pathologies and people with weakened immune systems, as well as people with problems of the respiratory and cardiovascular systems.

Tamiflu may be used during pregnancy only if there are compelling indications.

Although studies conducted on animals have not shown a negative effect of the drug on the development and health of the fetus, Tamiflu should be taken during pregnancy with caution and only after consulting a specialist.

About the danger of ARVI

The same flu is a viral infectious disease, the transmission of which is carried out by airborne droplets when a person talks, sneezes, or coughs. Another variant of infection is contact, when a person communicates with a sick person or touches objects that have previously been touched by an infected person.

The infection spreads quite quickly, is virulent, that is, it can infect still healthy cells, and is resistant to external factors (can withstand cold temperatures down to minus 20 degrees).

Every year, ARVI epidemics affect millions of people, cause billions of dollars in costs, and often lead to serious complications and even deaths. All this forces medical scientists to look for ways to prevent and combat acute respiratory viral infections. Regular vaccination, of course, produces positive results, but for one reason or another the number of sick people does not decrease, but, on the contrary, only increases over time.

In addition, many viruses are prone to constant mutation (they have a mutagenic system), as a result of which it becomes increasingly difficult to protect against them. Scientists are not always able to predict which virus will cause the next epidemic, and therefore some general means of protection are required that could help, regardless of the strain active at one time or another.

Tamiflu is considered to be a drug that perfectly performs its preventive function, protecting against colds and ARVI, and, in addition, is used to treat these same diseases.

However, this drug cannot be called a “panacea” for acute respiratory viral infections, since it may have certain side effects

Should we pay attention to them? Definitely yes

Among antiviral drugs for ARVI, Tamiflu is considered one of the most effective. In pharmacies it can be found in the form of capsules or in the form of powder from which suspensions are made. The medicine successfully counteracts viral agents, regardless of external factors.

Analogs

In order to prevent and treat viral diseases in winter, in addition to Tamiflu, drugs that are analogues of this antiviral agent are also used. This list includes the following:

• Viferon;
• Ribavirin;
• Ergoferon;
• Theraflu.

All of the above products have a similar composition and a similar effect on viral agents.

Now the drug Tamiflu can be purchased without problems in almost any pharmacy. It is well known to people thanks to the extensive advertising carried out by the manufacturer. The average price for the drug will be from 1000 to 1200 rubles per package and may vary slightly depending on the specific region of the country.

The multitude of medicines on the shelves of pharmacies makes one wonder which drugs on the pharmaceutical market are the most effective during the period of viral diseases. The drug Relenza is rightfully considered the best analogue of the drug Tamiflu. This is explained by the fact that the active substances included in both have a similar mechanism of action on viral agents. The main difference between these medications is the release form. Also, Tamiflu, despite its almost identical composition, is one and a half times cheaper than Relenza.

Analogues of the drug

What is the difference between the Russian analogue of Tamiflu?

There are contraindications, drugs are used only as prescribed by a doctor

Not long ago, a Russian analogue appeared on the pharmaceutical market - Nomides. It is a generic drug. This means that the medicine contains an active substance with exactly the same chemical formula. In this case it is oseltamivir phosphate

.

Tamiflu is produced by F. Hoffmann-La Roche Ltd. (Switzerland ). Nomides is produced by the Russian company Pharmasyntez. Both drugs have the same capsule form according to:

1. 75 mg,
2. 45 mg,
3. and 30 mg oseltamivir.

On the manufacturer's website, Tamiflu is also presented in bottles in the form of powder for the preparation of suspensions, although it is quite difficult to find it in our pharmacies (the same applies to capsules of 30 and 45 mg), as a rule, only 75 mg dosage is found on sale.

So, in the main there are no differences between the drugs, but if you compare them by excipients, you will find an insignificant difference.

What does Tamiflu help with and what is its composition and active ingredient?

Tamiflu: composition, active ingredient
Tamiflu is a new generation drug that does not easily remove the symptoms of flu and colds, and also fights their causative agents. The active substance of the drug is oseltamivir. Once in the body, literally within an hour it is completely absorbed into the blood and begins to spread throughout the body.

Initially, they are metabolized by internal organs, which leads to blocking the growth of pathogenic bacteria. As soon as the virus becomes weak, the active substance switches to healthy cells, becoming a kind of shield for them that prevents the remnants of the virus from destroying their membranes. In addition to the active substance, Tamiflu contains small amounts of sorbitol, monosodium citrate starch, talc, povidone, gelatin, aromatic additives.

Most often, this drug is used to treat influenza types A and B. It is also acceptable to use it to treat so-called pandemic parainfluenza. True, in this case, the drug will be able to effectively influence the virus if it is used no later than 48 hours after the appearance of the first symptoms.

What is oseltamivir

To understand how oseltamivir works, let's talk a little about the structure of the influenza virus.
It is an RNA+protein complex packaged in a lipoprotein shell. On the surface of this shell there are 2 functional proteins - hemagglutinin and neuraminidase (sialidase). The virus needs hemagglutinin to attach to the cell. After entering the cell, the virus rearranges the entire mechanism of cellular replication to produce its own kind. Newly synthesized bud-shaped viral particles appear on the surface of the host cell. In order to “go free swimming” they need neuraminidase.

Neuraminidase has enzymatic activity and is capable of breaking down sialic acids. Sialic acids are carbohydrates found on the surface of human and animal cells. Under the action of neuraminidase, the sialic acid molecule is broken and the viral particles “go free floating”, infecting new cells.

Knowing how necessary this enzyme is for the virus to reproduce, developers of anti-influenza drugs concentrated their efforts on it. As a result, the substance oseltamivir was obtained, which is capable of:

• selectively inhibit neuraminidase activity,
• reduce the release of new viral particles from infected cells,
• increase the aggregation of viral particles, which leads to their inactivation,
• prevent the virus from entering the cells of the respiratory tract.

Based on the peculiarities of the mechanism of action, oseltamivir is effective in the initial stages of infection (up to 48 hours) or when taken prophylactically.

Oseltamivir fights both type A and B viruses. At the same time, for quite a long time it has been among the substances to which viruses develop little resistance.

Can Tamiflu be combined with other medications or food?

This drug can be prescribed with almost all medications; no obvious interactions with other drugs have been noted. The studies conducted by the manufacturer covered a large number of medications that patients most often take:

• Blood pressure-lowering drugs from various groups (diuretics, ATP inhibitors and others);
• Nonsteroidal anti-inflammatory drugs (analgin);
• Antibacterial agents (penicillins, cephalosporins);
• Antacids (Almagel, Maalox);
• Bronchodilators to relieve attacks of bronchial asthma (salbutamol);
• Glucocorticoids (prednisolone).

Tamiflu did not show significant interaction with any of the above groups, so it can be used without canceling the constant therapy of chronic diseases.

Tamiflu and food

It can be taken at any time, with food or during a break between meals. But since the medicine occasionally causes nausea and vomiting, it is better to take it with food, this will help you better tolerate the treatment.

Side effects

Most often, when taking this drug, nausea, headache and vomiting occur (especially in the first days of treatment). Also observed in adult patients:

• dizziness;
• pneumonia, otitis media, sinusitis;
• insomnia, cough, cramps, runny nose, hallucinations;
• nausea, bronchitis, pain in the epigastric region, weakness, diarrhea, conjunctivitis, indigestion;
• respiratory tract infections;
• skin rashes, nosebleeds, eczema, asthma, dermatitis, hearing impairment, urticaria, etc.

Side effects

Each drug can theoretically have a fairly large list of undesirable consequences, because a self-respecting manufacturer is obliged to indicate all the side effects observed during drug trials.

Often, undesirable effects are so unlikely that they rather relate to the area of ​​individual intolerance to the drug. If a doctor prescribes a medicine, he takes into account the characteristics of the patient’s body, and the risk of unwanted reactions is minimized.

The most common side effects associated with taking Tamiflu:

• from the gastrointestinal tract: in 1% of cases, when taking the drug for the first time, moderate nausea and vomiting, diarrhea, and abdominal pain were observed, which went away on their own; with further treatment, the drug was well tolerated;
• dermatological manifestations and allergic reactions: in very rare cases, eczema, dermatitis, skin rashes, toxic epidermal necrolysis, anaphylactic reactions, Quincke's edema occurred;
• from the central nervous system: about 1% of patients complained of headache, sleep disturbance, dizziness, and weakness.

There is evidence of disturbances of consciousness, delirium, agitation, hallucinations, and convulsions observed in children while taking the drug. However, the negative impact of Tamiflu in this case is quite controversial, since the same psychoneurological symptoms are sometimes observed against the background of severe intoxication of the body and high body temperature, regardless of taking any medications.

Action of the medication

What properties are inherent in the drug Tamiflu? Reviews from experts report that this is a prodrug. Its active ingredient is a selective inhibitor of influenza B and A neuraminidase. It activates the release of viruses and is also responsible for the spread and multiplication of harmful agents throughout the body.

The drug in question significantly facilitates the course of the disease, shortens its duration, and reduces the likelihood of bronchitis, sinusitis, otitis media or pneumonia.

What else is remarkable about the drug Tamiflu? Reviews about the drug say that in children under 12 years of age, when taking it, the duration of the disease decreases by 2 days.

How to take the drug

The medicine is taken orally with a small amount of water. The drug is available in the form of capsules and powder, with which a suspension is prepared. Interestingly, people who cannot swallow the capsule on their own in the absence of powder can open it and mix it with something sweet (honey, condensed milk, chocolate milk) and drink it calmly.

It is necessary to start treatment on the first day of the disease, in this case the maximum effectiveness of the medicine is noted.

Tamiflu 75 mg

This dosage is used to treat adults and children over 12 years of age. If a child is able to swallow a capsule, this form of the drug can be used from the age of 8, provided that the child weighs more than 40 kg.

The medicine should be taken twice a day for 5 days. Exceeding the dosage does not increase the effectiveness of the drug, so increasing the dose is not advisable.

Tamiflu 30 or 45 mg

This dosage is recommended for children aged 2 to 8 years who are able to swallow tablets independently. The tablets are taken 2 times a day for 10 days without a break.

Tamiflu powder

In children from 1 year of age, in children and adults who cannot swallow a hard capsule, as well as in older people, use the powder form, with which a suspension is prepared. It is better if a pharmacist at the pharmacy prepares it, but you can prepare the solution yourself, carefully following the instructions. The dosage of Tamiflu in powder will be 12 mg/ml solution, in a sachet 1 g. powder.

Algorithm for preparing a suspension for oral administration

1) Tap the bottle with your fingertip several times, this is necessary to evenly distribute the powder along the bottom;

2) Pour 52 ml of water into a measuring cup and mix it with the powder in the bottle;

3) Close it with a cap and shake for 15 seconds so that the powder dissolves;

4) Remove the cap from the bottle and insert an adapter into the neck, with which you can easily draw the required amount of medicine with a syringe.

The syringe comes complete with the drug and has special labels indicating the dosages: 30, 45, 60 mg. To prevent the expiration date, the date of preparation of the medicinal solution is written on the bottle label.

Tamiflu for prophylactic purposes

Adults and children over 8 years of age (if the child weighs more than 40 kg) use a dosage of 75 mg once a day.

Children under 8 years of age, as well as those people who are unable to swallow a solid tablet, use a suspension. The amount of medication needed is determined based on the child’s weight.

Tamiflu suspension

One form of the medicine is powder . The pharmacist prepares a suspension from it. In this form, Tamiflu is prescribed to young children who are physically unable to swallow the capsule. It is also prescribed for adults who have problems swallowing solid objects.

Without opening the bottle with the suspension, shake it slightly, and then gently tap it with your finger several times. All these manipulations allow you to distribute the powder as evenly as possible across the bottom of the bottle.

Then purified water (52 ml) is taken into a measuring cup. The bottle is opened and filled with the contents of the glass. Then, closing the cap, shake vigorously for 15 seconds.

The resulting suspension is set aside. The cap is replaced with an adapter (included).

The date of manufacture of the drug must be marked on the bottle. You should always know its expiration date.

The suspension can be used using a dosing syringe.

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Composition and pharmacological action

The drug Tamiflu has the following composition: oseltamivir, the main active ingredient of this drug, is contained in the form of a powder contained in a capsule. Its amount can vary from 30 to 75 mg. In addition, the drug contains auxiliary components: starch, gelatin, dyes, titanium dioxide and others.

If we are talking about Tamiflu powder for preparing a suspension, then its dosage is 30 mg, while the proportion of the active substance in the finished solution is 12 mg.

Tamiflu flu tablets have such a high antiviral effect due to the ability of the active substance to reduce the ability of viral neuraminidase to infect healthy cells of the body, develop and reproduce.

This enzyme has the ability to separate newly created viral cells and promote them inside the human body. Thanks to the action of Tamiflu, which concentrates in the blood plasma and intercellular fluid, the activity of viruses decreases, their activity slowly fades, and their death occurs.

Oseltamivir has the ability to reduce the amount of viruses released in saliva during sneezing, coughing, and talking

This is very important to reduce the risks of infection and widespread spread of infection. This property of Tamiflu allows you to improve the epidemiological situation within the boundaries of any object, in addition, it helps reduce the concentration of toxic substances in human blood

Oseltamivir should be taken no later than 40 hours after the person became infected. Moreover, only 1% of influenza strains show resistance to the drug.

The drug, after being taken orally, is absorbed in the small intestine, its maximum concentration is reached after 120 minutes. Metabolic processes take place in the liver; the kidneys are responsible for excreting the active substance. The half-life is fixed at 8 to 10 hours.

Pharmacological properties

The use of Tamiflu for ARVI is based on its pharmacological action, which suggests the possibility of inactivating neurominidase, due to which viral agents infect healthy cells. Oseltamivir separates infectious particles from the infected cell membrane.

In addition to Oseltamivir, the composition of the drug is presented:

• starch;
• monosodium citrate;
• sodium benzoate;
• aromatic additives (in the case of diluted powder);
• gelatin;
• talc;
• povidone;

Among other things, Tamiflu helps reduce intoxication in the body by reducing the concentration of blood toxins. It helps to cope with the consequences of ARVI, such as:

• joint pain;
• loss of orientation;
• muscle aches;
• the appearance of hallucinations.

When treating ARVI with Tamiflu, it is possible to avoid serious complications, such as:

• meningitis;
• viral pneumonia;
• otitis;
• sinusitis.

As for maximum effectiveness, it appears within forty hours after the start of infection. Only one percent of patients show resistance to the action of this drug.

Immediately after administration, Tamiflu is absorbed into the walls of the small intestine. It is most actively concentrated in blood plasma and intercellular fluid.

Liver enzymes participate in subsequent metabolic processes, resulting in the formation of oseltamivir carboxylate, which is 20 times higher than the concentration of the original drug substance. More than 70 percent of the dose taken is transformed into the indicated metabolite.

The active metabolite is excreted through the kidneys in about 10 hours.

Tamiflu contraindications, side effects

Tamiflu: contraindications, side effects

If you do not want to harm your body, then be sure to keep in mind that this product has a number of contraindications. For example, it should absolutely not be taken by people who are intolerant to at least one component. In this case, you will not only not get rid of the flu, but in addition to this you will provoke a very severe allergy. Another taboo is reduced immunity.

In this case, additional stimulation of interferon production can provoke an even greater decrease in protective forces, which can lead to a worsening of the condition. And, of course, remember that this drug is absolutely not suitable for people who have kidney problems. Taking it can aggravate the pathology or even provoke a chronic inflammatory process.

Side effects of Tamiflu:

• Digestive system problems
• Headache
• Nausea
• Skin rash
• Fatigue for no reason
• Irritability

Use of Oseltamivir

Oseltamyvir is used for:

• treatment of viral pathologies (H3N2 and H1N1);
• disease prevention during seasonal outbreaks and after contact with sick people.

If treatment is started 2 days after the onset of symptoms, Oseltamyvir may not be effective. The same conditions occur with a repeated course of therapy with the same drug. The medicine is used only against 2 strains of influenza. It is not effective for other respiratory infections.

It must be remembered that the drug does not replace the administration of the influenza vaccine. It also does not affect the level of antibodies and can be combined with vaccination.

Use of Tamiflu for children and adults

The medicine is used without problems by patients of any age and even with problems with the gastrointestinal tract, just in such cases tablets are used.
The drug Theraflu is taken regardless of food intake. Elderly patients, children, people with weak immune systems, or those with pathologies of the kidneys and gastrointestinal tract are recommended to take tablets with meals to improve tolerability of the medicine.

Flu treatment

The course of treatment for influenza should not last more than 5 days, and the difference between doses of the medicine should not be less than 12 hours, so that an overdose does not occur.
To cure the flu, it is recommended to take Tamiflu every 12 hours from the moment the symptoms of the disease appear until they disappear completely (usually the course is 5 days).

Dosage Directions:

• Adults and children should take 75 mg of the drug twice a day. In this case, any form of release of the drug can be used, but it will be more convenient for adults to take the medicine in capsules.
• Children over one year old (weight up to 40 kg) dosage amount – 75 mg once a day. It is recommended to use Tamiflu for children in the form of a suspension, because... it is more convenient for calculating the dosage and tastes better.

For some indications, Tamiflu is prescribed for the treatment of influenza in children under one year of age - but expert opinions differ on whether the drug can be used at such a young age, because studies on the effect of the drug on small patients have not been conducted. In the event of an epidemic, infants from 6 months to a year are prescribed the drug at a rate of 3 mg per kilogram of body weight twice a day, always under the supervision of a doctor.

Flu prevention

If you or your child constantly stays in a place where an epidemic has broken out, then Tamiflu can also be used as a prophylaxis, but without exceeding the dosage,
it is advisable to start taking Tamiflu immediately after contact with a sick person or before likely staying in places where you can catch the flu.

For prevention, it is enough to take one capsule (75 mg) once a day for 10 days.

For children under 12 years of age, the dosage is calculated as follows:

• Up to 15 kg – 30 mg once a day;
• 15-23 kg – 45 mg once a day;
• 23-40 kg – 60 mg once a day.

During a severe epidemic, you can take the drug as a preventive measure for 1.5 months, keeping the same dosage - 75 mg once.

Tamiflu in the form of a suspension

To prepare a suspension from Tamiflu powder, you must perform the following steps:

• Shake the contents of the powder bottle to distribute the contents evenly.
• Pour 52 ml of clean water into a measuring cup.
• Pour a measured amount of water into the bottle, close it carefully, and then shake for at least 15 seconds.
• Remove the cap from the bottle and insert the adapter into the neck.

Before each use of the suspension, it must be shaken thoroughly, and the indicated dosage must be measured using a special syringe.

Flu: doctors recommend Tamiflu. But is evidence-based medicine evidence-based?

Continuing the series of publications on health, we cannot ignore the topic of influenza. Global use of the antiviral drug Tamiflu increased sharply following the outbreak of the H1N1 (swine or Mexican) flu virus in 2009. It was initially thought that this would lead to fewer hospitalizations and flu complications such as pneumonia during the pandemic.

But Tamiflu (Oseltamivir) appears to shorten the duration of flu symptoms by just half a day, and there is no evidence that it reduces hospitalizations or complications of the flu. This is evidenced by data from a Cochrane review of studies published by the Cochrane Community (an independent global health research network) and the British Medical Journal (BMJ) back in April 2019.

The Cochrane review is titled “Neuraminidase inhibitors for the prevention and treatment of influenza in healthy adults and children, based on the Tamiflu (Oseltamivir) trial and the Relenza (Zanamivir) trial.” The trial involved more than 24,000 people and its results challenged “historical” assumptions that neuraminidase inhibitors were effective against influenza. The evidence also suggests that there is insufficient evidence to support the use of Tamiflu in preventing person-to-person transmission of the virus.

This raises even more questions about the effectiveness of drug regulation and public health decision-making. Claims about the effectiveness of Tamiflu have raised questions about the effectiveness of decisions made by governments around the world to stockpile such drugs in the event of a pandemic. The US spent more than $1.3 billion on a strategic stockpile of antiviral drugs, while the UK government spent almost $424 million (about 40 million doses) on stockpiling Tamiflu and a further £136m on Relenza.

In 2009, lack of access to complete data hampered efforts by Cochrane researchers to test the safety and effectiveness of Tamiflu. The BMJ and the Cochrane Society have jointly written to governments and health policymakers around the world, asking them (in light of the Cochrane review) whether they could make the same recommendations about Tamiflu today?

Tamiflu, compared with placebo, resulted in relief of flu-like symptoms only half a day faster (reducing the duration of symptoms from 7 to 6.3 days in adults, while the effect in children was even more uncertain). There is also no evidence of a reduction in hospitalizations or serious complications of influenza (pneumonia, bronchitis, sinusitis, or ear infections in either adults or children). Tamiflu also increases the risk of nausea and vomiting in adults by about 4% and in children by 5%. There was an increased risk of psychiatric events of approximately 1%. There is also plenty of evidence that Tamiflu prevents some people from producing enough of their own antibodies to fight infection.

Dr David Tovey, Editor-in-Chief, Cochrane Society, said: “We now have the strongest evidence available for neuraminidase inhibitors. This shows the importance of ensuring trial data is transparent and accessible.”

Doctors Tom Jefferson, Carl Heneghan and Peter Doshi, authors of this Cochrane review, said: “Claims about the effectiveness of drug use cannot be based on biased or insufficient information. We are risking too much - the health of our population and unjustified economic expenses. And therefore our findings require wider public discussion. We urge people not to believe the results of single trials or the comments of public health decision-makers.”

Dr Fiona Godlee, Editor-in-Chief, BMJ, said: “This review is the result of many years of struggle to open up and use research that has not been previously published or even hidden from view. Future decisions about drug procurement and use, especially on a mass scale, must be based on the full picture of the evidence. We need complete clinical trial data for all drugs currently in use. The Cochrane review highlights the enormous problem we face. We need the support of organizations and pharmaceutical companies to reassess all available data, even if it means going back 20 years. Otherwise, we risk stepping on another rake in a series of pandemics. Can we really afford this?

So what is the essence of the claims of the BMJ and the Cochrane Society?

Today, there are few who do not believe that only “evidence-based” medicine can be called medicine. To understand whether a new treatment for a disease is truly better than the previous one, research doctors evaluate the available evidence. What needs to be taken into account is not that, for example, “this medicine helped Aunt Masha a lot,” but the fact that the result of treatment was confirmed in a statistically significant number of such patients, who also had similar parameters (physiological, lifestyle, influences of other significant influencing factors).

In 1972, epidemiologist Archie Cochrane proposed the creation of a central international registry of clinical trials. Back in 1938, rebellious young medical student Archie Cochran walked through the streets of London with a banner that read: “All effective treatments should be free.” His book "Effectiveness and Efficiency" did not receive sufficient recognition in its time, but it now forms the basis of the modern understanding of evidence-based medicine.

Pictured is Archie Cochran and the Cochrane Society "label".

Proponents of evidence-based medicine want to have a meaningful “last word” on disputes about what is best. But not all medical research is equal - there is a clear hierarchy of such evidence: * expert opinions and reports of individual events belong to the “lower tier”; *well-conducted randomized controlled trials are in the middle; * at the top of this hierarchy are meta-analyses - studies that contain the results of several studies that examined the same question; * and at the very top of this hierarchy are meta-analyses conducted by a group called the Cochrane Collaboration.

To be a member of the Cochrane Collaboration, researchers or study groups are required to adhere to very strict rules about how meta-analyses must be conducted and reported. This is why Cochrane reviews are generally considered the best of the meta-analyses.

The Boston University team decided to find out the real difference between Cochrane and non-Cochrane meta-analyses.

Imagine you have five small clinical trials and all find a common positive benefit for, say, taking aspirin to prevent heart attacks. But each of the studies involved only a small number of subjects; no one could confidently state that the beneficial effects were not the result of chance. Statisticians say such studies are considered "insufficient."

A good way to increase the statistical power of these studies is to combine these five small studies into one. This is exactly what a meta-analysis does. Combining several small studies and taking the average of those studies can sometimes tip the balance so that the medical community knows with certainty whether a given solution works.

Meta-analyses are efficient and cheap because they do not require the initiation of new experimental processes. Rather, it is a matter of finding a few similar studies that have already been published, but this can be surprisingly difficult. Researchers must be persistent and methodical in their search. Finding research and determining whether it is good enough to trust becomes a critical issue.

This is actually the main reason why the Cochrane Collaboration was founded. Cochrane meta-analyses must adhere to very high standards of transparency, methodological rigor and reproducibility. Unfortunately, few people take the time and effort to join the Cochrane Collaboration, which means that the vast majority of meta-analyses do not necessarily adhere to their standards. But is this really important? How different can meta-analyses be?

Boston University researchers found that nearly 40% of Cochrane and non-Cochrane meta-analyses disagreed in their final statistical answers. This means that typical readers (doctors and health care executives), for example, may receive fundamentally different information depending on whose meta-analysis they happen to read.

Second, these differences turned out to be systematic. Non-Cochrane reviews, on average, suggested that the studies they tested were more statistically powerful, and more likely to cure diseases or prevent some medical complications, compared with the conclusions of Cochrane reviews. However, non-Cochrane reviews were less accurate, meaning there is a high chance that this is due to chance.

The Boston researchers write: “Meta-analysis is nothing more than simply estimating a weighted average of each component of a study. But, we were surprised to find that about 63% of the included studies were unique to Cochrane and non-Cochrane meta-analyses. It would seem that two types of meta-analyses, using similar search criteria, taking a similar time period and similar databases, could find the same papers for analysis. But it turned out that among the studies included in Cochrane and non-Cochrane meta-analyses, only less than 37% of the studies were the same.”

It is clear that most or all of these differences are due to the Cochrane community's insistence on more stringent criteria. Meta-analysis is, first of all, a study; it includes and does not discard data that, for example, led to a bad result.

Interestingly, analyzes that report much larger effect sizes tend to be cited in other papers at much higher rates than analyzes that report small effect sizes. A large and bold effect attracts more attention than results that show minimal or ambiguous results. The medical community, after all, is made up of ordinary people.

The results of Boston University researchers show that Archie Cochran was absolutely right. Methodological consistency, rigor and transparency are essential. Without this, there is a risk of concluding that something works when it does not.

It also shows us, once again, how difficult it is to form a unified interpretation of the medical literature. Meta-analyses are often used as the final word on a given topic, as a arbiter of ambiguity. But, two meta-analyses (on the same topic) may come to different conclusions. If we view meta-analysis as the “gold standard” in our current era of “evidence-based medicine,” then how should the average physician or policymaker or even patient respond when two “gold standards” contradict each other? – And Boston doctors draw the only possible conclusion: “Let the buyer be vigilant.” But where are the criteria for such vigilance?

The findings of doctors from Boston fully confirm the results of an earlier study from Stanford University, published in the journal PLOS Biology in 2013. It suggests that scientific evidence may be skewed by significant bias in the reporting of animal studies, and may give the misleading impression that the results can be used in humans.

Testing a new therapeutic intervention (such as a drug or surgical procedure) on humans is expensive, risky, and ethically challenging, so the vast majority of drugs and techniques are first tested on animals. Unfortunately, cost and the same ethical issues limit the size of animal studies, limiting their statistical power. But, as a result, the scientific literature contains many studies that are either uncertain in their results or contradictory. A way to overcome these limitations would be to conduct a “meta-analysis.”

Stanford University researchers reviewed 160 previously published meta-analyses of animal studies evaluating potential treatments for a range of serious neurological disorders (multiple sclerosis, stroke, Parkinson's disease, Alzheimer's disease and spinal cord injury). These meta-analyses covered 1000 original previously published animal studies. The authors of this "meta-analysis of meta-analyses" used the most accurate studies in each meta-analysis as an estimate of the true effect size of a particular treatment. They then assessed the statistical significance of these studies' findings. What was alarming was that the authors found that the statistical significance of the work was overestimated by more than two times.

The authors suggest that this is the result of deliberate fraud on the part of the scientists conducting the original research. Overestimation of the statistical significance of studies occurs due to two main factors: * one

is that scientists conducting research tend to choose the method of data analysis that can give them the “best” result;
* the second
arises because scientists usually want to publish their results in more general journals. And such journals tend to favor studies with positive rather than negative results. Many studies with negative results were not even submitted for publication or, if submitted, were not published or were published very late, thereby reducing their chance of inclusion in the meta-analysis.

Clearly, it is the misrepresentation of the results reported in PLOS Biology that is responsible for the lack of “advancement” of research from animals to clinical trials in humans. It also seems unlikely that this reported phenomenon is limited to studies of neurological disorders. This is likely a common feature of research reporting.

The authors also proposed several remedies for the distortions they identified. First, research must adhere to strict methodological principles for conducting research and analyzing its results. Secondly, studies (both on animals and on humans) must be registered in advance and their results (including negative ones) must be published.

The trouble is, these proposals were formulated by Archie Cochran 40 years before the Stanford scientists, and almost 3 years have passed since the publication of the work of the Stanford scientists themselves. And, as they say, things are still there...

Therefore, when reading the next “advice” on how to treat you and what to eat, be vigilant and remember the lines from the poems of Vladimir Vladimirovich Mayakovsky, a poet of the times of socialism: “After all, if the stars light up, it means someone needs it...”. Of course, both Archie Cochran and Vladimir Mayakovsky aspired and encouraged others to high deeds. But, unfortunately, we increasingly find ourselves under the influence of people who are either unprofessional or “unhanded”, and the word “stars” increasingly has to be used only in quotation marks...

Pharmacokinetics of the drug

Is the drug Oseltamivir absorbed? Instructions for use indicate that about 90% of oseltamivir phosphate is absorbed from the gastrointestinal tract. The active substance is converted to oseltamivir carboxylate and then enters the systemic circulation.

About 3% of the active ingredient binds to plasma proteins. Its bioavailability is approximately 76-85% and its half-life is 120 minutes.

Oseltamivir carboxylate is excreted from the human body through the kidneys (about 80%) and intestines (20%). The half-life of this drug is 6-10 hours.

Comparative characteristics of medicines

Any medications, even those approved for use during breastfeeding, have a number of both positive and negative aspects. It is necessary to select medications for treatment together with your doctor. It all depends on the severity of the disease, the individual characteristics of the body, the presence of allergic reactions in the mother herself and possible allergic manifestations in the child, contraindications for use. The choice is also complicated by the fact that opinions about the safety of drugs differ. But every mother wants only the best for her baby and does not want to harm him.

Pros and cons of antiviral drugs for nursing mothers - table

"Tamiflu": drug analogues

In case of intolerance for any reason, doctors may prescribe substitutes for this medicine to patients. This drug, as already mentioned, has no synonyms. However, there are medications on sale today that are similar in therapeutic effect to Tamiflu capsules. These include, for example:

• "Arbidol";
• "Relenza";
• "Amiksin";
• "Kagocel".

Arbidol, unlike Tamiflu, can be used to treat not only influenza, but also other viral diseases. This medicine is not prescribed for children under 3 years of age. It has slightly fewer side effects than Tamiflu. This medication is perhaps the best analogue of Tamiflu in Russia today.

Relanza is used to treat influenza only. It is supplied to the market in the form of a suspension for inhalation. This medication can only be prescribed to adults and children over 5 years of age.

Amiksin is a very cheap analogue of Tamiflu. This drug is used to treat influenza, herpes, viral hepatitis, etc. It has virtually no side effects. However, children can only be prescribed it from the age of 6 years.

The medicine "Kagocel" is also used against influenza. It costs less than Tamiflu, but is also significantly inferior in effectiveness. The drug is non-toxic and can be prescribed to children over 3 years of age.

These are the medications that most often replace Tamiflu. Analogs of this drug are in most cases manufactured by pharmacological companies based on the substance zanamivir.

What can replace the medication?

You have already found out what the trade name of the active ingredient, oseltamivir, is. Analogues of the drug "Tamiflu" are drugs that have the same composition or identical effect on the human body. If we talk about absolute substitutes, then we can say that they do not exist. The active ingredient oseltamivir is unique and is presented only in the drug Tamiflu. There is an analogue of the drug, which is also a neurominidase inhibitor. In their action, these drugs are almost identical. The trade name of this drug is Relenza.

There are substitutes for the described medicine that work differently. However, they can also suppress the replication of the virus and have an immunomodulatory effect. Among them are compounds that have the trade names “Isoprinosine”, “Ergoferon”, “Cycloferon” and so on.

Drug substitutes

This drug contains analogues, substitutes for RF, and Russian ones. The following medications contain the same active substance:

• Tamiflu;
• Influcein;
• Oseltamivir phosphate;
• Nomides.

The following pharmaceuticals have a similar effect:

• Interferon;
• Engystol;
• Flu Heel.

The drug Oseltamivir is an excellent remedy for quickly getting rid of such an unpleasant disease as the flu. Using it according to the instructions can reduce the likelihood of complications and significantly shorten the course of the disease. We should not forget that this drug is a medication, so it can only be used after consulting a doctor.

Tamiflu during pregnancy and lactation

Tamiflu is used to treat adults, children, and pregnant women.

According to clinical studies conducted on animals, oseltamivir does not have a teratogenic effect on the fetus, the formation of its organs and further development. Therefore, the use of Tamiflu by women who are pregnant is allowed.

A pregnant woman should consult a doctor if any disturbing symptoms occur. He will be able to assess her condition and prescribe the dosage of the drug that will be effective and, at the same time, safe for the baby.

A small part of the drug consumed by a woman penetrates the blood-brain barrier into breast milk. Therefore, when prescribing this pharmaceutical drug, the doctor must take into account the risks potentially facing the child. In some cases, the best choice may be to temporarily stop breastfeeding.

In what cases can it be prescribed

Doctors usually prescribe Tamiflu to their patients in the following cases:

• for the prevention and treatment of infections caused by influenza virus group A or B;
• in the event of an influenza pandemic, infants from six months of age.

For its ability to be used as a prophylactic for those people who have been in contact with people infected with influenza, the drug Tamiflu has earned, among other things, good reviews from consumers. In most cases, its analogues can also be used to reduce the risk of infection.

What is oseltamivir?

The trade name, analogues, and price of this active substance will be presented to you a little later. First, we need to clarify some information about it. Oseltamivir, or oseltamivir, is an antiviral drug. Most often the component is used to treat influenza. The drug also has some immunomodulatory activity.

How can you describe the substance oseltamivir? Oseltamyvirum is a neurominidase inhibitor. The peculiarity of its action is that the medicine binds to viruses and suppresses compounds that are released from healthy human particles after a reaction with pathogenic flora. Oseltamivir prevents further replication of the virus in the body and thereby stops the deterioration of the patient’s condition.

Question of analogues

What to do if the drug is not commercially available in the required quantity? Then experts recommend paying attention to what analogs to Tamiflu® exist, that is, structural ones with a similar active ingredient and those that work on a similar principle.

Among the first is the Ukrainian Oseltamivir, produced by the Kharkov pharmaceutical plant. And Flustop, a Belarusian drug. However, it is worth noting that the Swiss manufacturer itself, which holds patent rights until 2019 inclusive, did not react in any way to such a copyright violation. Its representatives officially stated that the generic formula does not correspond to the original, so they see no point in filing lawsuits. So how much you should trust such analogues is a big question.

As for drugs with similar effects, there are quite a lot of them. Among the well-known ones are Neovir, Relenza, Araglin D, Tsitovir-3, Ergoferon. The doctor will give you a complete and detailed list, and he will be able to choose a safe alternative taking into account the patient’s condition.

Skin diseases

• Asmanex – (ointment, cream, lotion) to eliminate inflammation and itching in dermatoses. Allowed from 2 years.
• Risonel - available in sprays and solutions.
• Cutivate – ointment for eczema, psoriasis, itching.

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Manufacturers of Tamiflu:

1. The company was able to establish its production of drugs in an economically developed European country - Switzerland .
2. France also did not stand aside and built several more factories on its territory.
3. Germany is the center of European pharmaceuticals; the brand is largely maintained due to the abundance of production in this country.

This means that the drug is still produced abroad, not Russian. This is where we get such an expensive price for 10 capsules of the drug.

If the end consumer has any complaints about the quality of the product, you can contact the representative office located in Russia on Trubnaya Square, building two. There is also a hotline telephone number.

Release forms

Tamiflu has various forms of release, injections in ampoules, capsules, powder from which a suspension is prepared.

The two most common forms of medication are:

• capsules containing yellowish powder inside (there are 10 capsules on the blister);
• powder, it is used to prepare a liquid suspension. This mixture has a fruity aroma and a whitish color. The bottle has a volume of 30 g. The kit includes a syringe with marks indicating the dosage regimens of the medication.

Flu, cold, pandemic

A flu-like condition can be caused in humans by many different viruses that cause acute respiratory diseases.
Their symptoms—high fever and other illnesses—are often mistaken for the flu. Seasonal flu is common in winter. This is the so-called “real” flu, caused by a frequently mutating virus, which in Europe is also called “influenza”. This flu seriously affects the body for many days and can be fatal for children, the elderly and generally for those whose bodies are weakened.

A pandemic is characterized by the appearance on the territory of several states or even the entire world of a new strain of the virus, which is highly contagious because people have not yet developed immunity against it. In the 20th century, three pandemics were recorded: the so-called “Spanish flu”, from which in 1918-19. According to various estimates, from 50 to 100 million people died, the “Asian flu” (1957, 1-4 million deaths) and the “Hong Kong flu” (1968, 1-2 million deaths).

Vaccination , recommended by medical professionals, national ministries of health and WHO, remains the most effective method of protection against influenza. When you get sick, you must first of all ensure your peace. Then you need to try to control the temperature, and, most importantly, avoid possible complications, the main one of which is pneumonia.

End of infobox

Governments are in panic

Bernard Kiefer holds the exact opposite opinion. For him, the Cochrane Collaboration is “one of the most authoritative and serious scientific bodies in the world. Therefore, it should be trusted more than national certification authorities.” Where is the WHO? Is this organization, designed to monitor the health of citizens around the world, really resistant to external influence and is it really independent?

WHO headquarters does not believe that it could have lobbied for the drug Tamiflu in one form or another. This company itself categorically denies such suspicions,” says Bernard Kiefer. “The problem, however, is that there really aren’t enough completely independent experts at the moment, since all of them, whether privately or seeking funding for their own research, receive funds from the pockets of the flagships of the pharmaceutical industry.

As for the WHO, its work could not in good conscience be called completely transparent. The WHO claims that it has already prepared a list that lists all the experts who could have a conflict of interest, all the amounts they received from the pharmaceutical giants, all the congresses in which they took part, etc. But for some reason the organization refuses to publish this list.” The drug "Tamiflu" in this sense is not at all a unique phenomenon. Methodology for assessing the effectiveness of drugs is a constant weak link for the pharmaceutical industry.

“This situation, in addition to the colossal sums of money, is distinguished by the fact that most of the Tamiflu reserves were never used, so it is impossible to understand what happened or draw conclusions. Also, at some point, when governments were told, “If you don't buy the medicine immediately, it will run out,” there was general panic. No one had time to calmly assess the situation,” says Bernard Kiefer.

End of career

Around 2019 or 2019, the patent protection period for Tamiflu will end, thereby opening the way for the creation of generic medicines, which in their effectiveness will not differ from the “original” drug, but at the same time their price will be significantly lower.

What does she think about this, does she feel worried? “No, nothing like that, all this was foreseen a long time ago, and in any case, in 2013, the share of transactions with Tamiflu in our portfolio did not exceed 1%,” explained Nicolas Dunant.

For his part, Bernard Kiefer does not see any future for the notorious oseltamivir phosphate, no matter what name it is sold under. At the same time, he hopes that “research will continue to move forward, because there are no factors preventing us from finally finding a truly effective remedy against influenza.”

Translation from French and adaptation: Lyudmila Klot,

www.swissinfo.ch

Drug interactions

As evidence obtained from pharmacokinetic and pharmacological studies shows, clinical interaction with other drugs is unlikely. It is important to note that the interaction is due to special competition for the active site of esterases. It is not advisable to combine it with Cimetidine, because it is a strong nonspecific cytochrome inhibitor that has the properties of a cation.

Taking into account the data from phase 3 clinical trials, the drug can be prescribed for simultaneous use with drugs such as diuretics, erythromycin and penicillin, corticosteroids, codeine and cephalosporin, doxycycline and xanthines, as well as analgesics and NSAIDs. There are no unwanted manifestations or side effects.

Description

Tamiflu is a drug that suppresses the proliferation of viruses, it is used to treat:

• different types of flu,
• ARVI.

Taking the drug in the early stages helps reduce the risk of developing inflammatory processes (otitis, pneumonia), as well as significantly alleviate the symptoms of the disease.

Compound

The main active ingredient is oseltamivir phosphate. The therapeutic effect is as follows:

• in the body, the active substance activates the synthesis of its metabolite;
• this metabolite slows down the production of enzymes, without which the normal functioning of influenza viruses is impossible.

Thus, the medicine inhibits the spread of viruses in the body, inhibiting their growth and reproduction. It is for this reason that this medicine is effective only in the initial stages of the disease, when the number of viruses in the body is limited.

Pharmakinetics

Absorption of the active substance occurs in the stomach and small intestine. Under the influence of digestive enzymes, the substance turns into a metabolite, which inhibits the development of viruses.

The effective concentration of metabolites in the blood is observed approximately half an hour after taking the medicine. In this case, the content of the active metabolite is twice the content of the active substance entering the body.

After taking the drug, the active substance reaches all foci of infection, inhibiting the development of viruses. The kidneys are mainly responsible for the elimination of metabolites. But the intestines are also partially involved. The average release period is 7-9 hours.

Advice! With severe renal failure, the period of elimination of metabolites increases to a day.

Efficiency

The benefits of the drug are confirmed by clinical studies. At the same time, taking the medicine does not affect the natural or induced production of antibodies to viruses. During the study, patients took the drug no later than 40 hours after the onset of signs of the disease. Confirmed treatment effects of the product:

• the period of manifestation of painful symptoms is reduced, on average to one and a half days;
• the likelihood of developing inflammatory processes requiring treatment with antibiotics (sinusitis, pneumonia, otitis media, etc.) is reduced.

Side effects

During the study, negative side effects of the drug were also identified. Most often, patients noted the appearance of:

• nausea,
• pain in the temples.

These symptoms appeared during the first two days of use and disappeared within 24-48 hours without stopping the drug. Much less frequently observed reactions were:

• diarrhea,
• dizziness,
• allergic reactions in the form of urticaria or eczema. Anaphylactic shock develops extremely rarely.

Forms

Tamiflu can be purchased in two forms:

• in powder, it is used for suspension (active substance content 12 mg per 1 ml of finished suspension);
• in capsules containing the active substance 30, 40 and 75 mg.

Adults are usually prescribed capsules; the dosage is selected individually. Children and people who for some reason cannot take capsules are prescribed a suspension. You can buy this form ready-made or make it yourself from powder.

Advice! During long-term storage of the drug (more than 5 years), the gelatin shell of the capsules becomes fragile. At the same time, the active substance itself does not lose its properties. Once the capsules are opened, a suspension can be prepared from their contents. Take it by mixing the powder with some sweet product to hide the bitterness. You can use syrup, sweet condensed milk, honey. You cannot store your own prepared suspension; you must take the product immediately after preparation.

Research on the effectiveness of Tamiflu

Research of the drug by the creator

The drug was given to those people who fell ill with the flu within 40 hours. The majority of patients were infected with group A virus, and a minimal proportion were infected with virus B.

The virus significantly improved the well-being of patients and also reduced influenza symptoms for 32 hours.

Another part of the people took placebo drugs. And people who were diagnosed with the flu saw a 38 percent reduction in symptoms.

Moreover, 50 percent of young patients who took Tamiflu completely avoided complications.

As for older patients, the results of the studies did not diverge from those that were done on young people. The dosage of the drugs was completely identical.

The following studies were conducted on adults and teenagers who have heart or lung disease. There was no difference in the number of flu episodes between people who took the drug and people who took the placebo. But in patients who took Tamiflu, the proportion of viral shedding significantly decreased from the second to the fourth day.

When comparing this group of people with people from the general group, no additional risks were identified.

The same study was conducted on children. The age of patients is from one to twelve years. On average, children who took Tamiflu lost their flu symptoms one and a half days faster. Full recovery in children who took this medicine occurred two days faster.

When it comes to flu prevention, the results were even more impressive. Only 1 percent of adults who took Tamiflu when they had the flu became infected with it. And among older patients, the number of cases decreased by 92 percent.

Patients took Tamiflu for 42 days.

For patients with weakened immune systems who took Tamiflu it decreased to 0.04 percent!

Clinical trials

Despite the fact that on the RuNet you can often come across information that no studies have been conducted on pregnant women, this information concerns mainly the CIS. At the same time, scientists from the USA, Great Britain, the Netherlands, China and several other countries carefully studied the effect the drug has on patients. It is worth noting that some of the clinical trials were ordered and paid for by the manufacturer itself, which can serve as proof of the manufacturing company’s confidence in the effectiveness of the product.

Thus, in 2019, the Cockney Library published data from meta-analyses (notable for their extremely serious and in-depth study of the issue). The authors examined a total of 107 studies, in which the drug's effect was observed on 9,623 people. It was found that this remedy is most effective when taken prophylactically.

If you start the course in the first days of the disease, you can reduce the total time of illness. 16 hours is the average for adults. The most common side effects were vomiting and nausea. In second place are diarrhea and certain complications associated with the cardiovascular system.

A major medical journal, Infectious Diseases, also published information from the meta-analyses studied. This is the last study of this scale to date. A total of 107,702 patients took part in the experiment. The information released suggests that the medicine has a beneficial effect on the condition of patients suffering from fever. And (an important point for those carrying a child!) the need to take antibiotics decreased.

Among the patients in the studied groups there were also pregnant women. In addition, the manufacturer himself was collecting medical statistics. So, in Sweden there is a special register that allows you to track the condition of expectant mothers and make a connection with the drugs that were prescribed to them.

Scientists also collected messages from patients who took this medicine and wanted to voluntarily share their opinions. It was concluded that the number of abnormalities in fetal development was no more than usual. Approximately 900 women who gave birth took this medicine in Japan. The data there is consistent with European data.

Prices and conditions for dispensing from pharmacies

The drug is available only with a doctor's prescription. Prices for the drug start from 1000 rubles, but pricing may vary greatly depending on the region of sale. For example, the price in Moscow for this drug starts from 1,100 rubles per package of 10 capsules. In Yekaterinburg - from 1000 rubles. If we consider the CIS, then in Kazakhstan, for example, the average price tag is even below a thousand rubles, if we convert their local currency into the Russian ruble.

Some doctors and their patients believe that this is a fairly high price for this medicine, therefore, they prefer to use cheaper analogues.