Can oseltamivir (Tamiflu) be given to an infant with influenza who has a history of Epstein's anomaly with Supraventricular Tachycardia (SVT) and is currently on propranolol (Inderal)?

Oseltamivir Use in an Infant with Epstein's Anomaly and SVT on Propranolol

Oseltamivir can be safely administered to an infant with influenza who has Epstein's anomaly with SVT and is currently on propranolol, as there are no known drug interactions or contraindications specific to this cardiac condition. 1, 2

Dosing Recommendations for Infants

For infants with influenza, the American Academy of Pediatrics recommends:

• For term infants 0-8 months: 3 mg/kg per dose twice daily for 5 days 1
• For preterm infants: Dosing should be adjusted based on postmenstrual age (gestational age + chronological age) 1
  • For extremely preterm infants (<28 weeks), consultation with a pediatric infectious disease physician is recommended

Safety Considerations for Cardiac Patients

While the FDA label and clinical guidelines do not specifically list cardiac conditions like Epstein's anomaly or concurrent propranolol use as contraindications for oseltamivir:

• No significant drug interactions have been reported between oseltamivir and propranolol
• The benefits of treating influenza in this high-risk infant likely outweigh potential risks 1, 2
• Infants with congenital heart disease are considered high-risk for influenza complications, making antiviral treatment particularly important 1

Important Clinical Considerations

1. Early initiation is crucial: Treatment should begin within 48 hours of symptom onset for maximum effectiveness 2

2. Monitor for side effects:

   • Most common: Nausea and vomiting (can be minimized by administering with food) 1
   • Rare but reported: Neuropsychiatric events (although these are more commonly reported in older children) 3

3. Renal function: If the infant has impaired renal function (which can occur with some cardiac conditions), dose adjustment may be necessary 1

4. Duration: Treatment should be for 5 days, not the 10-day duration used for prophylaxis 2

Practical Administration Tips

• Oseltamivir is available as a powder for oral suspension (6 mg/mL) 1
• For infants, use an appropriate measuring device such as a 3-mL or 5-mL oral syringe rather than the syringe supplied with the medication 1
• Administration with feeds may improve gastrointestinal tolerability 1

Potential Pitfalls to Avoid

1. Avoid underdosing: Proper weight-based dosing is essential for efficacy

2. Don't delay treatment: Efficacy decreases significantly when started after 48 hours of symptom onset 2

3. Don't confuse treatment and prophylaxis dosing: Treatment requires twice-daily dosing for 5 days, while prophylaxis uses once-daily dosing for 10 days 1, 2

4. Don't withhold treatment due to cardiac condition: The benefits of treating influenza in this high-risk infant outweigh potential risks 1

The 2024 AAP guidelines support the use of oseltamivir in infants with underlying medical conditions that may increase their risk of complications from influenza, making this infant an appropriate candidate for treatment 1.