Contraindications for Tamiflu (Oseltamivir)
The only absolute contraindication to Tamiflu is known serious hypersensitivity to oseltamivir or any component of the product, including anaphylaxis, toxic epidermal necrolysis, Stevens-Johnson Syndrome, and erythema multiforme. 1
Absolute Contraindication
- Known serious hypersensitivity reactions to oseltamivir or any product component, which includes:
Important Clinical Context: What is NOT a Contraindication
Understanding what does NOT contraindicate oseltamivir use is equally important for clinical practice:
Age is Not a Contraindication
- Oseltamivir is approved for use in children as young as 2 weeks of age 2
- Preterm infants can receive oseltamivir with appropriate postmenstrual age-based dosing adjustments 3, 2
Renal Impairment is Not a Contraindication
- Patients with renal insufficiency can receive oseltamivir with dose adjustment rather than avoidance 2
- For creatinine clearance 10-30 mL/min: reduce treatment dose to 75 mg once daily for 5 days 3, 2
- For prophylaxis in renal impairment: 30 mg once daily or 75 mg every other day for 10 days 2
Pregnancy is Not a Contraindication
- No contraindication exists for oseltamivir use during pregnancy (unlike live attenuated influenza vaccine which is contraindicated in pregnant adolescents) 3
Common Medical Conditions Are Not Contraindications
- Asthma, chronic pulmonary disease, cardiovascular disease, diabetes, and immunodeficiency are not contraindications to oseltamivir 3
- These conditions may actually represent indications for treatment given higher risk status 3
Critical Drug Interaction to Monitor (Not a Contraindication)
- Probenecid is the only documented significant drug interaction, reducing oseltamivir carboxylate clearance by approximately 50% through competition for renal tubular secretion 4, 5
- This interaction does not contraindicate use but may require monitoring 4
Common Pitfalls to Avoid
- Do not withhold oseltamivir due to mild illness or fever alone - minor febrile illnesses are not contraindications 3
- Do not confuse adverse effects with contraindications - nausea, vomiting, and gastrointestinal symptoms are common adverse events (occurring in 5-15% of patients) but are not contraindications to use 3, 2, 6
- Do not delay treatment waiting for laboratory confirmation - suspected influenza in high-risk patients warrants empiric treatment within 48 hours of symptom onset 3, 7
- Avoid concurrent use with live attenuated influenza vaccine (LAIV) - do not administer oseltamivir within 48 hours before LAIV vaccination, and avoid oseltamivir for 14 days after LAIV 2