Are there any contraindications to prescribing Tamiflu (oseltamivir)?

Contraindications and Precautions for Tamiflu (Oseltamivir)

Absolute Contraindication

The only absolute contraindication to oseltamivir is known serious hypersensitivity to oseltamivir or any component of the product, including severe allergic reactions such as anaphylaxis, toxic epidermal necrolysis, Stevens-Johnson Syndrome, and erythema multiforme 1.

Clinical Situations That Are NOT Contraindications

Despite common concerns, the following are explicitly not contraindications to oseltamivir use:

Pregnancy and Breastfeeding

• Pregnancy is not a contraindication at any trimester 2, 3
• Oseltamivir 75 mg twice daily for 5 days is recommended for all pregnant women with suspected or confirmed influenza, regardless of trimester or vaccination status 3
• No adverse effects have been reported among women who received oseltamivir during pregnancy or among their infants 3

Age Extremes

• Oseltamivir is approved for use in children as young as 2 weeks of age with appropriate postmenstrual age-based dosing for preterm infants 2
• No dose reduction is recommended based on age alone for elderly patients (>65 years) 4

Chronic Medical Conditions

• Asthma, chronic pulmonary disease, cardiovascular disease, diabetes, and immunodeficiency are not contraindications 2
• Minor febrile illnesses are not contraindications 2

Important Dosing Adjustments Required (Not Contraindications)

Renal Impairment

• For creatinine clearance 10-30 mL/min (treatment): reduce to 75 mg once daily for 5 days 4, 5, 2
• For creatinine clearance 10-30 mL/min (prophylaxis): 30 mg once daily for 10 days OR 75 mg every other day for 10 days 4, 5, 2
• No dosing recommendations are available for patients undergoing routine renal dialysis, though research suggests a single 75 mg dose may be appropriate for APD patients with anuria 6

Hepatic Dysfunction

• Use has not been studied in persons with hepatic dysfunction, but this is not listed as a contraindication 4

Common Pitfalls and Caveats

Gastrointestinal Side Effects Are Not Contraindications

• Nausea occurs in approximately 10% and vomiting in approximately 9% of adults receiving oseltamivir 4
• Only 1% of patients discontinue treatment due to gastrointestinal side effects 4, 3
• Taking oseltamivir with food significantly reduces nausea and vomiting 4, 5, 2, 3

Neuropsychiatric Events

• Seizure events have been reported during postmarketing surveillance, but no epidemiologic studies have demonstrated increased risk 4
• Seizure disorders are not listed as contraindications 4

Drug Interactions

• Avoid live attenuated influenza vaccine (LAIV) within 48 hours before oseltamivir use, and do not use oseltamivir for 14 days after LAIV vaccination 2
• Limited clinical data exist regarding other drug interactions, but no clinically significant interactions have been identified 4

Timing Considerations

• Treatment should be initiated within 48 hours of symptom onset for maximum benefit 5, 2
• Do not withhold treatment while waiting for laboratory confirmation in high-risk patients 2