What is Tamiflu (oseltamivir) contraindicated with?

Tamiflu Contraindications

Tamiflu (oseltamivir) has only one absolute contraindication: known serious hypersensitivity to oseltamivir or any component of the product. 1

Absolute Contraindication

• Serious hypersensitivity reactions including anaphylaxis, toxic epidermal necrolysis, Stevens-Johnson Syndrome, and erythema multiforme are the sole contraindication to oseltamivir use 1
• If an allergic-like reaction occurs or is suspected during treatment, stop oseltamivir immediately and institute appropriate treatment 1

Important Drug Interaction to Avoid

• Live attenuated influenza vaccine (LAIV): Avoid oseltamivir within 48 hours before LAIV administration, and do not use oseltamivir for 14 days after LAIV vaccination, as oseltamivir may interfere with vaccine efficacy 2, 3

Conditions That Are NOT Contraindications

Despite common misconceptions, the following are not contraindications to oseltamivir:

• Pregnancy: No contraindication exists for oseltamivir use during pregnancy 2
• Age: Approved for use in children as young as 2 weeks of age, including preterm infants with appropriate dose adjustments 4, 2
• Chronic medical conditions: Asthma, chronic pulmonary disease, cardiovascular disease, diabetes, and immunodeficiency are not contraindications—in fact, these patients are priority candidates for treatment 2
• Renal impairment: Not a contraindication, but requires dose adjustment (see below) 2, 1
• Mild febrile illness: Minor fever alone is not a contraindication 2

Special Populations Requiring Dose Adjustment (Not Contraindicated)

Renal Impairment

• Creatinine clearance 10-30 mL/min (treatment): Reduce to 75 mg once daily for 5 days 2, 1
• Creatinine clearance 10-30 mL/min (prophylaxis): Reduce to 30 mg once daily OR 75 mg every other day for 10 days 2, 1
• ESRD on hemodialysis: 30 mg immediately, then 30 mg after every hemodialysis cycle (treatment duration not to exceed 5 days) 1

Hereditary Fructose Intolerance

• Use with extreme caution: One 75 mg dose of oral suspension delivers 2 grams of sorbitol, which exceeds the daily maximum limit for patients with hereditary fructose intolerance and may cause dyspepsia and diarrhea 1
• This is a warning, not an absolute contraindication, but capsule formulation should be strongly preferred over oral suspension in these patients 1

Critical Warnings (Not Contraindications, But Require Monitoring)

• Neuropsychiatric events: Postmarketing reports of delirium and abnormal behavior (primarily in pediatric patients) require close monitoring, but do not contraindicate use 1
• Secondary bacterial infections: Oseltamivir does not prevent bacterial complications; remain alert for secondary infections requiring antibiotic therapy 1

Common Pitfall to Avoid

• Do not confuse "warnings and precautions" with "contraindications"—the only true contraindication is serious hypersensitivity 1
• Do not withhold oseltamivir from high-risk patients due to concerns about minor adverse effects like nausea or vomiting, which are mild and transient 4, 2