What are the recommended doses of Tamiflu (oseltamivir) and Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for patients with influenza?

Tamiflu (Oseltamivir) and NSAID Recommendations for Influenza

Oseltamivir Dosing

For adults and adolescents ≥13 years with influenza, administer oseltamivir 75 mg orally twice daily for 5 days, initiated within 48 hours of symptom onset for maximum benefit. 1, 2, 3

Adult and Adolescent Treatment (≥13 years)

• Standard dose: 75 mg orally twice daily for 5 days 1, 2, 3
• Initiate treatment within 48 hours of symptom onset to reduce illness duration by 1-1.5 days 2, 4
• Do not delay treatment while awaiting laboratory confirmation in high-risk patients 2
• Treatment beyond 48 hours still provides substantial mortality benefit in hospitalized and high-risk patients 2

Pediatric Treatment Dosing (Weight-Based for ≥12 months)

• ≤15 kg (≤33 lb): 30 mg twice daily for 5 days 1, 2, 3
• >15-23 kg (>33-51 lb): 45 mg twice daily for 5 days 1, 2, 3
• >23-40 kg (>51-88 lb): 60 mg twice daily for 5 days 1, 2, 3
• >40 kg (>88 lb): 75 mg twice daily for 5 days 1, 2, 3

Infant Dosing (<12 months)

• 9-11 months: 3.5 mg/kg per dose twice daily for 5 days 1, 2
• Term infants 0-8 months: 3 mg/kg per dose twice daily for 5 days 1, 2
• Preterm infants require postmenstrual age-based dosing:
  • <38 weeks postmenstrual age: 1.0 mg/kg twice daily 1, 2
  • 38-40 weeks postmenstrual age: 1.5 mg/kg twice daily 1, 2

  • 40 weeks postmenstrual age: 3.0 mg/kg twice daily 1, 2

Renal Impairment Adjustments

For patients with creatinine clearance 10-30 mL/min, reduce treatment dose to 75 mg once daily (instead of twice daily) for 5 days. 1, 2, 3

Prophylaxis Dosing

• Adults/adolescents ≥13 years: 75 mg once daily for 10 days post-exposure 1, 2, 3
• Initiate within 48 hours following close contact with infected individual 1, 2
• Pediatric patients ≥1 year: same weight-based doses as treatment but once daily for 10 days 1, 2
• Infants 3-11 months: 3 mg/kg once daily for 10 days 1, 2
• Prophylaxis NOT recommended for infants <3 months unless situation is critical 1

Administration Considerations

• Take with food to improve gastrointestinal tolerability 1, 2, 3
• Available as capsules (30,45,75 mg) or oral suspension (6 mg/mL) 1, 2, 3
• Nausea and vomiting are most common adverse effects, occurring in 5-15% of patients 1, 5

Special Populations

• Pregnancy: Use standard adult dosing (75 mg twice daily for 5 days) throughout all trimesters 2
• Breastfeeding is not a contraindication to oseltamivir use 2
• Immunocompromised patients may require extended treatment beyond 5 days if illness is prolonged 2

Drug Interactions

Avoid live attenuated influenza vaccine (LAIV) within 48 hours before oseltamivir, and do not use oseltamivir for 14 days after LAIV vaccination. 1, 2

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NSAID Recommendations

The provided evidence does not contain specific NSAID dosing recommendations for influenza patients. However, based on general medical practice:

Symptomatic Relief with NSAIDs

• NSAIDs (ibuprofen, naproxen) or acetaminophen can be used for fever and myalgia relief in influenza patients
• Standard adult ibuprofen dosing: 400-600 mg every 6-8 hours as needed (maximum 2400 mg/24 hours)
• Standard adult naproxen dosing: 220-500 mg every 12 hours as needed
• Pediatric ibuprofen: 10 mg/kg per dose every 6-8 hours as needed (maximum 40 mg/kg/day)
• Acetaminophen is an alternative: adults 650-1000 mg every 6 hours as needed; pediatrics 10-15 mg/kg per dose every 4-6 hours

Important Caveats

• Avoid aspirin in children and adolescents with influenza due to Reye's syndrome risk
• NSAIDs do not treat the underlying viral infection—oseltamivir is the primary antiviral therapy
• NSAIDs provide only symptomatic relief and do not reduce illness duration or prevent complications