Can Tamiflu Be Given IV?
No, Tamiflu (oseltamivir) cannot be given intravenously—it is exclusively available as an oral medication in capsule or liquid suspension form. 1, 2
Available Formulations of Oseltamivir
Oseltamivir is only manufactured and approved for oral administration in two formulations 3, 2:
- Capsules: 30 mg, 45 mg, and 75 mg strengths
- Oral suspension: 6 mg/mL concentration after reconstitution
The drug is a prodrug that requires conversion in the liver to its active metabolite (oseltamivir carboxylate), which is why it must be given orally 4, 5. After oral administration, oseltamivir is readily absorbed from the gastrointestinal tract with 80% bioavailability of the active metabolite 4.
Alternative IV Neuraminidase Inhibitor Options
If intravenous administration is absolutely necessary (e.g., patients who cannot tolerate or absorb oral medications), there are two alternative neuraminidase inhibitors 1, 2:
Peramivir (Rapivab) - FDA-Approved IV Option
- Adults and adolescents 13-17 years: 600 mg as a single IV infusion over 15-30 minutes 2
- Children 2-12 years: 12 mg/kg (maximum 600 mg) as a single IV infusion over 15-30 minutes 2
- Approved for treatment only, not for chemoprophylaxis 2
- Approved for children ≥2 years as of September 2017 1
Zanamivir IV - Investigational/Compassionate Use Only
- Remains investigational and not FDA-approved in the United States 1
- May be obtained on a compassionate-use basis through the manufacturer (GlaxoSmithKline) for seriously ill patients 1
- Particularly important for immunocompromised patients or those who cannot tolerate/absorb oral oseltamivir 1
- Requires consultation with infectious disease specialists 1
- Availability for compassionate use is uncertain and may not be consistently available 1
Practical Workarounds for Oral Administration Challenges
If a patient has difficulty swallowing capsules but can tolerate enteral administration 3, 2:
- Open capsules and mix contents with liquid for administration
- Use the oral suspension formulation (6 mg/mL)
- Administer via nasogastric or orogastric tube if necessary
- Taking with food improves gastrointestinal tolerability and reduces nausea/vomiting 3, 2
Common Pitfall to Avoid
Do not attempt to compound an injectable form of oseltamivir from oral capsules or suspension—this is not pharmacologically appropriate and the drug requires oral absorption and hepatic conversion to become active 4, 5. The prodrug structure specifically requires first-pass metabolism through the liver to generate the active antiviral compound 4.