To Tamiflu or Not to Tamiflu?

The flu is hitting hard and you may have friends and family that are getting sick. Here is the information you need to know about current treatment options for the flu.

Your best protection from catching the flu is to get a flu vaccine (more information here). The vaccine does not work 100% of the time, but there are other simple steps you can take to prevent flu, such as washing your hands with soap frequently and avoiding contact with sick family, friends or coworkers.

If you have the flu, there are several prescription medications available including: oral oseltamivir (Tamiflu), inhaled zanamivir (Relenza), or the intravenous drug peramivir (Rapivab).[1] However, studies show that these medications only help you recover one day faster from the flu. Rather than going to the doctor’s office to get examined and get a prescription, you might prefer to stay home and rest and drink plenty of fluids.

Over the counter (OTC) medications don’t cure the flu but they can help you feel better by treating symptoms such as aches, coughs, and sore throats. A list of safe options can be found here. Antibiotics do NOT work against the flu because it is caused by a virus and not by bacteria.

Tamiflu is heavily advertised, but many doctors believe that Tamiflu does not work well enough to justify the high cost of the drug, or the CDC recommendation that all patients take it.[2] These doctors point out that there is very little high quality evidence that Tamiflu reduces the rate of serious complications from the flu. Since Tamiflu gets so much attention in the media, you may want to know more.  Here is the info that you need to help you decide if you want to try it for yourself or a loved one.

Is Tamiflu (Oseltamivir) Effective for Treating the Flu?

Tamiflu is a prescription antiviral medication used for treatment of the flu and to prevent catching the flu if you have been near someone sick. It has been heavily advertised, but there is lots of controversy over whether or not it is actually effective.

On average patients who start taking Tamiflu within 48 hours of getting sick will recover one day faster than patients who do not take anything.  Roche, the makers of Tamiflu, claim that Tamiflu also reduces the number of patients who have serious complications from the flu, such as pneumonia (by 44%) or hospitalization (by 63%).[3] However, the Tamiflu only worked in patients who had tested positive for the flu on a laboratory test, not patients with flu-like symptoms who subsequently were found to not have the flu. Other researchers examined the same study data and concluded that Tamiflu does not reduce hospitalizations or other complications when analyzing all people who went to the doctor because of flu-like symptoms.[4] This means that if your doctor prescribes Tamiflu without giving you a flu test, it is less likely to help you get better. That’s because many patients who think they have the flu have a cold instead, and they will not benefit from Tamiflu.

Similarly, when Tamiflu was used to prevent the flu in people exposed to confirmed cases of flu, it was able to reduce their likelihood of getting sick by as much as 55%.

Tamiflu has been approved for use in adults, infants as young as 2 weeks, children, and pregnant women. Tamiflu does not work as well in patients that are over 65.[5]

Is Tamiflu Safe?

The most common side effects of Tamiflu are:

  • Nausea
  • Vomiting
  • Diarrhea
  • Stomach pains
  • Dizziness
  • Headaches

The more serious side effects include:

  • Seizures
  • Sudden confusion
  • Delirium
  • Hallucinations
  • Unusual behavior
  • Self-injury

The serious side effects are very rare, but tend to occur more often in children, so if your child is taking Tamiflu and you notice any of these symptoms, speak to your doctor immediately and discontinue use of Tamiflu.[6]

You should also stop using Tamiflu immediately and seek medical attention if you have any signs of allergic reaction, including hives, difficulty breathing, swelling of the lips, tongue or throat or skin rash.

To help the FDA determine how common these Tamiflu side effects are, it is important to report any side effects to the FDA by calling 1-800-FDA-1088.

With all these risks, and so little benefit, why take Tamiflu?  The director of the Centers for Disease Control and Prevention thinks it is worth it, but experts in the field disagree. As a patient, you should weigh the risks and benefits before deciding if Tamiflu is right for you. If you can start taking Tamiflu quickly within 48 hours of getting flu symptoms and a positive flu test, it is more likely to work, but still may only shorten your flu by one day.  Patients such as pregnant women, infants, or patients with a weakened immune system are more at risk of complications from the flu and might be more likely to benefit from Tamiflu, but should talk to their doctors to weigh the risks and benefits before deciding.

Other Treatments

As mentioned above, there are two other FDA-approved antiviral medications to treat the flu virus. However, these medications are not better than Tamiflu at treating the flu, and also have serious side effects.

Inhaled zanamivir (Relenza) is FDA approved for the treatment of flu in children and adults ages 7 and older.[7] Rapivab is given intravenously in a hospital, doctors office or clinic, and was approved by the FDA in December 2014 for patients 18 and older with uncomplicated flu.[8]  However, it was shown to only reduce fever 12 hours earlier than placebo, which means it usually provides even less relief than Tamiflu. Relenza is inhaled and can cause serious breathing problems in patients. Both drugs must be taken within 2 days of the first flu symptoms in order to work, similar to Tamiflu.

You may wonder why the FDA approved these flu treatments that have such modest benefits.  It is important to understand that when the FDA approves a drug or device, that doesn’t mean the scientists there recommend it for patients to use.  It only means that they think it has some benefit for some patients, and that the average patient is more likely to benefit than to be harmed.  However, as with many other medications, some patients will not benefit at all, and some may be very seriously harmed.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

  3. Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomized controlled trials. The Lancet. 2015
  4. Jefferson T, Jones M, Doshi J, et al.  Oseltamivir for influenza in adults and children: systematic review of clinical study reports and summary of regulatory comments. BMJ. 2014 348:g2545
  5. Dobson J, Whitley RJ, Pocock S, Monto AS. Oseltamivir treatment for influenza in adults: a meta-analysis of randomized controlled trials. The Lancet. 2015