Formulary
Oseltamivir: Indications, Dosing, Side Effects and Interactions
Reduces replication of influenza A and B viruses by inhibiting viral neuraminidase.
MedNext Academy | 5 min read
Oseltamivir: Indications, Dosing, Side Effects and Interactions
Reduces replication of influenza A and B viruses by inhibiting viral neuraminidase.
Drug action
Reduces replication of influenza A and B viruses by inhibiting viral neuraminidase.
Indications and dose
**Prevention of influenza**
- **Child** (By Mouth): 13-17 years (body-weight 41 kg and above) 75 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks (or up to 12 weeks if immunocompromised) during an epidemic.
- **Adult** (By Mouth): (body-weight 41 kg and above) 75 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks (or up to 12 weeks if immunocompromised) during an epidemic.
**Treatment of influenza**
- **Child** (By Mouth): 13-17 years (body-weight 41 kg and above) 75 mg twice daily for 5 days (10 days if immunocompromised).
- **Adult** (By Mouth): (body-weight 41 kg and above) 75 mg twice daily for 5 days (10 days if immunocompromised).
**Prevention of influenza for oseltamivir**
- **Neonate** (By mouth): 3 mg/kg once daily for 10 days for post-exposure prophylaxis.
- **Child 1-11 months** (By mouth): 3 mg/kg once daily (max. per dose 30 mg) for 10 days for post-exposure prophylaxis.
- **Child 1-12 years (body-weight up to 16 kg)** (By mouth): 30 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks (or up to 12 weeks if immunocompromised) during an epidemic.
- **Child 1-12 years (body-weight 16-23 kg)** (By mouth): 45 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks (or up to 12 weeks if immunocompromised) during an epidemic.
- **Child 1-12 years (body-weight 24-40 kg)** (By mouth): 60 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks (or up to 12 weeks if immunocompromised) during an epidemic.
- **Child 1-12 years (body-weight 41 kg and above)** (By mouth): 75 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks (or up to 12 weeks if immunocompromised) during an epidemic.
- **Child 13-17 years (body-weight up to 41 kg)** (By mouth): 60 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks (or up to 12 weeks if immunocompromised) during an epidemic.
- **Child 13-17 years (body-weight 41 kg and above)** (By mouth): 75 mg once daily for 10 days for post-exposure prophylaxis; for up to 6 weeks (or up to 12 weeks if immunocompromised) during an epidemic.
**Treatment of influenza for oseltamivir**
- **Neonate up to 36 weeks corrected gestational age** (By mouth): 1 mg/kg twice daily for 5 days (10 days if immunocompromised).
- **Neonate** (By mouth): 3 mg/kg twice daily for 5 days (10 days if immunocompromised).
- **Child 1-11 months** (By mouth): 3 mg/kg twice daily (max. per dose 30 mg) for 5 days (10 days if immunocompromised).
- **Child 1-12 years (body-weight 10-15 kg)** (By mouth): 30 mg twice daily for 5 days (10 days if immunocompromised).
- **Child 1-12 years (body-weight 16-23 kg)** (By mouth): 45 mg twice daily for 5 days (10 days if immunocompromised).
- **Child 1-12 years (body-weight 24-40 kg)** (By mouth): 60 mg twice daily for 5 days (10 days if immunocompromised).
- **Child 1-12 years (body-weight 41 kg and above)** (By mouth): 75 mg twice daily for 5 days (10 days if immunocompromised).
- **Child 13-17 years (body-weight up to 41 kg)** (By mouth): 60 mg twice daily for 5 days (10 days if immunocompromised).
- **Child 13-17 years (body-weight 41 kg and above)** (By mouth): 75 mg twice daily for 5 days (10 days if immunocompromised).
Side effects
Common or very common Dizziness; gastrointestinal discomfort; herpes simplex; nausea; sleep disorders; vertigo; vomiting Uncommon Arrhythmia; consciousness impaired (in adults); seizure; skin reactions Rare or very rare Angioedema; anxiety; behaviour abnormal; confusion; delirium; delusions; haemorrhage; hallucination; hepatic disorders; self-injurious behaviour; severe cutaneous adverse reactions (SCARs); thrombocytopenia; visual impairment
Interactions
**Severe interactions:**
- Pharmacokinetic properties of oseltamivir, such as low protein binding and metabolism independent of the CYP450 and glucuronidase systems (see section 5.2), suggest that clinically significant drug...
**Other interactions (4):**
- Co-administration of probenecid, a potent inhibitor of the anionic pathway of renal tubular secretion, results in an approximate 2-fold increase in exposure to the active metabolite of oseltamivir.
- Amoxicillin Oseltamivir has no kinetic interaction with amoxicillin, which is eliminated via the same pathway, suggesting that oseltamivir interaction with this pathway is weak.
- However, care should be taken when prescribing oseltamivir in subjects when taking co-excreted agents with a narrow therapeutic margin (e.g.
- Additional information No pharmacokinetic interactions between oseltamivir or its major metabolite have been observed when co-administering oseltamivir with paracetamol, acetylsalicylic acid,...
Pregnancy
Although safety data are limited, oseltamivir can be used in women who are pregnant when the potential benefit outweighs the risk (e.g. during a pandemic).
Breast feeding
Although safety data are limited, oseltamivir can be used in women who are breast-feeding when the potential benefit outweighs the risk (e.g. during a pandemic). Oseltamivir is the preferred drug in women who are breast-feeding.
Renal impairment
In adults: Avoid for treatment and prevention if eGFR less than 10 mL/minute/1.73 m 2 . In children: Avoid for treatment and prevention if estimated glomerular filtration rate less than 10 mL/minute/1.73 m 2 . Dose adjustments In adults: For treatment , use 30 mg twice daily if eGFR 30-60 mL/minute/1.73 m 2 (30 mg once daily if eGFR 10-30 mL/minute/1.73 m 2 ). For prevention , use 30 mg once daily if eGFR 30-60 mL/minute/1.73 m 2 (30 mg every 48 hours if eGFR 10-30 mL/minute/1.73 m 2 ). In children: For treatment , use 40% of normal dose twice daily if estimated glomerular filtration rate 30-60 mL/minute/1.73 m 2 (40% of normal dose once daily if estimated glomerular filtration rate 10-30 mL/ minute/1.73 m 2 ). For prevention , use 40% of normal dose once daily if estimated glomerular filtration rate 30-60 mL/minute/1.73 m 2 (40% of normal dose every 48 hours if estimated glomerular filtration rate 10-30 mL/minute/1.73 m 2 ).
Medicinal forms
Solution,Capsule,Suspension,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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