The cost of taking (or not taking) flu antivirals

Should I take Tamiflu? It’s a common question this flu season, which is shaping up to be a real doozy. With a vaccine that doesn’t protect well against the more virulent-than-usual circulating flu strain – H3N2 – influenza is quickly reaching epidemic levels, leaving patients perplexed on the best remedies.  Antiviral medications are one option, but many question whether or not they are necessary, or even helpful at all.

While antivirals won’t cure flu the way an antibiotic might be used to cure a sinus infection, experts say they are still useful. This month, the Centers for Disease Control and Prevention (CDC) endorsed the use of antivirals to combat the spread of the flu, especially for patients at a high risk of complications. And infectious disease physicians like Cristie Columbus, MD, vice dean of the Texas A&M Health Science Center College of Medicine in Dallas, agree.

“I’m a big proponent of flu antivirals, which shorten the duration of illness and, perhaps more importantly, reduce the amount of contagious virus (or viral shedding), which can potentially help prevent secondary cases, particularly in vulnerable populations,” she said.

The CDC has three recommended antiviral drugs:

• Tamiflu (oseltamivir) – Comes in liquid or pill form and is the most popular influenza antiviral medication; side effects include nausea, vomiting, dizziness and headaches.
• Relenza (zanamivir) – Comes as an inhalable powder; not recommended for people with breathing problems, because it could cause bronchial spasms.
• Rapivab (peramivir) – An intravenous medication, given as a single dose, and recommended for people who are unable to tolerate Tamiflu or Relenza due to side effects.

All three antiviral drugs work by inhibiting neuraminidase, the protein that allows the virus to spread from cell to cell, which plays a key role in reducing the amount of contagious virus. The antiviral drugs could also reduce the duration of the flu by one-half to two days, especially if started within the first 48 hours of symptoms.

“If we can get antiviral medicines to patients as soon as the first symptoms are displayed, it could mean the difference between hospitalization and home-based care,” Columbus said.

This is especially important for those at a high risk for flu complications, including aging adults, pregnant women, and those with underlying conditions, such as asthma or other chronic lung problems, and those who are already hospitalized. While there are differing opinions on the use of antivirals due to side effects in pediatric patients, Columbus recommends that children also be treated with antivirals.

“I recommend antivirals be prescribed for pediatric patients as per CDC guidelines, with symptom control for nausea if needed,” Columbus said. “Particularly for high-risk pediatric patients, the benefit of antiviral treatment outweighs the risk of side effects.”

For otherwise healthy individuals, starting antivirals in the first 48 hours can speed their recovery time, allowing for a quicker return to work and normal daily activities and, theoretically, preventing spread to others.

“Even if it’s past the 48-hour window, previously healthy people who are exhibiting severe or progressive symptoms might benefit from antivirals,” Columbus noted.

Because flu is so widespread this season, the CDC recommends a decision to treat for influenza should not depend on a positive flu test. However, this has led to complications with some insurance companies, who require a positive test result before they will cover the cost of Tamiflu.

“It’s unfortunate, because, depending on the test used and availability of testing, results can be falsely negative or delayed, all of which contributes to the flu spreading further,” Columbus said. “Tamiflu can be expensive, especially if you have to pay out-of-pocket, but it may be the difference between a relatively mild illness and a trip to the hospital for some.”

When deciding whether or not to fill a Tamiflu prescription, consider this: One less day of feeling sick could help reduce the spread of the H3N2 virus this season and could keep you or a loved one out of the hospital and ultimately, it might even save your life.

For more information on antiviral medications, visit the CDC website.

Dr. Columbus has particular interest in health care epidemiology and infection control and prevention. A diplomate of the American Board of Internal Medicine and of the Subspecialty Board of Infectious Diseases, Dr. Columbus is also a member of several national professional organizations including the American Medical Association, the American College of Physicians, the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. She is also a member of the Texas Infectious Disease Society, Texas Club of Internists and active regionally in the Texas Medical Association, where she served on the Committee on Infectious Diseases.