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Recommended Antiviral Medications for Prevention and Treatment of Influenza (September 2008) Prescription Coveragec a 5 mg blisters of oral powder for inhalation via Diskhaler Prophylaxis of influenza A and B in patients aged ≥5 years; treatment of influenza A and B in patients aged ≥7 years All 30mg QD 30mg BID 45mg QD 45mg BID 60mg QD 60mg BID 75mg QD 75mg BID 10mg QD 10mg BID Veteran Affairs Prophylaxis and ≤ 15 kg treatment of 15-23 kg influenza A and B 23-40 kg in patients aged > 40 kg ≥1 year Midwest Health Plan 30, 45, and 75mg oral capsules; 12mg/mL oral powder for suspension Prevention Treatment (≥ 10 Days) (5-Day Course) $101 for 10 2QL • Prophylaxis in children aged 1-12 years is capsules; recommended for 10 days • Prophylaxis in $51 for 25mL patients aged ≥13 years is recommended for at least 10 days (up to 6 weeks for community outbreaks) • Most effective if started within 48 hours of onset of illness or exposure • Reduce dose by half for patients with CrCl between 10 and 30 mL/min • Pregnancy category C • Most common side effects are nausea and vomiting 2 2 2QL PA NF 2 • Prophylaxis is recommended for 10 days for household settings and 28 days for community outbreaks • Most effective if started within 48 hours of onset of illness or exposure • If scheduled at the same time, patients should use their inhaled bronchodilator first before taking zanamivir • Patients should be instructed about the correct use of the inhalation device • Not recommended for treatment in patients with underlying airway disease due to limited data • Contains lactose • Pregnancy category C • Most common side effects are cough, diarrhea and nasal symptoms 2 2 2QL PA NF NF Comments Cost b 3QL $67 for 1 inhaler (20 blisters) BlueCaid Weight MI Medicaid Zanamivir ® (Relenza ) Indicationsa BCN Oseltamivir (Tamiflu®) Strength(s) UM Employees Antiviral Agent BCBSM Dosage Antiviral therapy should be considered during periods of increased influenza activity in the community as: • Prophylaxis for people at high risk during the 2 weeks after influenza vaccination (after the second dose for children aged <9 years who have not previously been vaccinated); • Prophylaxis for people at high risk for whom influenza vaccine is contraindicated (e.g., persons allergic to eggs or other components of the vaccine); • Prophylaxis for people with immune deficiencies or those who might not respond to vaccination (e.g., persons infected with HIV or receiving immunosuppressive medications); • Prophylaxis for people who are unvaccinated and are living with and/or caring for high risk people or infants aged <6 months (e.g, health care workers, household members); • Treatment for people with influenza who live with or care for high risk people; • Treatment for people with influenza who are at higher risk for influenza complications; and • Treatment for people presenting with influenza symptoms within 48 hours who want to decrease the duration or severity of their symptoms and transmission of influenza to others at higher risk for complications. b Cost is based on the average wholesale price as listed on the Amerisouce Price Lookup. c Coverage levels are obtained from the respective prescription drug plan formularies. Code definitions are: 1 = generic; 2 = preferred brand; 3 = nonpreferred brand; NF = non-formulary; QL = quatity limits apply; PA = prior authorization required. Questions and/or comments about this information may be directed to Annie Sy, PharmD ([email protected]). References: 1. Fiore AE, Shay DK, Broder K, et al. Prevention and control of influenza. August 8, 2008. Centers for Disease Control and Prevention. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5707a1.htm. Accessed September 10, 2008. 2. Oseltamivir. Drug Facts and Comparisons . Drug Facts and Comparisons 4.0 [online]. 2008. Available from Wolters Kluwer Health, Inc. Accessed September 10, 2008. 3. Zanamivir. Drug Facts and Comparisons . Drug Facts and Comparisons 4.0 [online]. 2008. Available from Wolters Kluwer Health, Inc. Accessed September 10, 2008.