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Anti-virals Can Supplement, Replace Flu Shot

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Q: I heard there are anti-viral pills you can take to prevent the flu. Can they be used instead of getting a flu shot?

A: The anti-viral drugs you refer to are not a substitute for a flu vaccination. Think of the flu shot as first-line prevention of the flu and the drugs as second-line agents that can be used in certain situations during the flu season.

Four such anti-viral drugs are available. Symmetrel and Flumadine are effective only against influenza A. Tamiflu and Relenza, two newer agents, work against both influenza A and B.

All four can be used for both treatment and prevention of the flu.

When used to treat the flu, the drugs can shorten the duration of illness by a day or more. To get this benefit, you need to start the drug within two days of coming down with flu symptoms.

Symmetrel and Flumadine are taken twice daily. For treatment, the drug is taken for up to seven days. For prevention, it's typically taken during peak flu activity in the community or, in individuals who can't get the flu shot, for the entire flu season. Elderly people usually take a smaller dose.

Both drugs come in pill and liquid form.

Tamiflu and Relenza, the two newer anti-viral drugs, are called neuraminidase inhibitors.

For treatment, Tamiflu is taken twice daily for five days. For prevention, it's taken once daily for at least seven days, and may be used for as long as six weeks.

It comes in capsule and liquid form.

Relenza is a powder designed to be inhaled through the mouth similarly to some asthma medications. For treatment, the dose is two inhalations twice daily for five days. Though Relenza is not currently FDA-approved for flu prevention, it has been used once daily for up to six weeks for this purpose.

These anti-viral drugs can play an important role in preventing the flu in specific situations.

For instance, after a flu outbreak has begun, the drugs may be considered for use in unvaccinated or very recently vaccinated high-risk individuals, such as the elderly and those with chronic diseases. Similarly, during flu outbreaks in the community or in institutions (e.g., hospitals, nursing homes), unvaccinated caregivers could take the drugs to help prevent spread of the flu to the high-risk individuals they care for.

These agents also should be considered for those who are allergic to the flu shot.

It's interesting to note that Flumadine was used successfully to control a flu outbreak aboard a cruise ship.


(Richard Harkness is a consultant pharmacist who writes on health care topics. You can write him at 1224 King Henry Drive, Ocean Springs, MS 39564. His e-mail address is Volume of mail prohibits individual replies; selected letters will be answered in his column.)


(c) 2003, The Sun Herald (Biloxi, Miss.). Distributed by Knight Ridder/Tribune News Service.

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