March 9, 2020
I have seen a lot of fear and misinformation circulating these days regarding Tamiflu, so I decided to put some evidenced-based information together for parents to have at their fingertips. The flu, or more accurately, influenza, is a serious illness, and it can be scary to watch your child go through it. Add to this the confusion and contradictory anecdotes mixed with strong opinions regarding Tamiflu, and what is a parent to do? Here are a few basics that is essentials about Tamiflu for every parent to know.
First things first. What exactly is Tamiflu? Tamiflu, or more accurately oseltamivir, is an antiviral medication used to SHORTEN the duration of the flu. In certain cases, it can be given to try to prevent the flu for at-risk children and adults that have been exposed to influenza. Tamiflu is available as a liquid or a pill, and the liquid should always be kept in the refrigerator.
Antibiotics can be given at any point during a bacterial infection and still be highly effective. Antivirals like Tamiflu, however, are different. They must be started within the first 48 hours to have much effect. This has to do with how the virus replicates within the body.
When someone with influenza sneezes or coughs, droplets of saliva or mucus containing the virus can get into the nose or mouth of another person. The influenza virus then enters this person’s body and actually goes into the very cells that make up our body, especially the cells of our nose, throat, and lungs. Once they are inside these cells, they replicate, meaning they make more of themselves.
The influenza virus is a terrible guest, and it wreaks havoc in the cells that host it, making it hard for the cells to do their important jobs. Then, the infected cell releases capsules containing the essential elements of the virus. This is called a virion, and these virions are what enter the blood stream and go on to enter other healthy cells where the process is repeated over and over and over again, until more and more of our cells are busy making virions or “virus babies” instead of what they are supposed to be doing. The immune system kicks in trying to get rid of these foreign invaders, and we start feeling the classic fevers, aches, and chills.
Tamiflu works by stopping the virions (virus babies) from being released into the blood stream. It does not help the cells already infected, and it does not kill the actual virus. Our bodies’ immune systems still have to do that. Tamiflu’s purpose is to stop the virus from being able to infect more cells. This is why Tamiflu works best in the beginning of the infection. Taking it after our cells are already infected doesn’t do us as much good.
Studies are showing that taking Tamiflu within the first 48 hours can take off a day to a day and a half of symptoms. This might not sound like much, but for a young child or someone immunocompromised, this can make all the difference. For a healthy person, however, it is simply a day.
Clearly, Tamiflu is no substitute for the flu vaccine. The best way to protect you and your loved ones from the flu is the flu vaccine. On top of preventing the flu in many cases, the flu vaccine is also known to decrease the severity of symptoms of the flu if your child does contract it. Prevention is always better than treatment, and the flu vaccine is the best way to protect you and your loved ones.
The American Academy of Pediatrics recommends that if your child falls into one of the following groups, that he or she should receive Tamiflu as soon as possible:
Now we get into the gray area. If your child fits into the categories above, it is not a gray area, and it is recommended that they be treated with Tamiflu. However, there are times when it is not so clear.
Now it is time to talk about the potential side effects of Tamiflu. Some of you may have heard anecdotal reports of some scary side effects, and I would like to address that. No medication is without side effects, and it is always a case of weighing risk vs benefit.
Also, no medication should be taken lightly. We do not want to overuse Tamiflu as that can cause the influenza virus to develop resistance to this antiviral. We also do not want to subject children to any unnecessary medication. However, there has also been an overemphasis lately on the side-effects, and they have been blown largely out of proportion.
It is also important to remember the complications of the flu. The flu itself can lead to hospitalizations, pneumonia, and even death.
The most common side effect of Tamiflu is nausea, vomiting, and stomach pain. Giving food at the same time your child takes Tamiflu can help decrease this side effect. There has also been some diarrhea reported.
The second most common side effects reported are rashes, including diaper rashes. It is important to note that, apart from a diaper rash, some rashes can simply be a side-effect whereas others are a symptom of a hypersensitivity (allergic) reaction.
If your child is having a significant rash or is having severe vomiting or diarrhea, make sure to call your pediatric provider. It is possible to have an allergic reaction, and this would be an important reason to stop giving Tamiflu.
After Tamiflu was released, some concern developed about neurological problems following people taking Tamiflu including seizures, hallucinations, behavioral changes, and self-harming behaviors. This has received a lot of attention, and there is some discussion over whether this is being caused by Tamiflu or if it’s a symptom of the flu, which Tamiflu is given to treat. Studies have been done to determine if there is a causal relationship. One study, in particular, was conducted in 2018 over the concern that Tamiflu may cause suicide, and it clearly showed that there was no relationship between Tamiflu and suicide. Studies will continue to be conducted to evaluate the safety of this life-saving medication, and your pediatric provider can answer questions or concerns you may have about what research is currently being done.
It is worth noting that influenza itself can cause neurological problems, including febrile seizures and encephalopathy. Encephalopathy is swelling of the brain that can cause seizures, hallucinations, and behavioral changes. Any study that looks at the side effects of Tamiflu will have the difficult task of differentiating between the side effects of the medication and the symptoms and complications of the disease itself. This is easier said than done.
If your child develops ANY severe symptoms whether neurological or otherwise after starting Tamiflu, call your child’s medical provider immediately.
Like we discussed previously, no medication is without side effects and should never be given lightly. We need to weigh the benefits against the risk for each situation and determine what is best for the individual child. Following guidelines helps in that determination.
If your child is under 2 years of age, falls into the high-risk category, has severe influenza, or is hospitalized for the flu, the benefits outweigh the risks. Influenza can be a very severe illness. In fact, the Center for Disease Control estimates that over 14,000 people have died from the flu this season (and this number may even be closer to 36,000 deaths), and the flu season is not over yet.
For children who do not fall into the above categories, there needs to be a conversation between you and your child’s doctor about the best course of action. Tamiflu is not a magic cure.
As a medical provider, I cannot pass up this opportunity to, once again, bring up the the flu vaccine. The flu vaccine is the BEST way to protect your child and loved ones, and it carries very minimal risk.
Some of you have probably heard that Tamiflu can be used in an attempt to prevent the flu in certain cases. Just like with antibiotics, we have to be careful to not create resistance to Tamiflu by using it too much. Also, we do have to balance side effects with how effective the prevention will be. No medication is 100% effective. The dose used to prevent the flu is lower than the dose that would be used to treat the flu. If your child is on a prevention dose of Tamiflu, it is important to watch for symptoms of the flu, because the dose would need to be changed.
Taking Tamiflu as a preventative is going to be up to your child’s medical provider. If they prescribe Tamiflu, it is usually for a good reason, but always question if you do not understand why it’s been prescribed or the care instructions.
Tamiflu should always be used judiciously, but there are some very legitimate reasons to give it. Like any medication, it can have side effects and may only take away about a day to a day and a half of symptoms. For some kids, however, this day and a half is what they need to fight off the infection, so don’t be afraid to give it when their pediatric provider recommends it.
Once again, as a vaccine advocate, I have to say that Tamiflu is no substitute for the flu vaccine. Please, please always vaccinate your child. (And wash those hands!) I wish all of you a healthy, flu-free home.
Author: Dani Stringer, MSN, CPNP, PMHS