Oseltamivir and Peramivir Administration Guidelines

Introduction to Neuraminidase Inhibitors

Oseltamivir is exclusively administered orally, available as capsules or oral suspension, according to the American Academy of Pediatrics 1, 2, 3

Peramivir is an intravenous neuraminidase inhibitor approved for influenza treatment, with dosing as follows:
Peramivir is not approved for chemoprophylaxis, as stated by the Centers for Disease Control and Prevention 1, 2

Oseltamivir comes in two formulations: capsules (30 mg, 45 mg, and 75 mg) and oral suspension (6 mg/mL concentration), according to the American Academy of Pediatrics 1, 2, 4
Standard oseltamivir treatment dosing for 5 days is as follows:

Treatment must be initiated within 48 hours of symptom onset for maximum benefit, as recommended by the Infectious Diseases Society of America 4
Renal dose adjustments are necessary for patients with renal impairment, with the following recommendations:
Oseltamivir can be given with or without food, though taking with meals improves GI tolerability, according to the American Academy of Pediatrics 1, 2, 4

The American Academy of Pediatrics recommends that oseltamivir is exclusively available as an oral medication in capsule or liquid suspension form, and cannot be given intravenously 5, 6

For patients who cannot tolerate or absorb oral medications, the Centers for Disease Control and Prevention suggests considering alternative neuraminidase inhibitors, such as peramivir (Rapivab), which is FDA-approved for IV administration in adults and adolescents 13-17 years at a dose of 600 mg as a single IV infusion over 15-30 minutes 6
The FDA recommends peramivir (Rapivab) for treatment only, not for chemoprophylaxis, and it is approved for children ≥2 years as of September 2017 6
For seriously ill patients, zanamivir IV may be obtained on a compassionate-use basis through the manufacturer, particularly important for immunocompromised patients or those who cannot tolerate/absorb oral oseltamivir 5, 7

The Infectious Diseases Society of America suggests that zanamivir IV requires consultation with infectious disease specialists and its availability for compassionate use is uncertain and may not be consistently available 5, 6, 7