Overview
Peramivir belongs to a class of medications that are prescribed for the treatment of influenza infections. It is an inhibitor of the cyclopentane neuraminidase receptor, and thus, this drug has a higher affinity for influenza viruses when compared to other drugs of the same group. During the N1H1 influenza pandemic phase, the drug Peramivir was made available for clinical prescription under the norms of emergency drug authorization; this provision for prescribing the drug Peramivir was made several months before the clinical approval of the drug.
The Food and Drug Administration (FDA) approved Peramivir on December 14, 2014. It is used for the treatment of uncomplicated influenza. Prescribing this drug to patients aged 18 years or older is advisable. Peramivir is a highly effective antiviral drug. It acts against A and B influenza strains and is highly active against newer influenza strains with pandemic potential. During the pandemic era, it was considered a life-saving drug.
What Are the Uses of Peramivir?
Peramivir is the drug of choice for treating the symptoms caused by the influenza virus (flu). This drug retards the growth of the virus and helps the body fight deadly infections like influenza. These drugs are highly effective against influenza strains but should not be considered a substitute for influenza vaccines. The prescription of this drug is based on the individual's age, the systemic medical conditions they are suffering from, and the body's response to the Peramivir drug treatment.
Dosage and Administration:
Adult Dose:
600mg IV (intravenous) as a single dose.
It is indicated for patients suffering from an acute, uncomplicated influenza infection who have had symptoms of influenza for two or fewer days.
Child Dose:
Peramivir is indicated in children over six months of age suffering from an acute uncomplicated influenza infection who have had symptoms of influenza for two or fewer days.
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In children less than six months, safety and efficacy are not established.
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12 mg/kg IV is the indicated dose for children aged six months to twelve years, and the dosage should not exceed 600 mg/ dose.
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600mg IV as a single dose is indicated for children thirteen years of age and older.
Dosage Forms and Strengths:
IV Solutions:
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200mg/20ml (10mg/ml)
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Before administering the drug, it is diluted to the recommended final volume.
Dosage and Modifications:
Renal function tests should be advised before prescribing Peramivir, and periodic renal function tests should be done for patients undertaking Peramivir.
In patients with renal impairment, the following modifications are advised:
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In patients undergoing hemodialysis, the drug Peramivir is prescribed after the dialysis is over to avoid renal disorders.
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If the CrCl (creatinine clearance) level is 10-29 ml/min, 100mg IV is prescribed as a single dose.
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If the CrCl level is 30-49 ml/min, 200 mg IV is prescribed as a single dose.
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No drug adjustment is required in individuals with a CrCl level more than or equivalent to 50 ml/min.
Contraindications:
It is contraindicated for patients with the following conditions:
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Allergy: Allergy to the drug Peramivir as allergic patients may show symptoms of hypersensitivity reactions like angioedema (swelling affecting the tissue below the mucous membrane), anaphylaxis (acute allergic reaction), or exfoliative skin diseases(severe inflammation affecting the entire skin surface).
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Alcohol intake: A well-established report is not yet published regarding the interaction of alcohol with Peramivir, but it is contraindicated as it can worsen drowsiness and dizziness symptoms.
Warnings and Precautions:
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Heart Failure:
Peramivir has been documented to worsen the symptoms of heart failure in patients suffering from myocarditis.
Following are a few of the features of heart failure that should be noted in these patients:
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Shortness of breath during exercising or while doing any other physical activity, shortness of breath can also be present at rest in individuals suffering from heart failure.
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Fatigue and weakness are commonly noted, and the individual gets tired while performing basic day-to-day activities.
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Swellings in the legs, ankles, and feet are an important indicator of heart failure due to electrolyte imbalance in these individuals.
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Irregular heartbeat.
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Persistent cough and wheezing with whitish or pinkish-tinged mucus are also commonly seen in these individuals.
2. Hypersensitivity:
Clinical trials have reported a few cases of urticaria (extensively itchy rashes caused by an allergic reaction), facial edema (swelling of the face), and exfoliative skin disease associated with individuals taking Peramivir while managing benign prostate enlargement. The medication should be immediately discontinued in individuals with severe hypersensitivity symptoms, and emergency management protocols should be followed. Alternative drugs should be prescribed when an allergic reaction to Peramivir is established to protect the individual from the life-threatening hypersensitivity reactions associated with Peramivir.
3. Neuropsychiatric Events:
Hallucinations, delirium, and abnormal behavior are commonly noted neurological symptoms associated with influenza. These symptoms are primarily reported in people suffering from encephalitis but can also occur in uncomplicated influenza. A few studies state that these symptoms are rare. It is always advisable to closely monitor the signs of abnormal behavior in these patients.
Drug Interactions:
No serious drug interactions of Peramivir have been noted with other drugs, but a few cases of severe drug interactions of Peramivir include the influenza virus vaccine. Aspirin should not be prescribed for relieving fever as Peramivir can interact with the drug and lead to the development of Reye's syndrome (the central nervous system and liver are involved in these individuals, and children can have symptoms like vomiting, drowsiness, and behavioral changes). It is always advisable to refer them to their doctor before stopping or changing the dosage of any medicine.
Adverse Reactions Associated With Peramivir:
Adverse reactions include unexpected or dangerous reactions associated with a particular drug.
Following are a few commonly associated adverse reactions with Peramivir:
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Stevens-Johnson syndrome, exfoliative dermatitis, and rashes are noted as hypersensitivity reactions with the drug Peramivir. The medication should be immediately discontinued in individuals with severe hypersensitivity symptoms, and emergency management protocols should be followed. Alternative drugs should be prescribed when an allergic reaction to Peramivir gets established to protect the individual from the life-threatening hypersensitivity reactions associated with Peramivir.
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Hallucinations, delirium, and abnormal behavior are commonly noted neurological symptoms associated with influenza. Few studies state that these symptoms are rare findings. It is always advisable to closely monitor the signs of abnormal behavior in these patients.
For Patients:
What Is an Influenza Infection?
Influenza is commonly referred to as the flu. It is a viral infection. The causative virus for this infection belongs to the ortho-myxoviridae group. It mainly affects the nose, throat, bronchi, and, in severe cases, the lungs. Symptoms of this infection usually last for a week.
These are the following subtypes of the influenza virus:
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Type A
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Type B
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Type C
Type A and Type B are of clinical importance; these subtypes were responsible for epidemics of influenza infection worldwide. It has been stated in various studies that a significant reservoir of the influenza virus is present in animals and birds. Swine, horses, dogs, and domestic poultry are noted to carry the influenza virus.
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The incubation period for influenza infections is around 18 to 72 hours. The period of Infectivity of the influenza virus is determined by the number of days before and after the onset of the symptoms. The virus is present in the nasopharynx, and the respiratory droplets are noted to be infectious.
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Influenza can affect all age groups and all gender types equally, but the mortality rate is higher in old-aged individuals and infants under 18 months of age.
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People with diabetes, chronic heart diseases, and kidney and respiratory ailments are more susceptible to influenza infections.
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Immunity plays a vital role in fighting influenza infections. Antibodies appear about seven days after the viral attack and return to normal levels in about two weeks.
Following are a few common signs and symptoms of influenza infection:
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Chills and high fever.
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Sore throat.
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Dry cough.
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Muscle aches.
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Fatigue.
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Diarrhea.
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Dizziness.
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Malaise.
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Pneumonia is the most severe complication of influenza infection.
Influenza can be diagnosed using the following diagnostic tests:
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Viral isolation from nasopharyngeal secretion sample.
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Indirect fluorescent antibody detection tests.
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Rapid influenza test kit.
What is Peramivir?
Peramivir belongs to a class of medications that are prescribed for the treatment of influenza infections. It is an inhibitor of the cyclopentane neuraminidase receptor, and thus, this drug has a higher affinity for influenza viruses when compared to other drugs of the same group. Peramivir is a highly effective antiviral drug. It acts against both A and B influenza strains and is highly active against newer influenza strains with pandemic potential. During the pandemic era, it was considered a life-saving drug.
This drug retards the growth of the virus and helps the body fight deadly viral infections like influenza. These drugs are highly effective against influenza strains but should not be considered a substitute for influenza vaccines. The prescription of this drug is based on the individual's age, the systemic medical conditions they are suffering from, and the body's response to Peramivir drug treatment.
What Is the Most Significant Information That Should Be Known About Peramivir?
The drug should be judiciously prescribed.
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As prescribed in older individuals, it can lead to lightheadedness and dizziness. These symptoms may cause difficulty in carrying out daily activities, and in severe cases, the patients may also undergo syncope. Sudden fainting has been reported. Once the drug gets prescribed, the patient should be made aware of the side effects, and the family members should be asked to take care of the patient.
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In conditions influenza associated with myocarditis, it can even worsen heart failure symptoms. So, individuals who are under Peramivir should constantly check the signs and symptoms of the side effects associated with the drug, and they should immediately report any abnormal features to their consulting doctor.
What Is to Be Done in the Event of a Missed Dose and an Overdose of Peramivir?
Usually, the prescribed dose for Peramivir is 600 mg daily, but in cases where individuals.
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Missed Dose: In case the individual forgets to take the prescribed dose of the tablet, or in any case, the dose is omitted, then the tablet should be taken as soon as they remember, or if it is time for the second dose, then the individual can skip the first dose and immediately take the double prescribed dose.
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Overdose: In case of overdose, the individual may have symptoms like nausea, vomiting, dizziness, or pain in the stomach. If this happens, the patient should be immediately taken to the hospital, and a thorough checkup should be done. In severe toxicity, gastric lavage is given, and the patient is supervised by medical staffs.
What Should One Inform the Doctor Before Starting the Treatment With Peramivir?
Whenever an individual visits a doctor for the management of influenza, the following pieces of information should be given to the doctor:
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Family History: The patient should inform the doctor if family members, like their parents, suffer from diabetes mellitus (increased blood glucose levels), hypertension (increased blood pressure), hypotension, or renal and hepatic disorder. They should also disclose if their siblings or other family member has any history of underlying medical conditions. This information helps the doctors know the disorder's hereditary pattern and the common signs and symptoms in the individual's family. Family history of the disease guides the doctor in planning a better management and treatment protocol.
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Personal History: Personal history includes altered symptoms that an individual faces, like excessive weight gain or weight loss, drowsiness, lethargy, swollen legs, increased heart rate, increased thirst, increased urge to eat, and increased or reduced urination.
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Other Systemic Disorders: The patient should always inform the doctor if they suffer from other underlying diseases like kidney disorders or liver dysfunction. Doctors prescribe medications, keeping in consideration the other underlying systemic conditions.
For Doctors:
Pharmacology:
It is an inhibitor of the cyclopentane neuraminidase receptor, and thus, this drug has a higher affinity for influenza viruses when compared to other drugs of the same group.
Mechanism of Action:
Peramivir is a cyclopentane analog and competitively binds to the active site of the neuraminidase receptor in the influenza virus. Peramivir acts on the influenza virus by inhibiting the neuraminidase activity of influenza virus A and B strains.
Absorption:
Peramivir can be classified into two categories:
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High solubility or low permeability.
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High solubility or poor metabolism.
Both active and passive transportation is associated with the permeability of Peramivir.
The oral bioavailability of Peramivir is very low.
Protein Binding:
The Peramivir rate of human plasma protein binding is less than 30 %.
Route of Elimination:
The kidney is the primary route of elimination, and renal clearance for Peramivir in unchanged form is around 90 % of total support.
