Jones TE. Oseltamivir - Current dosing recommendations reduce the therapeutic benefit in patients with mild to moderate renal function and/or large body mass. A review of the literature with recommendations to. her Drug Monit. 2020;10.1097/FTD.0000000000000797
Method: Oseltamivir is administered as a pro-drug and converted to the active carboxylate moiety in the liver. Published papers that included Oseltamivir Carboxylate pharmacokinetics in patients with renal impairment and those with large body mass were reviewed. Concentrations of Oseltamivir Carboxylate achieved in the first 24h were compared with those from patients with normal renal function and body mass.
Results: Studies that informed dosage regimens for patients with mild to moderately impaired renal function focussed on attaining steady state concentrations similar to those observed in patients with normal renal function. They overlooked the importance of achieving therapeutic concentrations EARLY in the course of the infection. As a result, many patients will not attain therapeutic concentrations until too late in the infection. This is also true for patients with a large body mass.
Conclusions: Current dosing advice for Oseltamivir in patients with mild to moderate renal impairment and those with a larger body mass are likely to reduce (or even negate) its efficacy. The first dose should be 75mg for patients with normal body mass and proportionately larger when body mass is larger. Subsequent doses should be reduced in proportion to the degree of renal impairment. Timely therapeutic drug monitoring can provide invaluable dosing (and other) information to the clinician treating patients with Influenza and could improve patient outcomes.
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