Oseltamivir: Dose adjustment for renal impairment

  • Dosing recommendations are based on creatinine clearance calculated using the Cockcroft-Gault equation.
  • Do not use eGFR estimates (available on PAS) for drug dosing purposes (for more information  click here )
  • To calculate creatinine clearance (CrCl) using the Cockcroft-Gault equation, use the creatinine clearance calculator :
  • Accurate estimation of CrCl is only possible in patients with STABLE renal function. In patients with rapidly changing renal function (i.e. ACUTE renal failure), the serum creatinine levels will no longer provide a true reflection of renal function.
  • Dose adjustment may not be appropriate in ACUTE renal impairment secondary to SEPSIS. In this case it is important to treat the infection aggressively for the first 24hrs and re-check renal function before reducing the dose accordingly.
  • (In 'acute on chronic' renal impairment the initial dose should correspond to the previous level of chronic renal impairment).

We recommend using the following dosing regimen in patients with renal impairment

GFR (ml/min)

Treatment for 5 days

Prophylaxis 10 days

>30

Dose as in normal renal function

Dose as in normal renal function

10-30

75mg once daily

75mg every 48 hours

<10

75mg as single dose

30mg once a week

Haemodialysis (HD)

75mg 3x / week post dialysis

30mg 3x / week post dialysis

Peritoneal dialysis(PD)

30mg weekly

30mg weekly

CAV/VVHD

75mg once daily

75mg every 48 hours

 Side effects of oseltamivir:

Nausea, vomiting, abdominal pain, dyspepsia, headache;

 Less commonly arrhythmias, convulsions and altered consciousness (usually in children and adolescents), eczema, rash;

Rarely hepatitis, gastro-intestinal bleeding, neuropsychiatric disorders (usually in children and adolescents), thrombocytopenia, visual disturbances, Stevens-Johnson syndrome, toxic epidermal necrolysis

References:

1.Summary of Product Characteristics for Tamiflu, Roche ®. Last updated on the Electronic Medicines Compendium 15th December 2016. Accessed via the Electronic Medicines Compendium http://emc.medicines.org.uk on 24/01/2017.

2.Ashley C & Currie A. Ed. The Renal Drug Handbook, 4th Edn. Oxford: Radcliffe Publishing, 2014.