peramivir

General

Pronunciation:
per-am-a-veer


Trade Name(s)

  • Rapivab

Ther. Class.
antivirals

Pharm. Class.
neuraminidase inhibitors

Indications

Treatment of acute uncomplicated influenza in patients who have had symptoms for 2 days or less.

Action

Inhibits the enzyme neuraminidase, which may alter virus particle aggregation and release.

Therapeutic Effect(s):

Reduced duration or prevention of flu-related symptoms.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism and Excretion: Mostly eliminated unchanged by kidneys (> 90%).

Half-life: 20.8 hr.

TIME/ACTION PROFILE (blood levels)

ROUTEONSETPEAKDURATION
IVrapidend of infusionunknown

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity.

Use Cautiously in:

  • Renal impairment (dose ↓ required for CCr <50 mL/min)
  • Geri: Consider age-related ↓ in hepatic, renal, cardiac function, concurrent diseases and drug therapy;
  • OB: Use only if clearly needed
  • Lactation: Consider benefits of breastfeeding, need for peramivir, and potential for adverse effects;
  • Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

CNS: insomnia, neuropsychiatric events

CV: hypertension

GI: constipation

Derm: ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Avoid use of live attenuated influenza vaccine within 2 wk prior and 48 hr after peramivir; interference may occur.

Route/Dosage

IV: (Adults and Children) ≥13 yr): 600 mg x 1 dose.

IV: (Children 2–12 yr): 12 mg/kg (max = 600 mg) x 1 dose.

Renal Impairment
IV: (Adults and Children) ≥13 yr): CCr 30–49 mL/min–200 mg x 1 dose; CCr 10–29 mL/min–100 mg x 1 dose.

Renal Impairment
IV: (Children 2–12 yr): CCr 30–49 mL/min–4 mg/kg (max = 600 mg) x 1 dose; CCr 10–29 mL/min–2 mg/kg (max = 600 mg) x 1 dose.

Availability

Solution for injection: 10 mg/mL

Assessment

  • Assess for signs and symptoms of influenza (fever, dyspnea, tachypnea, tachycardia, hypotension) prior to and at least daily during therapy. Patient must be symptomatic for no more than 2 days to receive peramivir.
  • Monitor for signs of neuropsychiatric symptoms (hallucinations, delirium, abnormal behavior) during therapy.
  • Assess patient for skin rash during therapy. Monitor closely and treat symptomatically.

Lab Test Considerations:

May cause ↑ serum ALT, AST, glucose, creatine kinase, and ↓ neutrophils.

Potential Diagnoses

Implementation

IV Administration

  • Intermittent Infusion: Diluent: 0.9% NaCl or 0.45% NaCl, D5, or LR to a maximum volume of 100 mL. Solution is clear and colorless; do not administer solution that is discolored or contains a precipitate. Upon dilution, administer immediately or refrigerate up to 24 hrs; discard after 24 hrs. Allow to reach room temperature prior to administration. Discard unused portion of single use vial.
  • Rate:Infuse over 15 to 30 min.
  • Y-Site Incompatibility: Do not administer simultaneously with any other medication.

Patient/Family Teaching

  • Explain purpose of peramivir to patient.
  • Advise patient to notify health care professional if signs and symptoms of anaphylaxis or rash, or neuropsychiatric symptoms occur.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Resolution of sign and symptoms of influenza.

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