The flu (Influenza): Treating with Xofluza and Tamiflu

The FLU

We’ve seen an uptick of flu or influenza. Flu numbers plummeted when the pandemic that is Covid hit. Now the numbers are increasing and most likely due to Covid strains weakening and not "winning" as the infection over the flu along with less masking up, since those restrictions are no longer mandated in most places. In my work place (hospital setting), we have to mask up if we do not get the flu vaccine by October 31st.

What to prescribe? I typically just treat the symptoms but there are some people I will offer either baloxavir (Xofluza) - my anti-influenza drug of choice, or oseltamivir (Tamiflu).

Tip #1 - baloxavir or Xofluza

Baloxavir or Xofluza is a medication to help shorten the duration of the flu. Big perk: It is a one time dose. Big downfall: may be expensive if not covered by insurance.

The dose is based on a weight range.

>80kg = 80mg dose x 1 within 48 hours of symptom onset

<80kg = 40mg dose x 1 within 48 hours of symptom onset

I remember that by knowing that the generic name starts with a B which looks similar to an 8.

Pediatric dosing is based on weight as well:

Indicated for ages 5 and older.

• for those < 20kg = 2 mg/kg/dose x 1 dose within 48 hours of symptoms onset

• the rest is like adults:

  • <80kg dose with 40mg

  • >80kg dose with 80mg

Tip #2 - oseltamivir or Tamiflu

I don't have a good memory tip for Tamiflu. But, you also need to start this within 48 hours of symptoms to be of benefit. Tamiflu is a 5 day course, may still be expensive, and anecdotally has worse side effects (abdominal pain, nausea, vomiting, diarrhea to list a few common ones I hear patients complain about). However, do not let that deter you, as it may work well for some patients. This is where you need to listen to the patient.

*Special info from epocrates: >98% of currently circulating influenza virus in the US is oseltamivir-susceptible

ADULT DOSING: 75 mg PO bid x 5 days

Pediatric dosing:

Indicated for all ages! Dosing on epocrates as follows:

Tip #3 - Zinc

I love Zinc and Zicam products for cold/flu symptoms. I have read where it does help shorten the duration of the course of symptoms by 1-2 days because zinc helps fight infection and heal wounds. However, if you already get enough in your diet, is it of any benefit to take more? There is conflicting data for cold/flu tx.

The other downside is GI side effects and drug interactions with antibiotics like penicillamines, quinolones, and tetracyclines.

Tip #4 - just treat the symptoms

You can 100% get away with just treating the symptoms. Especially in those low-risk for needing hospitalization. Will they still feel horrible and "like they got run over by a truck?" Yes. But give cough medicine, give instructions on alternating Tylenol and ibuprofen, educate on what a fever is and that it's not a bad thing to run fever but it might make you feel bad. Drinking plenty of fluids (but make sure they add electrolytes and not just straight water! I had a patient come back in once after drinking wayyyyy too much water and was symptomatic with hyponatremia!

Tip #5 - Don't prescribe antibiotics

Lastly, don't prescribe antibiotics for viral infections UNLESS they have a superimposed pneumonia.

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