peramivir

Therapeutic Classification: antivirals

Pharmacologic Classification: neuraminidase inhibitors

Indications ⬆ ⬇

REMS

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 effects:

Reduced duration or prevention of flu-related symptoms.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

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

Half-Life: 20.8 hr.

Time/Action Profile ⬆ ⬇

(blood levels)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

Renal impairment (dose ↓ required for CCr <50 mL/min);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children 6 mo (safety and effectiveness not established); risk of neuropsychiatric events;
Geri: Consider age-related in hepatic, renal, cardiac function, concurrent diseases and drug therapy.

Adv. Reactions/Side Effects ⬆ ⬇

CV: hypertension

Derm: ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME

GI: constipation

Neuro: insomnia, neuropsychiatric events

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

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 as single dose.
IV (Children 6 mo–12 yr): 12 mg/kg (max = 600 mg) as single dose.

Renal Impairment

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

Renal Impairment

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

Implementation ⬆ ⬇

IV Administration:

Intermittent Infusion: Diluent: Dilute with 0.9% NaCl or 0.45% NaCl, D5W, or LR. For adults and children 20 kg, to a maximum volume of 100 mL. For children 15 kg to 20 kg, maximum volume of infusion is 75 mL. For children 10 kg to 15 kg, maximum volume of infusion is 50 mL. For infants 6 mo to 1 yr and children 5 kg to 10 kg, maximum volume of infusion is 25 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.

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Pronunciation ⬇

Classifications ⬆ ⬇