What are Antivirals?

Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that can be used to treat H1N1 (Swine) flu, or to prevent infection with H1N1 (swine) flu viruses. These medications must be prescribed by a health care professional. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious influenza complications. The sooner a sick person is treated with an antiviral, the greater effect it will have on the patient’s recovery. These antiviral drugs also can be used to prevent influenza when they are given to a person who is not ill, but who has been or may be near a person with the flu. When used in this way, these antiviral drugs are about 70% to 90% effective.

There are four influenza antiviral drugs approved for use in the United States:

1. oseltamivir
2. zanamivir
3. amantadine
4. rimantadine 

Only two, oseltamivir and zanamivir are effective in treating H1N1 (swine) flu.

General Information on Oseltamivir (TAMIFLU®)

• TAMIFLU® is approved to both treat and prevent influenza A and B virus infection.
• TAMIFLU® is effective in people 1 year of age and older.
• TAMIFLU® comes in capsule form and in liquid form that can be measured for proper dosage.

The most common side effects of TAMIFLU® are nausea and vomiting. These are not usually severe and usually happen in the first 2 days of treatment.

General Information on Zanamivir (RELENZA®)

• Relenza® is approved to treat and, in some cases, prevent influenza A and B virus infection.
• Relenza® is effective in people 7 years and older and can prevent influenza A and B virus infection in people 5 years and older.
• Relenza® is packaged in a medicine disk called a Rotadisk® and is inhaled by mouth using a delivery device called a Diskhaler®.
• Regarding the possible side effects from taking Relenza®, people should be aware of the risk of increased difficulty breathing, especially among people with a history of underlying breathing problems. If patients have increased difficulty breathing, they should stop Relenza® and get medical attention right away.

2. Nonspecific Treatments used to Relieve Symptoms

Antiviral medications can sometimes help lessen influenza symptoms, but require a prescription. Most people do not need these antiviral drugs to fully recover from the flu. However, persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization, might benefit from antiviral medications. Antiviral medications are available for persons 1 year of age and older. Ask your health care provider whether you need antiviral medication.

Influenza infections can lead to or occur with bacterial infections. Therefore, some people will also need to take antibiotics. More severe or prolonged illness or illness that seems to get better, but then gets worse again may be an indication that a person has a bacterial infection. Check with your health care provider if you have concerns.

Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome. Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin. 

• Children 5 years of age and older and teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms. 
• Children younger than 4 years of age should NOT be given over-the-counter cold medications without first speaking with a health care provider. 
• The safest care for flu symptoms in children younger than 2 years of age is using a cool-mist humidifier and a suction bulb to help clear away mucus. 
• Fevers and aches can be treated with acetaminophen (brand name Tylenol®) or ibuprofen (brand names Advil®, Motrin®, Nuprin®) or Naproxen (brand name Aleve®).
• Although over-the-counter cold and flu medications used according to the package instructions may help lessen some symptoms these medications will not lessen how infectious a person is.
• Check the ingredients on the package label to see if the medication already contains acetaminophen or ibuprofen before taking additional doses of these medications—don’t double dose! 
• Check with your health care provider or pharmacist if you are taking other over-the-counter or prescription medications not related to the flu and if you have any stomach or kidney problems.

3. Complementary and Alternative Medicine to Prevent the H1N1 Flu

(from the U.S. National Center for Complementary and Alternative Medicine)

Recently, the FDA and the Federal Trade Commission alerted the public to be wary of Internet sites and other promotions for CAM (Complementary and Alternative Medicine) products that claim to diagnose, prevent, mitigate, treat, or cure the 2009 H1N1 influenza virus (swine flu). Such products have not been tested for safety and efficacy. Currently, the only approved medications for this flu virus are Oseltamivir (TAMIFLU®) and Zanamivir (RELENZA®).

This latest advisory reinforces the need for consumers to educate themselves and be wary of unsupported health claims. All too often, we see claims being made for unproven products, seeking to take advantage of people who are simply trying to protect the health and wellness of themselves and their loved ones. If a claim seems too good to be true, it probably is.

If you are thinking about using a CAM product to prevent the flu or "boost your immune system," first get information on it from reliable sources. The NCCAM Web site offers information about many CAM products, as does the NIH Office of Dietary Supplements and MedlinePlus. Talk to your health care provider about your use of dietary supplements or other forms of complementary and alternative medicine. This will help ensure safe and coordinated care. Only by fully discussing everything you do for your health can you be an effective manager of your health care. (For tips about talking with your health care providers about CAM, see NCCAM's Time to Talk campaign.)

Keep in mind that although many CAM products (and some prescription drugs) come from natural sources, "natural" does not always mean "safe." And be aware that an herbal supplement may contain dozens of compounds and that its active ingredients may not be known. (See our fact sheet for more tips on Using Dietary Supplements Wisely.)

4. Fraudulent Products

The FDA maintains a list that is intended to alert consumers about Web sites that are illegally marketing unapproved, uncleared, or unauthorized products in relation to the 2009 H1N1 (swins) Flu Virus. The uses related to the 2009 H1N1 Flu Virus are not necessarily being promoted by the manufacturers of the products. 

This list does not include every Web site that is marketing products related to the 2009 H1N1 Flu Virus without FDA approval, clearance, or authorization, only those Web sites to which FDA has issued a warning letter.

Even if a Web site is not included in this list, consumers should exercise caution before purchasing over the Internet any product purporting to diagnose, mitigate, prevent, treat, or cure the 2009 H1N1 Flu Virus. 

Some of these products may be approved or cleared by FDA for other medical uses. The fact that a product is listed on this page indicates ONLY that the products are not cleared, approved, or authorized for the diagnosis, mitigation, prevention, treatment, or cure of the 2009 H1N1 flu virus.

There are a number of fraudulent product categories including:

• Air System Products
• Body Wash Products
• Device Products
• Gel Products
• Gloves Products
• Hand Sanitizer Products
• Herbal Extract Products
• Inhaler Products
• Kit Products
• Mask Products
• Shampoo Products
• Spray Products
• Supplement Products
• Tea Products
• Test Products

You can view and download the complete list of products at the bookmark labeled "The FDA's list of fraudulent flu products" that is included with this Casebook.