Influenza Drug Summary

• Mild CNS effects (nervousness, inability to concentrate, dizziness, insomnia, nightmares, headache); Other CNS effects that occur more often in the elderly or in patients with renal impairment (psychotic reactions, hallucinations and confusion)
• Less commonly orthostatic hypotension, urinary retention, lethargy, nausea

• Prophylaxis: Initiate before anticipated contact and continue through outbreak or for 2-3 weeks after vaccine administration
• Influenza A treatment: Therapy should be started within 48 hours of symptom onset
• Contraindicated in patients with severe renal disease, history of seizure disorder or GI ulcer
• Use with caution in patients with CV or liver disease, impaired renal function, recent eczema or psychosis
• Elderly patients and patients with compromised renal clearance may be more sensitive to antimuscarinic adverse reactions

• Tend to be mild and low incidence: GI effects (nausea/vomiting, anorexia); CNS effects (headache, nervousness, insomnia, concentration difficulties)

• Influenza A treatment: Therapy should be started within 48 hours of symptom onset
• Use with caution in patients with epilepsy
• Lower doses are typically needed in patients with severe renal or hepatic impairment and in the elderly

Adverse Reactions

• Generally well tolerated; GI effects (nausea/vomiting, diarrhea); Respiratory effect (bronchitis); CNS effects (insomnia, vertigo, headache)

Special Instructions

• Influenza treatment: Therapy should be started within 48 hours of symptom onset
• Use with caution and reduce dosage in patients with moderate-severe renal failure
• Monitor closely for behavioral changes throughout the treatment period

Adverse Reactions

• Dermatologic effects (Stevens-Johnson syndrome [SJS], exfoliative dermatitis, rash, injection site reaction); CNS effects (abnormal behavior, hallucination); GI effect (diarrhea)

Special Instructions

• Therapy should be started within 48 hours of symptom onset
• Discontinue if severe anaphylactic and skin reactions occur
• Administration with LAIV should be avoided

Adverse Reactions

• Generally well tolerated; Respiratory effects (cough, bronchitis, acute bronchospasm, decline in respiratory function has occurred in patients with history of respiratory disease, rarely occurs in patients with no history of respiratory disease); Other effects (nasal symptoms, headache, dizziness, GI symptoms)

Special Instructions

• Inhaled drugs (eg asthma medications) should be administered prior to administration
• Prophylaxis: Dose should be administered at approximately the same time each day
• Influenza treatment: Therapy should be started within 48 hours of symptom onset
• Use with extreme caution in patients with chronic respiratory diseases since they may be at risk for bronchospasm
  • If administered to patients with COPD or asthma, fast-acting bronchodilator should be available during treatment
• If patient experiences bronchospasm, should discontinue drug and seek medical attention

Adverse Reactions

• Shock, anaphylaxis, pneumonia, hepatic dysfunction, hemorrhagic colitis, toxic epidermal necrolysis, Stevens-Johnson syndrome, acute kidney injury, neurological and psychiatric symptoms, decreased white blood cell (WBC), neutrophil and platelet count

Special Instructions

• Use with caution in patient with hepatic impairment, gout or hyperuricemia, severe abnormal behavior leading to fall accidents
• Contraindicated in known or suspected pregnancy

Adverse Reactions

• Headache, nausea/vomiting, arthralgia, fatigue, vertigo, pruritus, skin rashes and elevated LFTs; may also cause transient increase in urine and/or serum uric acid levels

Special Instructions

• Use with caution in patient with renal impairment, gout or hyperuricemia

• GI effects (nausea, diarrhea); Other effects (headache, nasopharyngitis, bronchitis)

• Should be started within 48 hours of symptom onset
• Serious bacterial infection may coexist with or occur as a complication of influenza and should be treated appropriately
• Avoid consumption of dairy products and calcium-fortified beverages, and intake of polyvalent cation-containing laxatives, antacids, or oral supplements (eg calcium, iron, magnesium, selenium, zinc)

• GI effects (GI discomfort, nausea and vomiting); Hypersensitivity effects (bronchospasms, rashes); Other effect (hypotension)

Special Instruction

• Use with caution in patients with gastric or duodenal ulcer

Adverse Reactions

• GI effects (GI disturbances, anorexia or increased appetite); CNS effects (drowsiness, headache, epileptiform seizures); Other effects (blurred vision, difficulty in micturition, dry mouth, chest tightness, hypotension, muscle weakness, tinnitus, photosensitivity)

Special Instructions

• Use with caution in patients with narrow-angle glaucoma, urinary retention, prostatic hypertrophy
• Contraindicated in acute asthmatic attacks
• May impair ability to drive or operate machinery

Adverse Reactions

• Rarely, laxative effect due to sorbitol content

Special Instructions

• Use with caution in patients with fructose or sorbitol intolerance

Adverse Reactions

• GI effects (GI discomfort, nausea and vomiting)

Special Instructions

• Use with caution in patients with persistent cough or chronic cough, asthma, chronic bronchitis or emphysema
• Discontinue use if cough persists for >7 days with fever, rash or persistent headache

Adverse Reactions

• GI effects (nausea and vomiting, diarrhea); Other effect (itchiness)

Special Instructions

• May be taken with or without food

Adverse Reactions 

• CNS effects (somnolence, faintness, clouding of consciousness, dizziness, headache); Other effects (palpitations, GI disturbance)

Special Instructions

• Use with caution in patients with excessive mucus discharge, limited mucociliary function, hepatic dysfunction, renal insufficiency, and diabetes

Adverse Reactions

• CNS effects (drowsiness, restlessness, excitement, ataxia); GI effects (nausea and vomiting); Other effect (respiratory depression)

Special Instructions

• Use with caution in patients with decreased respiratory reserve, asthma, hepatic impairment

Vaccine, influenza, inactivated virus^1,2
(Influenza virus strains type A & B determined annually by WHO according to surveillance data)

• Trivalent influenza vaccine: 2 type A & 1 type B strains
• Quadrivalent influenza vaccine: 2 type A & 2 type B strains
• High-dose trivalent or quadrivalent influenza vaccine
  
  

0.5 mL IM/deep SC to be given annually
Dose and route (IM or deep SC administration) will depend on formulation
Please verify dosing with package information

• Local effect (injection site soreness); CNS effect (headache); Other effects (GI disturbances, oculorespiratory syndrome, fever, malaise)

• High-dose influenza vaccine is indicated for use in persons ≥65 years old
• Contraindicated in individuals with severe allergic reaction to any component of the vaccine
• Use with caution in patients with a history of Guillain-Barré syndrome

• Respiratory effects (runny nose, nasal congestion, cough); CNS effect (headache); Other effect (fever)

• Do not administer parenterally
• Contraindicated in individuals with severe allergic reaction to any component of the vaccine, pregnant patients, or with severe immunodeficiency
• Avoid use of antivirals 48 hours before and 14 days after vaccination
• Use with caution in patients with moderate to severe acute illness, with history of GBS, and close contact with an immunosuppressed individual

• Trivalent influenza vaccine: 2 type A and 1 type B strains
• Quadrivalent influenza vaccine: 2 type A and 2 type B strains

Adverse Reactions

• Local effect (injection site soreness, pain); CNS effect (headache); Other effects (myalgia, fatigue, fever)

Special Instructions

• Contraindicated in individuals with severe allergic reaction to any component of the vaccine
• Postpone vaccination in patients with acute febrile illness
• Use with caution in patients with thrombocytopenia or bleeding disorder

• Local injection site reactions (redness, swelling, pain, ecchymosis and induration); Other effects (fever, malaise, shivering, headache, sweating, myalgia and arthralgia)

• Not to be administered intravascularly
• Contraindicated in patients with allergies to aminoglycosides, formaldehyde, cetyltrimethylammonium bromide and polysorbate 80
• Postpone immunization in febrile illness or acute infection