Influenza Drug Summary

• Rare and usually mild; rarely hypersensitivity reactions
• Hematologic effects have been reported (thrombocytopenia, leukopenia, pancytopenia, agranulocytosis)

• Use with caution in patients with renal or hepatic dysfunction and in patients with alcohol dependence

• 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 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 reactions (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

• GI effects (GI discomfort, nausea, diarrhea, including risk of GI bleeding and ulcers); Hematologic effect (inhibition of platelet aggregation which is reversible except with Aspirin); Other effect (Reye’s syndrome has been associated with Aspirin)

• To be administered with or after food, milk or anti-ulcer drugs to prevent GI effects
• Avoid in patients with peptic ulceration, hypersensitivity to Aspirin or any other NSAID including those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by Aspirin or any other NSAID
• Use with caution in patients with hypertension, renal, hepatic or cardiac dysfunction

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
  
  

Dose and route (IM or deep SC administration) will depend on formulation
Please verify dosing with package information

• Typically mild local reactions that last <2 days
• Systemic reactions (eg fever, malaise, myalgia) occur more commonly in patients who have no prior exposure to the virus antigens in the vaccine
• Hypersensitivity reactions can occur

• High-dose influenza vaccine is indicated for use in persons ≥65 years old
• Contraindicated in individuals with anaphylactic 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 effects (lethargy, myalgia, decreased appetite, sore throat, fever)

• Do not administer parenterally
• Contraindicated in individuals with anaphylactic reaction to any component of the vaccine, children and  adolescents receiving Aspirin
• Use with caution in patients with a history of Guillain-Barré syndrome, individuals with known or suspected immune deficiency, persons with history of asthma or reactive airway diseases

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

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