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Key takeaways
Xofluza, Relenza, Rapivab, amantadine, and rimantadine are alternatives to Tamiflu for treating influenza, with options available for different administration methods.
Tamiflu, commonly prescribed for influenza A and B, faces shortages and may have adverse effects or interactions, leading to consideration of alternative antivirals.
Xofluza is a notable Tamiflu alternative that requires only a single dose but lacks a generic version, potentially making it more expensive.
The CDC does not recommend amantadine and rimantadine due to high resistance rates in the United States, indicating limitations in the effectiveness of some alternatives.
Influenza packs a punch, causing vicious body aches, headaches, cough, sore throat, and fever. The flu can go so far as to precipitate sinusitis, pneumonia, and life-threatening respiratory failure. Besides the flu vaccine, which remains the best bet for the prevention of influenza and its complications, the other top way to fight back is the drug Tamiflu, an antiviral pill. The seasonal nature of the flu virus lends itself to surges in rates over the winter months in America, leading to a spike in Tamiflu demand that cannot always be sustained. Shortages of Tamiflu, particularly regionally, are common. For example, in the current 2022-23 flu season, the liquid suspension form of Tamiflu can be hard to find.
Aside from shortages or the possibility of drug interactions with your current prescriptions, adverse effects are other reasons you may desire a different flu medicine. You should know that there are other options besides Tamiflu for influenza treatment, and knowing these alternatives can prepare you to ask your healthcare provider if they are a good choice for you.
What can I take in place of Tamiflu?
Taken early in the course, antivirals can reduce the duration and severity of influenza. The goal of treatment is to keep people out of the hospital and allow them to get back to school or work and their routine as soon as possible. The benefits of antiviral medications are largely seen if influenza infection can be caught and identified early, within the first 48 hours. Initiating an antiviral beyond 48 hours is a stricter judgment call because the benefits are more questionable. Still, regardless of the timeframe, a drug is often given to anyone at high risk for severe influenza. Risk factors include age less than five years old, 65 years and older, heart disease, lung disease, neurologic disease, diabetes, obesity, pregnant women, and a compromised immune system.
If taking an antiviral makes sense, Tamiflu is typically a first-line choice. The drug combats the influenza virus by inhibiting neuraminidase, a protein the virus needs to be released from a cell to infect other cells. Fortunately, Tamiflu is available as generic oseltamivir and comes in capsule and liquid formats. Pharmacists can even compound a liquid form if needed using capsules. Alternative neuraminidase inhibitors are available as inhaled medications, which are easier for those with difficulty swallowing pills, and injectable medications, for those who cannot take an oral or inhaled drug. A single-dose oral med also works by inhibiting endonuclease, an enzyme influenza needs for replication. Two older adamantane antiviral drugs are also still in the picture. Let’s dive into the details of these Food and Drug Administration (FDA) approved influenza medications, so you know your options better.
Compare Tamiflu alternatives |
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|---|---|---|---|
| Drug name | Uses | Dosage | Savings options |
| Tamiflu (oseltamivir phosphate) | Influenza A and B treatment and prophylaxis | 75 mg orally twice daily for 5 days for treatment or once daily for prophylaxis (pediatric dosing based on age and body weight) | Tamiflu coupons |
| Relenza (zanamivir) | Influenza A and B treatment and prophylaxis | 2 puffs every 12 hours for 5 days for treatment of those 7 years and older or once daily for prophylaxis of those 5 years and older | Relenza coupons |
| Xofluza (baloxavir marboxil) | Influenza A and B treatment and post-exposure prophylaxis | 40 mg for adults weighing 20 to 79 kg or 80 mg for adults weighing over 80 kg orally for one dose (pediatric dosing based on age and body weight) | Xofluza (40 mg) coupons |
| Rapivab (peramivir) | Influenza A and B treatment | 600 mg intravenously once | |
| Amantadine | Influenza A treatment and prophylaxis, extrapyramidal symptoms, parkinsonism | 100 mg twice daily for 3 to 5 days for treatment or longer for prophylaxis (once-daily dosing for elderly or debilitated individuals and pediatric dosing based on age and body weight) | Amantadine coupons |
| Rimantadine | Influenza A treatment and prophylaxis | 100 mg twice daily for 3 to 5 days for treatment or longer for prophylaxis (once-daily dosing for elderly or debilitated individuals and pediatric dosing based on age and body weight) | Rimantadine coupons |
Top 5 Tamiflu alternatives
The following are some of the most common alternatives to Tamiflu.
1. Xofluza
Xofluza has some enticing features when considering Tamiflu alternatives. It only requires one dose compared to five days of treatment with Tamiflu. Like Tamiflu, Xofluza is effective against influenza types A and B, which currently have very low resistance rates to the drug, according to the Centers for Disease Control and Prevention (CDC). Both medications are available in pill and liquid forms, although Xofluza is only FDA-approved for children ages five years or older compared to Tamiflu’s approval down to infancy. Tamiflu does have the advantage of being approved for prophylaxis before being exposed to the influenza virus as well as after exposure, while Xofluza is only approved for post-exposure prophylaxis.
Perhaps the most prominent difference is that Xofluza does not have a generic version available, meaning that it can cost much more compared to oseltathan Oseltamivir of Tamiflu. If cost concerns are holding you up, try getting a Singlecare discount card and using it at a local pharmacy to save money.
2. Relenza
Nausea and vomiting are two of Tamiflu’s most common side effects, affecting nearly 10 percent of those taking the drug to treat influenza. Relenza is an alternative antiviral that avoids those adverse effects by being inhaled rather than taken orally. Unfortunately, it can provoke bronchospasm (bronchial tube tightening) in the setting of asthma or chronic respiratory disease, making the drug contraindicated in these medical conditions.
Effectiveness findings should also cause you to hesitate about taking Relenza instead of Tamiflu. Tamiflu has been shown in clinical trials to shorten the duration of influenza illness by about one day and reduce the incidence of flu complications like pneumonia. In a study of Relenza, the medication was found to shorten the illness by only about 14 hours and not reduce complication rates. It is no wonder why Tamiflu is typically chosen first.
3. Rapivab
Rapivab offers you an option for flu treatment with a single intravenous (IV) dose. A research study comparing Tamiflu and Rapivab found them to be equally effective. Enthusiasm for Rapivab’s one-and-done dosing is usually offset by the inconvenience of needing a medical environment where an IV catheter can be placed and IV medication given.
4. Amantadine
Although amantadine is technically an alternative, it is not a good one. The drug inhibits influenza’s M2 protein, which prevents the virus from replicating, but this only works for type A influenza. More importantly, viral strains in the United States have become resistant to the drug. The CDC currently recommends against the use of amantadine due to the high rates of resistance.
5. Rimantadine
Rimantadine has the same mechanism of action and limitations as amantadine. Likewise, the CDC does not recommend it currently due to highly prevalent resistance amongst recent influenza strains.
Natural alternatives to Tamiflu
As you can see, the prescription treatment options for influenza other than Tamiflu are limited, and it’s possible that none of them appeal to you. The decision to take a prescription for influenza is one that you and your healthcare provider can make together. It is based on the time since symptom onset, your age, what your health history is like, and the severity of your flu symptoms. If you both determine that a prescription is not needed, then instead, the provider might just recommend you focus on hydration and taking over-the-counter Tylenol as needed for fever or aches. In such a scenario, you might be interested in natural treatments for influenza, such as elderberry. The reality is that supplements need more investigation before being recommended for flu prevention or treatment of symptoms.
How to switch to a Tamiflu alternative
Being aware of the alternatives to Tamiflu as an influenza treatment option is important. Especially in the case of a Tamiflu shortage. The choices are limited, but you have every right to question if any are a better fit for you. You can pose the question to your healthcare provider utilizing what you have learned here. Ultimately, you may both decide that Tamiflu is still the right choice.