peramivir


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peramivir

(per-am-a-veer),

Rapivab

(trade name)

Classification

Therapeutic: antivirals
Pharmacologic: neuraminidase inhibitors
Pregnancy Category: C

Indications

Treatment of acute uncomplicated influenza in patients ≥18 yr who have had symptoms for two 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 bioavailaility.
Distribution: Unknown.
Metabolism and Excretion: Mostly eliminated unchanged by kidneys (> 90%).
Half-life: 20.8 hr.

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
IVrapidend of infusionunknown

Contraindications/Precautions

Contraindicated in: None noted.
Use Cautiously in: Renal impairment (dose reduction required for CCr <50 mL/min); Geriatric: Consider age-related decrease in hepatic, renal, cardiac function, concurrent diseases and drug therapy; Obstetric: Use only if clearly needed; Lactation: Consider benefits of breastfeeding, need for peramivir and potential for adverse effects; Pediatric: Safety and effectiveness in children <18 yr has not been established.

Adverse Reactions/Side Effects

Central nervous system

  • insomnia
  • neuropsychiatric events

Cardiovascular

  • hypertension

Gastrointestinal

  • constipation

Dermatologic

  • skin reactions including stevens-johnson syndrome (life-threatening)

Interactions

Drug-Drug interaction

Avoid use of live attenuated influenza vaccine within 2 wk prior and 48 hr after peramivir; interference may occur.

Route/Dosage

Intravenous (Adults and Children ≥18 yr (CCr ≥50 mL/min) 600 mg.

Renal Impairment

Intravenous (Adults and Children ≥18 yr) CCr 30–49 mL/min—200 mg, CCr 10–29 mL/min—100 mg

Availability

Solution for IV use: 200 mg/ 20 mL vial

Nursing implications

Nursing 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 phosphokinase, and ↓ neutrophils.

Potential Nursing Diagnoses

Risk for infection (Indications)

Implementation

  • Intravenous Administration
  • Intermittent Infusion: Diluent: 0.9% NaCl or 0.45% NaCl, D5, or LR to a maximum volume of 100 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.

Evaluation/Desired Outcomes

  • Resolution of sign and symptoms of influenza.
References in periodicals archive ?
RAPIVAB (peramivir injection), a viral neuraminidase inhibitor for the treatment of influenza, is BioCryst's first approved product and has received regulatory approval in the U.S., Canada, Australia, Japan, Taiwan, Korea and the European Union.
The stakeholders of this report include companies and intermediaries engaged in the manufacture, commercialization, providing services of Influenza Medication Market products such as Zanamivir, Oseltamivir, Peramivir, and others as well as new entrants planning to enter this market.
Testing of seasonal influenza A(H1N1)pdm09, influenza A(H3N2), and influenza B viruses for resistance to the neuraminidase inhibitors oseltamivir, zanamivir, and peramivir is performed at CDC using next-generation sequencing analysis, a functional assay (2), or both.
B/Quebec/1182C/2018 demonstrated reduced inhibition (RI; 5- to 50-fold increases in [IC.sub.50] over wild-type) (4) to oseltamivir, zanamivir, and peramivir, showing 5.97-, 32.44-, and 38.34-fold increases in [IC.sub.50]s, respectively, over B/Quebec/88855/2018 WT (Table).
Antiviral agents such as oseltamivir (Tamiflu), zanamivir (Relenza), and peramivir (Rapivab) are now also increasingly being used for flu, especially for people who are at high risk for complications.
Subsequently, the drug regimen was revised with tigecycline, cefotaxime, amikacin, ciprofloxacin, and peramivir. Fortunately, with continuous ECMO therapy for 77 days, antibiotic and antiviral therapy, and other supportive treatments, the patient recovered and was discharged from the hospital on day 145 of hospitalization.
Treatment for flu includes common antiviral drugs like oseltamivir (available as a generic version or under the trade name Tamiflu), zanamivir (trade name Relenza), and peramivir (trade name Rapivab).
Currently approved antiviral drugs recommended for the 2018-2019 flu season are oseltamivir, zanamivir, and peramivir.
(14) Oseltamivir (Tamiflu) and zanamivir (Relenza) are the recommended prophylactic agents; a related intravenous medication, peramivir (Rapivab), is recommend for treatment only (see table 3 (14)).
Peramivir continues to be a source of non-dilutive capital for BioCryst and we will use these additional resources to support advancement of our exciting pipeline."
Three prescription antiviral medications (oseltamivir [Tamiflu[R]], zanamivir [Relenza[R]], peramivir [Rabivab[R]]) are approved by the U.S.
The Committee recommended granting a marketing authorisation for Alpivab (peramivir), for the treatment of uncomplicated influenza.