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 ?
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.
All of those viruses are currently sensitive to all three of the medications that are currently approved for treating the flu, those are oseltamivir, zanamivir, and peramivir.
Results of the NA inhibition assay indicated that the H7N2 viruses were susceptible to 4 NA inhibitors: oseltamivir, zanamivir, peramivir, and laninamivir (data not shown).
The WHO Collaborating Center for Surveillance, Epidemiology, and Control of Influenza at CDC tested 486 influenza virus specimens collected during May 21September 23, 2017, from the United States and worldwide for resistance to the influenza neuraminidase inhibitor antiviral medications currently approved for use against seasonal influenza: oseltamivir, zanamivir, and peramivir.
M2 EQUITYBITES-January 31, 2017-BioCryst's peramivir Marketing Authorization Application accepted by EMA
M2 PHARMA-January 31, 2017-BioCryst's peramivir Marketing Authorization Application accepted by EMA
Food and Drug Administration (FDA, 2016) has approved three influenza antiviral medications: oseltamivir (Tamiflu[R]), Zanamivir (Relenza[R]), and Peramivir (Rapivab[R]).
Neuraminidase inhibitors, including oral oseltamivir, inhaled zanamivir, and intravenous peramivir, can be used for treatment of H3N2v infections.
Peramivir is the only neuraminidase inhibitor drug administered by the intravenous route as a single dose which was licensed in 2010 in Japan and Republic of Korea and was approved by the FDA (Food and Drug Administration) in USA for treatment of uncomplicated acute influenza in December 2014 in individuals aged older than 18 years.
SAN DIEGO--The neuraminidase inhibitor peramivir inhibited about 99% of seasonal influenza A and B viruses circulating globally during the 2013-2014 and 2014-2015 influenza seasons, a large analysis demonstrated.
Except for peramivir, there is no reported human pregnancy experience with any of these agents.