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<\/a><\/p>\nFor most of us, we\u2019ll be choosing between Tamiflu and Xofluza. The others have specific limitations\u2014Relenza requires an inhaler device and isn\u2019t safe for people with respiratory conditions, and Rapivab is IV-only, typically reserved for hospitalized patients.<\/p>\n
Here\u2019s what antivirals can do:<\/p>\n
Shorten illness (how long you\u2019re sick) by about one to two days (potentially<\/a> three days in young kids when started within 12 hours of infection)<\/p>\n Reduce severity of symptoms (how crappy you feel) and risk of certain complications (e.g., ear infections in kids)<\/p>\n Reduce risk of death<\/a> in high-risk groups (especially older adults)<\/p>\n Prevent flu after a known exposure (if someone in your household has the flu, taking antivirals right away can cut your risk of symptomatic flu in half<\/a>)<\/p>\n Here\u2019s what they can\u2019t do: work magic if you wait too long. These medications work best when started within 48 hours of symptom onset, though people with severe illness or high-risk conditions may still benefit even if treatment starts later. If you are at increased risk of severe flu and you are exposed to it, you should not wait until you have severe symptoms before requesting antivirals\u2014the earlier they are taken, the better off you will be, even if you don\u2019t have symptoms yet. (This is a general rule for all antiviral medications.) Don\u2019t sit on it hoping things improve.<\/p>\n Flu tends to hit hard and fast\u2014sudden high fever, significant body aches, exhaustion that knocks you flat. Colds usually come on more gradually with milder symptoms. If you feel like you got hit by a truck out of nowhere, think flu. That said, flu and Covid can look a lot alike, and both have antivirals that work best when started early\u2014but they\u2019re different drugs. (Tamiflu won\u2019t help Covid, and Paxlovid won\u2019t help flu.) Many at-home tests now check for both, and test-to-treat programs (like this one, at CVS<\/a>) can help sort out which virus you\u2019re dealing with and get you the right treatment.<\/p>\n Like any medication, flu antivirals can cause side effects, but for most people, they\u2019re mild and temporary. The most common issues are gastrointestinal, especially nausea and vomiting, particularly with Tamiflu. Taking it with food can help. Headaches can also happen. Serious side effects are rare, and most people complete the five\u2011day course<\/a> without needing to stop the medication. For most high-risk people, the benefits of preventing flu complications outweigh these potential side effects.<\/p>\n Not everyone with the flu needs an antiviral. For many healthy older kids and adults, rest, fluids, and fever reducers will get you through just fine. Adding a medication that might cause nausea or vomiting isn\u2019t always worth it.<\/p>\n But for some people, antivirals aren\u2019t optional\u2014they\u2019re an important tool to prevent serious complications.<\/p>\n The American Academy of Pediatrics<\/a> (AAP) and the Infectious Diseases Society of America<\/a> (IDSA) recommend antiviral treatment for:<\/p>\n Anyone hospitalized with flu<\/p>\n Anyone with severe or worsening illness<\/p>\n Kids under 5 (especially under 2)<\/p>\n Adults 65+<\/p>\n Pregnant women<\/p>\n Anyone who is immunocompromised<\/p>\n People with underlying conditions like asthma, diabetes, or heart disease<\/p>\n If you or your child falls into one of these groups, don\u2019t wait. Call your doctor or use a test-to-treat program at a pharmacy or clinic, where you can get tested, be seen by a clinician, and receive medication on the spot. If you\u2019re not sure whether you or your loved ones fit into one of these groups, it\u2019s worth speaking with a prescriber about whether or not to get treatment.<\/p>\n Tamiflu is the workhorse. It\u2019s been around for decades, we have extensive safety data (including in babies as young as two weeks), and it\u2019s available as a cheap generic. <\/p>\n But you have to take it twice daily for five days (if you have symptoms; if you are taking it as prevention, it is once daily), and about one in five people experience nausea or vomiting<\/a> (GI upset). It\u2019s the preferred choice for individuals who have severe illness, are at high-risk for complications, or are hospitalized. <\/p>\n Resistance to Tamiflu can occur, but tends to be rare\u2014though we have<\/a> had flu epidemics in the past with resistant viruses.<\/p>\n Xofluza is newer. One dose and you\u2019re done. Less GI upset. Clinical trial data suggest it may stop viral shedding faster<\/a>\u2014around one day vs. three days with Tamiflu. This means people taking Xofluza may be contagious for a shorter period of time, be able to return to school or work sooner, and be less likely to spread the flu to household members than those taking Tamiflu. And Xofluza may work better than Tamiflu against influenza B. <\/p>\n But it\u2019s pricier, and insurance coverage is limited<\/a>. Less than half of Medicare plans and ACA marketplace plans cover it, and many Medicaid plans require prior authorization. Availability has been a real problem this season. (We\u2019ve heard from many of you struggling to find it.) We also lack evidence to support its use among those pregnant or breastfeeding, in children under age 12, and those who are immunocompromised. This does NOT mean it doesn\u2019t work in these populations or that it\u2019s unsafe\u2014it reflects the relative novelty of the drug. <\/p>\n Finally, there\u2019s a chance<\/a> the virus can become resistant to medication. (This seems more likely with H3N2 strains than with H1N1, and more likely in younger kids<\/a>). If resistant strains start to circulate more widely, the medication might become less effective for others who get infected with the resistant strain. For these reasons, many clinicians still default to Tamiflu.<\/p>\n Want a quick visual summary? My team at Unbiased Science put together a post that walks through the key points about flu antivirals:<\/p>\n Dr. Jess Steier | Unbiased Science on Instagram: “With flu seas\u2026<\/p>\n The falsehoods circulating right now hit on a few specific fears. Let\u2019s address them directly.<\/p>\n \u201cTamiflu causes hallucinations and makes people suicidal.\u201d There have been rare reports of neuropsychiatric effects\u2014mostly from Japan, mostly in adolescents. The FDA added a warning to the drug label about this in 2006. But a subsequent 2008 Japanese review<\/a> of over 10,000 children and adolescents found no evidence that Tamiflu caused abnormal behavior. An even more recent<\/a> study of nearly 700,000 children showed that use of Tamiflu was actually associated with a lower risk of neuropsychiatric manifestations in children. This suggests that the more likely explanation for these events is that they were caused by flu directly, and Tamiflu was not effective enough at preventing them. Yes, the flu itself can cause delirium<\/a>, confusion, and neurological symptoms. Though rare, it\u2019s more common in kids with high fevers. Teasing apart drug effects from disease effects is genuinely difficult. After millions of doses worldwide, serious negative effects remain rare. The known risks of flu complications in high-risk groups\u2014hospitalization, pneumonia, death\u2014are not.<\/p>\n \u201cTamiflu is made from star anise, so just make star anise tea.\u201d This one has a kernel of truth but misses the mark. Tamiflu was originally derived from shikimic acid<\/a>, found in star anise. But shikimic acid is just a starting material; it undergoes extensive chemical processing in a lab to become oseltamivir, a completely different molecule. Consuming star anise to get Tamiflu is like eating flour hoping to get bread. If warm tea and honey<\/a> bring you comfort when you\u2019re sick, great. (Note: do NOT<\/a> give honey to kids under 12 months of age.) But it\u2019s not a substitute for antivirals when your clinician recommends them.<\/p>\n \u201cTamiflu is ineffective.\u201d Tamiflu is extremely effective when used for the right patients at the right time, as long as the viruses are not resistant. The challenge is that flu moves so quickly that getting it early enough to make a difference can be tough. There\u2019s solid evidence that it can prevent certain flu complications, such as ear infections, and shorten the duration of illness. It\u2019s less clear how well it protects against hospitalization and death from flu, though observational studies are supportive. The earlier it\u2019s started, the better it works\u2014and this is particularly important for those at high risk for severe flu. However, it does have some side effects (the main one being nausea), which means it might not be worth it for low-risk people who will almost certainly recover on their own, especially if many days have passed since symptoms started.<\/p>\n If you or your child gets sick:<\/p>\n Get tested early. Many pharmacies and clinics offer test-to-treat programs.<\/p>\n If you\u2019re high-risk, start antivirals within 48 hours; don\u2019t wait to \u201csee how it goes.\u201d<\/p>\n If you\u2019re not high-risk, talk to your clinician about whether treatment makes sense for your situation.<\/p>\n If you\u2019re seeing scary claims online:<\/p>\n A scary story can feel compelling, but rare side effects get amplified online precisely because they\u2019re unusual, not because they\u2019re typical.<\/p>\n Consider the source. Is this someone with relevant expertise, or a wellness influencer?<\/p>\n Vetting sources can be tricky, but look for red flags: Are they selling a product or sharing a referral link? Do their claims contradict what major medical organizations recommend? Remember, the wellness industry is a multi-trillion-dollar market. A lot of anti-pharma content is really just pro-alternative-pharma content.<\/p>\n Flu antivirals are a useful tool\u2014not a miracle cure, but not something to fear either. They work best when started early by people who need them most. The evidence supports their use in high-risk groups to reduce complications and severity. For everyone else, they\u2019re an option worth discussing with your clinician. Don\u2019t forget to ask about other members of your household who might be at high risk for severe flu and whether they should consider taking antivirals preventively.<\/p>\n Still, none of this is a substitute for vaccination. Getting the flu shot won\u2019t always prevent infection, but it significantly reduces your risk of severe illness, hospitalization, and death. Add in good ventilation, masking, and handwashing. But when flu breaks through, antivirals are a valuable backup\u2014and the best one is the one you can start quickly.<\/p>\n Stay safe out there.<\/p>\n Love,<\/p>\n Jess<\/p>\n Dr. Jess Steier, DrPH, is a public health scientist and founder of Unbiased Science<\/a>. Your Local Epidemiologist <\/a>(YLE) is founded and operated by Dr. Katelyn Jetelina, MPH PhD\u2014an epidemiologist, wife, and mom of two little girls. YLE reaches more than 425,000 people in over 132 countries with one goal: \u201cTranslate\u201d the ever-evolving public health science so that people will be well-equipped to make evidence-based decisions. This newsletter is free to everyone, thanks to the generous support of fellow YLE community members. To support the effort, subscribe or upgrade below:<\/p>\n<\/a><\/p>\n