peramivir
Brand: Rapivab
Prototype: oseltamivir
Drug Class: neuraminidase inhibitor antiviral
Drug Family: antiviral
Subclass: IV neuraminidase inhibitor (influenza)
Organ Systems: infectious-disease
Mechanism of Action
IV neuraminidase inhibitor; competitively and reversibly inhibits influenza A and B neuraminidase; single IV dose provides complete treatment course due to prolonged protein binding at the active site.
influenza neuraminidase (NA)
Indications
- acute uncomplicated influenza in adults (single IV dose when patient cannot take oral drugs)
Contraindications
- peramivir hypersensitivity
Adverse Effects
Common
- diarrhea
- hypertension
- increased serum glucose
Serious
- anaphylaxis
- serious skin reactions (Stevens-Johnson syndrome, erythema multiforme)
- neuropsychiatric effects
Pharmacokinetics (ADME)
| Absorption | IV only |
| Distribution | widely distributed; minimal protein binding |
| Metabolism | not metabolized |
| Excretion | renal (unchanged; >90%) |
| Half-life | 20 hours |
| Onset | immediate (IV) |
| Peak | end of infusion |
| Duration | single dose is full treatment course |
| Protein Binding | <30% |
| Vd | 12.6 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| live attenuated influenza vaccine | antiviral may reduce live vaccine replication | moderate |
Nursing Considerations
- Administer single dose IV over 15–30 minutes; a single 600 mg dose is the complete treatment.
- Useful for patients who cannot take oral oseltamivir (vomiting, NG tube, post-operative).
- Reduce dose in severe renal impairment (CrCl <49 mL/min); consult pharmacist for dosing.
- Initiate within 48 hours of influenza symptom onset for efficacy.
Clinical Pearls
- Peramivir's key clinical advantage is the single IV dose, enabling treatment of influenza in patients who cannot receive oral medications — a practical advantage in hospitalized patients with nausea, vomiting, or impaired enteral access.
- Cross-resistance between neuraminidase inhibitors is not universal; oseltamivir-resistant H3N2 strains may remain peramivir-sensitive, though resistance testing should guide therapy when resistance is suspected.
Safety Profile
Pregnancy use-with-caution
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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