The influenza epidemic that is sweeping North America has a lot of people freaked out. And with good reason. Headlines have reported “Killer flu.” There is a growing tally of deaths from this year’s influenza epidemic. First, we were told that children were vulnerable. More recently baby boomers were told that they, too, could succumb to the H3N2 virus. That got the attention of millions of people. Then we have been told that the vaccine is not all that effective. What’s left? Oseltamivir. This oral drug has been quite controversial. Some people have reported that Tamiflu did not work. Why not?
Q. You have written that Tamiflu can help people recover more quickly from influenza. I don’t think it works.
I came down with the flu and called my doctor’s office. It took a week for them to fit me into the schedule. The doctor did a test and confirmed I had influenza. He gave me a prescription for Tamiflu, but it didn’t do anything for me. It took another week before I felt better. Why all the hype for a drug that doesn’t work?
Why Tamiflu Did Not Work:
A. Oseltamivir (Tamiflu) is an oral antiviral medication for influenza. It works by blocking an enzyme (neuraminidase or NA) the virus uses to spread throughout the body.
Think of this drug a bit like glue. It firmly attaches itself to neuraminidase and makes the enzyme less active. Without fully functional NA, the virus cannot escape the infected cell. If the flu virus cannot escape, it cannot move on to infect other cells. The immune system is then in better shape to help the body recover faster.
The Window of Opportunity:
To be maximally effective, Tamiflu should be taken within 48 hours of the first symptoms. It may still be somewhat helpful taken up to four days after flu symptoms begin. In your case, though, too much time had passed for Tamiflu to provide decent benefit. Tamiflu did not work because too many virus particles managed to escape and multiply.
Even under the best of circumstances, clinical trials show that Tamiflu shortens flu symptoms by a day or two. The drug may, however, reduce the chance of complications (Medical Letter, Jan 1, 2018). That can make a difference for people who would otherwise become extremely ill.
Learn more about Tamiflu at this link:
The Tamiflu Naysayers:
Many health professionals downplay the effectiveness of oseltamivir. By the way, the drug is now available generically at slightly lower cost. Tamiflu (10 pills) can cost $160 to $180 if your insurance company won’t pay. The generic oseltamivir (with a GoodRx coupon) could run between $51 and $93. Still pricey, but a bit more affordable.
A Reader (Lee from Oregon) shares her doctor’s negativity:
My primary care physician is an infectious diseases specialist. He teaches at OHSU [Oregon Health & Science University] and stays current on the latest information available to physicians. He used to prescribe Tamiflu to me but no longer does (even though I am very high risk, immune compromised, COPD ) because it does not have a verifiable effect. It is really effective at garnering massive profit, because patients insist on it. My advice; wash your hands, eat healthily and get plenty of rest.”
Is It True that Tamiflu Did Not Work?
So, what’s the straight and skinny on oseltamivir?
Tamiflu is not a magic bullet against the flu. It won’t eliminate all symptoms within 24 hours. On the other hand, there is solid scientific evidence that it does make a difference. Here is Canadian “systematic review of systematic reviews” (Journal of Antimicrobial Chemotherapy, Nov. 1, 2017). In other words, they reviewed other SR/MAs [systematic reviews and meta-analyses] of most of the available data. Here is what they found:
We identified 27…of 3723 articles reviewed. NI [neuraminidase inhibitors] (n = 2) or oseltamivir (n = 1) versus no treatment were consistently associated with a decrease in mortality odds among the hospitalized, general population. Oseltamivir versus no treatment was associated with a decrease in hospitalization and pneumonia risk/odds in 2/4 SR/MAs. Oseltamivir (n = 4) and zanamivir (n = 3) were consistently associated with a 0.5 - 1 day decrease in symptom duration.”
“NI treatment is likely to be effective at reducing mortality among hospitalized patients, and symptom duration by up to 1 day in the general population. Oseltamivir or zanamivir prophylaxis are likely to be effective at reducing secondary symptomatic influenza transmission. Increased nausea and vomiting are likely associated with oseltamivir use…Among hospitalized patients, NI administration seems warranted to reduce mortality risk.”
Norwegian researchers reported on the experience with oseltamivir (Knowledge Centre for the Health Services at The Norwegian Institute of Public Health (NIPH); 2005). Here are their conclusions:
Oseltamivir reduces the duration of illness with 1-2 days in previously healthy adults and children with clinical influenza. Severity of illness was significantly reduced by oseltamivir in previously healthy adults, and the frequency and duration of fever was significantly reduced in previously healthy adults and children. Oseltamivir treatment reduces lower respiratory tract complications, antibiotic use, and hospitalization in both healthy and at risk adults (age ≥ 65 years, individuals with underlying chronic respiratory or cardiovascular problems).
“Oseltamivir reduces the duration of cough, fever, time to resolution of illness and frequency of hospitalization in both previously healthy adults, children and at risk adults. The frequencies of secondary complications like bronchitis, sinusitis, otitis media, pneumonia, in addition to antibiotic use, were also reduced in most patients. Use of oseltamivir for prophylaxis for periods of five days to six weeks provides a protective effect of 58-89 % against clinical influenza in healthy adults. Prophylaxis for six weeks in a vaccinated frail, elderly population gave a protective effect of 92 %. Children given post exposure prophylaxis for 10 days achieved a protective effect of 55-80 %.
Stories from Readers:
What does all that statistical talk mean in real terms? We have no doubt that Tamiflu did not work for some people. But the Norwegian data suggest that the drug is probably working better than this year’s influenza vaccine for a significant number of individuals. Here is what some of our readers have to say:
J. in Pennsylvania reported some benefit from Tamiflu:
I took tamiflu for the first time for an influenza A infection. It did cut my symptoms off after just a few days. My last bout with influenza was about 10 years ago, and I was extremely sick for about 10 days compared to about 5 days with the Tamiflu. My only complaints are an increased headache about 30 minutes after every dose and awful insomnia. No sleep for 3 days. I was so wired I was shaking. I had to stop taking it on day 3 because of the insomnia.”
Anita says “I love Tamiflu!”
I had the flu last year and was so ill, I went to the health clinic. My doctor put me on Tamiflu, and I started feeling better within 24 hours. I am taking it now, as I was just diagnosed with the flu. I started it a little over 2 days ago, but I so believe in the effectiveness of this medicine. And, thank The Lord, no side effects! Feeling stronger and better each day.”
MOL in New Jersey was also pleased:
Last year, I had flu symptoms including fever for several days before going to doctor. Doctor prescribed Tamiflu & I was pleasantly surprised at the relief in a short time. I’m a believer of the effectiveness of Tamiflu.”
People’s Pharmacy Perspective:
To repeat, Tamiflu is not a miracle medicine. But some people do seem to get benefit. The data also suggest that the severity of the symptoms is lessened. If the drug can prevent hospitalizations that is a blessing. Tamiflu side effects include nausea and vomiting, so it is not benign. Headache is another complication. For more details visit:
Share your own Tamiflu story below. If Tamiflu did not work for you we want to hear about it. If it made a difference in your recovery, let others know about it.
Bottom line: We need far better vaccines and antiviral medicine so we are not overwhelmed by the next influenza epidemic.