Do You Need Tamiflu for the Flu?
Who should consider these antiviral drugs—and who can probably skip them
By Hallie Levine and Catherine Roberts
The flu season is off to an early start this year. A number of states, particularly in the southeast, are already experiencing high levels of influenza-like illnesses, according to the Centers for Disease Control and Prevention. The agency estimates that already this season, there have already been 880,000 cases of the flu, 6,900 hospitalizations, and 360 deaths in the U.S.
If you get the flu, your doctor may prescribe an antiviral medication, such as oseltamivir (Tamiflu and generic), that can help get you back on your feet a bit faster. But antivirals can have side effects, and not everyone with the flu needs one. Here are answers to some questions about these drugs.
What Are Antivirals, Anyway?
Tamiflu is the best-known of the prescription flu antivirals, which can ease symptoms and shorten the course of the illness by inhibiting the growth of the flu virus in the body.
For those who may need an antiviral, the CDC is recommending one of four for this flu season: Tamiflu and its generic (in pill or liquid form); baloxavir (Xofluza in pill form); zanamivir (Relenza, an inhaled powder); and the IV drug peramivir (Rapivab, which is reserved for very sick, already hospitalized flu sufferers).
Both Tamiflu and its generic and Relenza are usually prescribed for five days, while the newer Xofluza is taken in a single dose of two pills. One dose of Rapivab is given via an IV for 15 to 30 minutes.
It’s important to know that these drugs aren’t a type of antibiotic. Antibiotics are used to fight bacterial infections and are ineffective for viral infections, including the flu.
How Effective Are Antivirals?
A 2014 Cochrane review found that when given within 48 hours of the onset of flu symptoms—such as fever, cough, sore throat, body aches, and chills—oseltamivir lessened the sick time for adults by about 17 hours and for children by 29 hours.
There may be some benefit in taking antivirals even outside of that 48-hour window. One 2013 CDC study published in The Lancet Infectious Diseases found that children given oseltamivir within five days of getting sick experienced an improvement in symptoms.
They also had significantly less virus shedding, which means they were much less likely to spread the illness to others.
Some research suggests that taking an antiviral can help reduce the likelihood that the flu will become severe enough to require hospitalization or lead to death, especially for those at high risk for flu complications. For example, a 2021 analysis in the journal Health Science Reports found that oseltamivir could reduce the risk of severe illness specifically among people with chronic heart and lung conditions.
But the evidence “is not crystal clear about the prevention of those serious complications,” says Michael Hochman, MD, MPH, director of the Gehr Family Center for Health Systems Science and Innovation at the Keck School of Medicine of USC in Los Angeles. The Cochrane review, for example, didn’t find evidence that antivirals reduced the risk of severe flu complications.
Still, for people at a higher risk of flu complications, the potential protective benefit of an antiviral probably outweighs the risks of side effects, Hochman says. (There’s more on antiviral side effects below.)
Who Should Take Tamiflu?
If you’re in good health and come down with the flu, you don’t necessarily need Tamiflu or another antiviral medication. That’s because you’ll most likely get better on your own within one to two weeks using self-care strategies, such as resting, getting plenty of fluids, and taking over-the-counter pain relievers for fever, headache, and muscle aches.
“By the time most people drag themselves out of bed to see the doctor, they’re on the road to recovery already,” says Nicole Bouvier, MD, an infectious disease specialist at the Icahn School of Medicine at Mount Sinai in New York City.
But many experts, including those at the CDC, say that people at high risk for flu complications should take an antiviral medication. This includes people older than 65, children ages 5 and younger—especially those younger than 2—pregnant people, those up to two weeks postpartum, and people who live in nursing homes. Find the entire list here. (Note that because Relenza is inhaled, it shouldn’t be taken by anyone with asthma or chronic obstructive pulmonary disease.)
In addition, “if anyone’s sick enough to already need to be in the hospital, and they come down with the flu, they absolutely should be on one,” Bouvier says.
If you have a loved one in a nursing home or an assisted-living facility, he or she should also receive an antiviral if there’s a flu outbreak there, even if he or she isn’t sick.
According to the CDC, if at least two residents get the flu within three days of each other, everyone should get a drug such as Tamiflu for at least two weeks and continue for at least a week after the last case has been identified.
And if you have elderly or infirm people living with you at home, some evidence suggests that taking an antiviral could help prevent you from spreading the flu to them, Hochman says.
Otherwise, for normally healthy people, deciding whether to take an antiviral comes down to whether getting better about a day quicker is more important than the possibility of the drug’s side effects.
What Are the Side Effects of Antivirals?
The most common side effects of Tamiflu and its generic are headaches, nausea, and vomiting, but taking the drug with food can minimize stomach discomfort. Diarrhea, fever, nausea, and body aches have been reported after taking Relenza. Diarrhea can occur with Rapivab and Xofluza.
There have also been rare reports of psychiatric side effects, such as delirium and hallucinations, with Tamiflu and its generic and Relenza, mostly in children. Let your doctor know right away if you notice anything like this.
How Much Do Antivirals Cost?
It depends on your insurance plan. Antivirals can be a bit pricey, although the 2016 introduction of generic Tamiflu has helped.
If you don’t have health insurance or your insurer doesn’t adequately cover Tamiflu, its generic, or Relenza (or doesn’t cover them at all) you may be able to get a coupon online that can help you save.
For instance, GoodRx has a coupon that lets you purchase generic Tamiflu for just under $30 at RiteAid. Xofluza’s manufacturer offers a coupon that may allow you to pay as little as $30 for the drug.
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