Zanamivir (RelenzaŽ)

Class:

Zanamivir is a neuraminidase inhibitor.

Antiviral Activity:

Zanamivir has more active against influenza A than B.

Mechanism of Action:

Zanamivir is a reversible competitive inhibitor of influenza neuraminidase. Virion release from infected cells and spread with the respiratory tract are inhibited due to blockade of this enzyme.

Mechanism of Resistance:

In vitro resistance to zanamivir occurs from mutations in either the hemagglutinin or neuraminidase genes, or both.

Pharmacokinetics:

Zanamivir has low absolute oral bioavailability. The mean bioavailability after oral inhalation of zanamivir powder is 2 to 8 times greater than after ingestion. It has low plasma protein binding, ranging from less than 1 to 14% for concentrations from 10 to 0.05 mg/L. Zanamivir is almost exclusively eliminated from the body via the kidney and undergoes no metabolic biotransformation.

Adverse Effects:

Bronchospasm is the most common adverse effect.

Dosage:

Powder for inhalation 5mg

Adults and children > 7 years of age and adults:

Two inhalations of 5mg each twice daily for 5 days (initiated within 48 hours of the onset of symptoms)

Disease state based dosing:

Renal Impairment: No dose adjustment necessary

Hepatic Impairment: No dose adjustment necessary

Contraindications/Warnings/ Precautions:

No data are available to support safety or efficacy in patients who begin treatment after 48 hours of symptoms.

Drug Interactions:

There are no documented clinically significant drug interactions with zanamivir.

Pregnancy:

Category C: Risk unknown. Human studies inadequate.

Monitoring Requirements:

None.

Brand names/Manufacturer:

RelenzaŽ/GlaxoSmithkline