I have mentioned Tamiflu (oseltamivir) and Relenza (zanamivir) previously – see Bird Flu: Tamiflu and Relenza for Prevention and Treatment inside the Articles section on our Web page, http://www.AvoidBirdFlu.com . This current article adds necessary info concerning creating your provide of Tamiflu go farther in an emergency situation.
First, as I noted in my previous article, it is terribly necessary pay attention to the indisputable reality that the effectiveness of Tamiflu and Relenza has been studied against circulating strains of individual influenza (so referred to as seasonal influenza), not against the bird flu virus. In a study reported inside the August 2005 issue of the Journal of Infectious Diseases, Dr. Yen and others from St. Jude ChildrenÂ’s Research Hospital in Memphis, Tennessee found that in animal experiments eight-day regimens of Tamiflu were more advantageous than the advised five-day regimen for treating infections with the H5N1 bird-flu virus.
The authors concluded that a protracted and higher-dose oseltamivir regimen may be required for primarily the most advantageous antiviral effect. This risk was recently underscored when 2 Vietnamese (one a thirteen year recent girl) died of bird flu—as reported in a December 2005 issue of the recent England Journal of Medicine—even when receiving treatment throughout the required forty eight hours when the begin of infection with normal doses of Tamiflu.
LetÂ’s assume that you’ve got got got one treatment course of Tamiflu (one seventy 5 mg pill taken twice a day for 5 days, for a total of ten pills), that you merely either acquired in your own or that was given to you by your healthcare supplier or by the govt. Unfortunately you are still not home free yet, to be in a position to speak. You currently may face one of 2 problems:
Problem # 1: If preliminary scientific studies indicating that a course of treatment of bird flu using higher doses than those currently counseled by the FDA, for more than the current counseled 5 days of treatment are correct—as indicated by Dr. Yen’s research—you will would like more that one dose pack. In actuality, the appropriate treatment may mean taking 2 pills (150 mg) twice a day for eight or maybe ten days. That may mean that you will have FOUR dose packs (40 pills) for the treatment of one person, not solely 1 !
Problem # 2: You’ve gotten a dose pack—officially the quantity ought to treatment one person—but there are 2 those who merely became infected with bird flu on your family. In case you mix this drawback with drawback variety 1, you currently really would like EIGHT dose packs, not merely two!
What will you do? There are 2 potential solutions:
SOLUTION # 1: Take PROBENECID, a medication approved for the treatment of gout, along aspect the Tamiflu. Probenecid interferes with the normal metabolism of Tamiflu, increasing the blood level of Tamiflu and keeping it in circulation longer—effectively doubling the quantity of Tamiflu “exposure.” The appropriate dose is unclear. Until more scientific info turns into available, in an emergency situation, for otherwise healthy adults, I’d advocate taking one 5 hundred mg table twice daily. Probenecid is normally terribly safe. Nevertheless, I really have included detailed info concerning it below.
According to info concerning probenecid from the National Library of MedicineÂ’s and the National Institutes of HealthÂ’s Website on-line Medline Plus (available at http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202480.html ):
Probenecid (proe-BEN-e-sid) is used inside the treatment of chronic gout or gouty arthritis. These conditions are due to too a heap of uric acid inside the blood. The medication works by removing the additional uric acid from the body. Probenecid will not cure gout, however once you have been taking it for a variety of months it is going to facilitate forestall gout attacks. This drugs will facilitate you forestall gout attacks solely thus long as you continue to take it.
Probenecid is additionally used to stop or treat totally totally totally totally totally different medical issues that may happen if too a heap of uric acid is gift inside the body.
Probenecid is typically used with particular designs of antibiotics to cause them to more advantageous inside the treatment of infections.
Probenecid is offered solely along with your doctor’s prescription, inside the following dosage type (tablets):
a. Before Using This Medicine
In deciding to exploit a drugs, the hazards of taking the drugs ought to be weighed against the nice it’s going to do. It is a call you and your doctor will make. For probenecid, the subsequent would like to be considered:
Allergies—Tell your doctor if in case you have ever had any uncommon or allergy to probenecid. Also tell your health practitioner if you are allergic to any totally totally totally totally totally different substances, corresponding to foods, preservatives, or dyes.
Pregnancy—Probenecid has not been shown to cause birth defects or totally totally totally totally totally different issues in humans.
Breast-feeding—Probenecid has not been reported to cause issues in nursing babies.
Children—Probenecid has been tested in children 2 to fourteen years of age for use along aspect antibiotics. It has not been shown to cause totally totally totally totally totally different unwanted effects or issues than it will in adults. Studies on the consequences of probenecid in patients with gout were done solely in adults. Gout is terribly rare in children.
Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether or not they work precisely an identical method they do in younger adults. There is not any particular info comparing use of probenecid inside the elderly with use in totally totally totally totally totally different age groups.
Other medicines—Although particular medicines cannot be used along at all, in totally totally totally totally totally different cases 2 totally totally totally totally totally different medicines will be used along in spite of the reality that an interaction may occur. In these cases, your doctor ought to would like to amendment the dose, or totally totally totally totally totally different precautions may be necessary. If you find yourself taking probenecid, that is particularly necessary that your physician grasp if you are taking any of right here:
• Antineoplastics (cancer medicine)—The probability of nice unwanted aspect effects will be increased
• Aspirin or totally totally totally totally totally different salicylates—These medicines may keep probenecid from operating properly for treating gout, counting on the volume of aspirin or totally totally totally totally totally different salicylate that you are taking and how frequently you are taking it
• Heparin—Probenecid may increase the consequences of heparin, that will increase the prospect of unwanted aspect effects
• Indomethacin (e.g., Indocin)
• Ketoprofen (e.g., Orudis)
• Methotrexate (e.g., Mexate)—Probenecid may increase the blood levels of these medicines, that will increase the risk of negative effects
• Medicine for infection, as well as tuberculosis or virus infection—Probenecid may increase the blood levels of a heap of these medicines. Sometimes, this will be a desired result and probenecid will be used to aid the various drugs work better. However, the danger of unwanted effects is typically additionally increased
• Nitrofurantoin (e.g., Furadantin)—Probenecid may keep nitrofurantoin from operating properly
• Zidovudine (e.g., AZT, Retrovir)—Probenecid will increase the blood level of zidovudine and ought to permit lower doses of zidovudine to be used. However, the probability of uncomfortable aspect effects may additionally be increased
Other medical problems—The presence of various medical issues may have an effect on using probenecid. Be positive you tell your doctor when you have any totally totally totally totally totally different medical problems, especially:
• Blood disease or
• Cancer being treated by antineoplastics (cancer medicine) or radiation (x-rays) or
• Kidney disease or stones (or history of) or
• Stomach ulcer (history of)—The probability of unwanted aspect effects will be increased
b. Proper Use of This Medicine If probenecid upsets your stomach, it is typically eager concerning food. If this would not work, an antacid may in all probability be taken. If abdomen upset (nausea, vomiting, or loss of appetite) continues, consult your doctor.
For patients taking probenecid for gout:
• Once you begin to take probenecid, gout attacks may continue to happen for some time. However, once you take this drugs frequently as directed by your doctor, the attacks will gradually become less frequent and not more painful than before. Once you have been taking probenecid for many months, they may stop completely.
• This drugs may additionally facilitate forestall gout attacks however it surely is not going to relieve an attack that has already started. Even though you are taking another drugs for gout attacks, continue to take this drugs also. When you have any queries on this, refer to your doctor.
For patients taking probenecid for gout or to aid take away uric acid from the body:
• Once you 1st begin taking probenecid, the volume of uric acid inside the kidneys is greatly increased. This will doubtless cause kidney stones or totally totally totally totally totally different kidney issues in some people. To assist forestall this, your doctor may would like you to drink at the least ten to twelve full glasses (8 ounces each) of fluids day by day, or to take another drugs to build your urine less acid. It’s crucial that you merely follow your doctor’s directions terribly carefully.
Dosing—
The dose of probenecid shall be totally totally totally totally totally different for totally totally totally totally totally different patients. Follow your doctor’s orders or the directions on the label. The subsequent info includes solely the typical doses of probenecid. In the event that your dose is different, do not amendment it unless your doctor tells you to accomplish that.
• For treating gout or removing uric acid from the body:
Adults: 250 mg (one-half of a 500-mg tablet) 2 times a day for approximately one week, then 5 hundred mg (one tablet) 2 times a day for a variety of weeks. After this, the dose will rely on the quantity of uric acid on your blood or urine. Most individuals would like 2, 3, or four tablets a day, however some individuals may would like higher doses.
Children: It is not doubtless that probenecid will be required to treat gout or to take away uric acid from the body in children. If a tot wants this medicine, however, the dose would ought to be determined by the doctor.
• For serving to antibiotics work better:
Adults: The volume of probenecid will rely on the condition being treated. Sometimes, solely 1 dose of 2 tablets is needed. Other times, the dose will in all probability be 1 pill four times a day.
Children: The dose ought to be determined by the doctor. It depends upon the infant’s weight, in addition as on the condition being treated. Older children and teens may have an identical quantity as adults.
Missed dose—
If you take probenecid frequently and you miss a dose, take the missed dose as soon as possible. However, in case you do not keep in mind till it’s way virtually time for a higher dose, skip the missed dose and go back in your regular dosing schedule. Do not double doses.
Storage—
To store this medicine:
• Keep out of the reach of kids.
• Store faraway from heat and direct light.
• Do not store this drugs inside the bathroom, close to the kitchen sink, or in totally totally totally totally totally different damp places. Heat or moisture will cause the drugs to injury down.
• Do not keep outdated drugs or drugs not needed. Ensure any discarded drugs is out of the reach of youngsters.
c. Precautions While Using This Medicine
• While you will be taking probenecid for a variety of weeks, your doctor ought to check your progress at regular visits.
Before you may have any medical tests, tell the person to blame that you are taking this medicine. The consequences of some tests may additionally be suffering from probenecid.
For diabetic patients:
• Probenecid may cause false check results with copper sulfate urine sugar tests (Clinitest®), however not with glucose enzymatic urine sugar tests (Clinistix®). In case you have any queries on this, confer with your medical professional.
For patients taking probenecid for gout or to assist take away uric acid from the body:
• Taking aspirin or totally totally totally totally totally different salicylates may reduce the consequences of probenecid. This may increasingly rely upon the dose of aspirin or totally totally totally totally totally different salicylate that you are taking, and on how frequently you are taking it. Also, drinking too a heap of alcohol may increase the volume of uric acid inside the blood and reduce the results of this medicine. Therefore, do not take aspirin or totally totally totally totally totally different salicylates or drink alcoholic beverages whereas taking this medicine, unless you’ve got got got 1st checked along with your doctor.
d. Unintended effects of This Medicine
Along with its required effects, a medication may cause some aspect effects. Although not all of these unwanted effects may occur, if they do happen they will would like medical attention.
The following unwanted effects may mean that you merely are having an hypersensitive reaction to this medicine. Discuss with your doctor immediately if any of here uncomfortable aspect effects occur:
• Rare
Fast or irregular breathing; puffiness or swellings of the eyelids or around the eyes; shortness of breath, troubled breathing, tightness in chest, or wheezing; shifts inside the skin color of the face occurring in conjunction with any of the various negative effects listed here; or skin rash, hives, or itching occurring along with any of the opposite unintended effects listed here
Also, consult your doctor as soon as potential if any of the subsequent unwanted effects occur:
• Less common
Bloody urine; troublesome or painful urination ; came or aspect pain (especially if severe or sharp); skin rash, hives, or itching (occurring while not totally totally totally totally totally different signs of an hypersensitive reaction)
• Rare
Cloudy urine; cough or hoarseness; quick or irregular breathing; fever; pain in back and/or ribs; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or while not chills; sudden decrease inside the quantity of urine; swelling of face, fingers, feet, and/or lower legs; swollen and/or painful glands ; uncommon bleeding or bruising; uncommon tiredness or weakness; yellow eyes or skin ; weight gain
Other unwanted effects may happen that typically do not have medical attention. These unwanted aspect effects may match away throughout treatment as your body adjusts to the drugs. However, discuss with your doctor if any of here unwanted effects continue or are bothersome:
• More common
Headache; joint pain, redness, or swelling ; loss of appetite; nausea or vomiting (mild)
• Less common
Dizziness; flushing or redness of face (occurring while not any signs of an allergy); frequent urge to urinate; sore gums
Other unintended effects not listed higher than may additionally happen in some patients. In the event you notice any totally totally totally totally totally different effects, confer with your doctor.
SOLUTION # 2: Unless you may be a divine follower of the late Mahatma Gandhi, who used to drink his urine daily, this answer is not terribly nearly as appealing as taking probenecid. However, it apparently will be terribly effective. Dr. Grattan Woodson, a professional in inner drugs at the Druid Oaks Health facility in Decatur, Georgia, offers the following pointers for emergency treatment of bird flu:* It really is a complicated, probably life-saving emergency strategy, that are meant to solely be done beneath medical supervision—unless none is on the market.
Tamiflu Re-Administration Strategy: Tamiflu is excreted unchanged virtually entirely inside the urine. If Tamiflu provides are limited, as they virtually definitely shall be [during a bird-flu pandemic], think about giving the patient 2 Tamiflu tablets concurrently, collect the patientÂ’s urine and re-administer it to the patient via naso-gastric (NG) tube or orally. If managed carefully, this approach permits you to utterly treat a patient with solely 2 Tamiflu tablets [by re-administering the patientÂ’s urine daily for 5 to ten days].
*Woodson G: Preparing for The arriving Influenza Pandemic. Fluwikie.com . Available at: http://fluwikie.com/annex/WoodsonMonograph.htm#_Toc116746508 .