Psychiatric Implications of Influenza Treatments Identified
As experienced providers, you know how patients’ behavioral needs are often intertwined with physical conditions—especially when they are taking medication. With flu season and the new threat of H1N1 upon us, Magellan would like our providers to be aware of potential neuropsychiatric events associated with administration of medications used to treat influenza.
Neuraminidase inhibitors have been found to be effective in decreasing the duration of the influenza virus. However, the use of these medications and their potential impact on behavior also carries the risks of some rare but serious adverse reactions. We suggest ongoing communications with your patients’ PCPs and encourage you to educate patients taking these medications about the risk of abnormal behaviors.
For your reference, the following paragraphs discuss these neuraminidase inhibitors as well as offer precautionary measures to keep in mind during flu season.
Neuraminidase Inhibitors
According to published studies, the neuraminidase inhibitors oseltamivir (Tamiflu®) and zanamivir (Relenza®) have been shown to be effective treatments against the influenza A and B viruses, including the H1N1 virus (Swine Flu), and are the CDC recommended treatments for H1N1. For the treatment or prophylaxis of uncomplicated cases of influenza, oseltamivir is approved for patients greater than one year of age who have been symptomatic for less than 48 hours. Zanamivir is indicated for the treatment of influenza for patients seven years of age and older who have not been symptomatic for greater than two days, and for prophylaxis in children greater than five years of age.
Neuropsychiatric Events Associated with Neuraminidase Inhibitors
In 2008, the FDA required neuraminidase inhibitors to include warnings about neuropsychiatric events associated with administration of these medications. These neuropsychiatric events include increased risk of seizures, delirium, hallucinations, and abnormal behavior, in some cases resulting in death. These adverse reactions were more commonly reported in children and adolescents, and generally occurred within 48 hours of illness onset and initiation of treatment. It is recommended to monitor patients for symptoms of abnormal behavior.
Flu Precautions
As a part of typical flu precautions, we encourage you and your staff to take the following measures:
- Patients complaining of flu symptoms, such as chills, weakness, tremor, URI symptoms, accompanied by an elevated temp over 100 F, should be taken seriously. Immediately refer patients with these symptoms to their primary care physician (PCP), local emergency room, and/or medical clinic.
- All providers at every level of care should be familiar with the CDC recommendations found at http://cdc.gov/h1n1flu/recommendations.htm. In addition, you and your staff should take precautions outlined in the recommendations to prevent spread of infection.
- Please ensure all staff is familiar with antiviral treatment, and possible interactions with psychotropic medication and the exacerbation of psychiatric symptoms that antiviral medications might cause.
- It is imperative that special precautions be taken to protect susceptible populations such as the elderly, patients with concurrent physical health issues, such as diabetes and cardiac disease, pregnant women as well as children.
Again, advise patients or caregivers to inform you if any behavioral changes are noticed. With the appropriate education and monitoring, influenza medications can be safely used to effectively minimize the influenza virus with minimal adverse reaction.