Medical term:

Peramivir

peramivir

(per-am-a-veer),

Rapivab

(trade name)

Classification

Therapeutic: antivirals
Pharmacologic: neuraminidase inhibitors

Pregnancy Category: C

Indications

Treatment of acute uncomplicated influenza in patients ≥18 yr who have had symptoms for two days or less.

Action

Inhibits the enzyme neuraminidase, which may alter virus particle aggregation and release.

Therapeutic effects

Reduced duration or prevention of flu-related symptoms.

Pharmacokinetics

Absorption: IV administration results in complete bioavailaility.

Distribution: Unknown.

Metabolism and Excretion: Mostly eliminated unchanged by kidneys (> 90%).

Half-life: 20.8 hr.

Time/action profile (blood levels)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	end of infusion	unknown

Contraindications/Precautions

Contraindicated in: None noted.

Use Cautiously in: Renal impairment (dose reduction required for CCr <50 mL/min); Geriatric: Consider age-related decrease in hepatic, renal, cardiac function, concurrent diseases and drug therapy; Obstetric: Use only if clearly needed; Lactation: Consider benefits of breastfeeding, need for peramivir and potential for adverse effects; Pediatric: Safety and effectiveness in children <18 yr has not been established.

Adverse Reactions/Side Effects

Central nervous system

insomnia
neuropsychiatric events

Cardiovascular

hypertension

Gastrointestinal

constipation

Dermatologic

skin reactions including stevens-johnson syndrome (life-threatening)

Interactions

Drug-Drug interaction

Avoid use of live attenuated influenza vaccine within 2 wk prior and 48 hr after peramivir; interference may occur.

Route/Dosage

Intravenous (Adults and Children ≥18 yr (CCr ≥50 mL/min) 600 mg.

Renal Impairment

Intravenous (Adults and Children ≥18 yr) CCr 30–49 mL/min—200 mg, CCr 10–29 mL/min—100 mg

Availability

Solution for IV use: 200 mg/ 20 mL vial

Nursing implications

Nursing assessment

Assess for signs and symptoms of influenza (fever, dyspnea, tachypnea, tachycardia, hypotension) prior to and at least daily during therapy. Patient must be symptomatic for no more than 2 days to receive peramivir.
Monitor for signs of neuropsychiatric symptoms (hallucinations, delirium, abnormal behavior) during therapy.
Assess patient for skin rash during therapy. Monitor closely and treat symptomatically.
Lab Test Considerations: May cause ↑ serum ALT, AST, glucose, creatine phosphokinase, and ↓ neutrophils.

Potential Nursing Diagnoses

Risk for infection (Indications)

Implementation

Intravenous Administration
Intermittent Infusion: Diluent: 0.9% NaCl or 0.45% NaCl, D5, or LR to a maximum volume of 100 mL. Solution is clear and colorless; do not administer solution that is discolored or contains a precipitate. Upon dilution, administer immediately or refrigerate up to 24 hrs; discard after 24 hrs. Allow to reach room temperature prior to administration.. Discard unused portion of single use vial.
Rate: Infuse over 15 to 30 min.
Y-Site Incompatibility: Do not administer simultaneously with any other medication.

Patient/Family Teaching

Explain purpose of peramivir to patient.
Advise patient to notify health care professional if signs and symptoms of anaphylaxis or rash, or neuropsychiatric symptoms occur.
Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes

Resolution of sign and symptoms of influenza.

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