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Medication Spotlight [Xofluza]

With flu season coming up, it’s best to review our options for influenza treatment. Everyone knows Tamiflu (oseltamivir) but do you know Xofluza? Both agents are made by Roche, so let’s see how they compare.

------------- Xofluza (baloxavir marboxil) is indicated for the treatment of uncomplicated influenza (A and B) in patients ages 12 and up ( and >40 kg) who have been symptomatic for no more than 48 hours, and are otherwise healthy or at risk of complications.

------------- Mechanism: Baloxavir marboxil is hydrolyzed into baloxavir and this active form inhibits the function of cap-dependent endonuclease, which is part of the RNA polymerase. Therefore, it prevents viral replication and this is a novel mechanism of action compared to Tamiflu (which inhibits viral release), resulting in approximately 24 hours faster symptom resolution compared to placebo.

------------- Dosing: a single dose of two 20 mg tablets for those weighing 40 to 80 kg, or a single dose of two 40 mg tablets for those weighing more than 80 kg. Treatment should be started within 48 hours of presentation. It can be taken with or without food, but should not be administered with calcium, iron, magnesium or any polyvalent ions. No dose reduction is required in renal impairment.

------------- Adverse Effects: monitor for anaphylaxis or rash. Otherwise, it is well tolerated, with most common adverse effects as nausea, diarrhea, headache, bronchitis and sinusitis.

------------- Drug Interactions: Only with calcium, magnesium, iron, zinc etc. Avoid coadministration due to reduced absorption.

------------- Xofluza is only indicated for treatment (not prevention → use Tamiflu instead). It is convenient as a single dose, compared to Tamiflu which is a 5 day course. There are no direct comparisons between the two agents, but nonetheless, both are effective options for reducing the time to symptom resolution and hopefully more post-marketing data will be available to determine its place in therapy.

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