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peramavir

General

**Off Market Drug**
This medication is no longer available in the United States. Information provided here is for reference purposes only.

Pregnancy Category
Category Unknown

Pronunciation:
per-am-a-veer

Pregnancy Category
Category Unknown

Ther. Class.
antivirals

Pharm. Class.
neuramidase inhibitors

Indications

Hospitalized patients with confirmed/suspected H1N1 influenza infection who are either not responding to PO/Inhaled antiviral therapy or where delivery by non-IV routes is not feasible/unreliable or adults where IV therapy is deemed appropriate for other reasons.

Action

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

Therapeutic Effect(s):

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.

Half-life: 7.7–20.8 hr.

TIME/ACTION PROFILE (blood levels)

ROUTEONSETPEAKDURATION
IVrapidend of infusion24 hr

Contraindication/Precautions

Contraindicated in:

  • Hypersensitivity including history of severe allergic reaction to other neuraminidase inhibitors (zanamivir, oseltamivir).

Use Cautiously in:

  • Renal impairment (dose reduction required for CCr <50 mL/min)
  • Other medications that undergo renal tubular secretion or impair renal function
  • Geri: Consider age-related decrease in hepatic, renal, cardiac function, concurrent diseases and drug therapy
  • OB: Use only if potential benefit justifies potential risk for mother and fetus children have not been assessed
  • Pedi: Safety and effectiveness in children have not been assessed.

Adverse Reactions/Side Effects

CNS: neuropsychiatric events

CV: EKG abnormalities

GI: diarrhea, nausea, vomiting, anorexia, hyperbilirubinemia

GU: cystitis, hematuria, proteinuria

Derm: SKIN REACTIONS INCLUDING STEVENS-JOHNSON SYNDROME

Endo: hypoglycemia

Hemat: neutropenia

Misc: ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Use cautiously with drugs that reduce renal function or compete for active tubular secretion; may ↑ increase levels and/or ↑ levels of other renally excreted drugs.

Route/Dosage

IV: (Adults) 600 mg once daily for 5–10 days.

Renal Impairment
IV: (Adults) CCr 31–49 mL/min– 150 mg once daily for 5–10 days; CCr 10–30 mL/min– 100 mg once daily for 5–10 days; CCr <10 mL/min or hemodialysis– 15 mg once daily for 5–10 days.

IV: (Children 6–17 yr): 10 mg/kg once daily for 5–10 days.

Renal Impairment
IV: (Children 6–17 yr): CCr 31–49 mL/min– 2.5 mg/kg once daily for 5–10 days; CCr 10–30 mL/min– 1.6 mg/kg once daily for 5–10 days; CCr <10 mL/min or hemodialysis– 0.25 mg/kg once daily for 5–10 days.

IV: (Children 181 days–5 yr ): 12 mg/kg once daily for 5–10 days.

Renal Impairment
IV: (Children 181 days–5 yr): CCr 31–49 mL/min– 3 mg/kg once daily for 5–10 days; CCr 10–30 mL/min– 1.9 mg/kg once daily for 5–10 days; CCr <10 mL/min or hemodialysis– 0.3 mg/kg once daily for 5–10 days.

IV: (Children 91–180 days): 10 mg/kg once daily for 5–10 days.

Renal Impairment
IV: (Children 91–180 days): CCr 31–49 mL/min– 2.5 mg/kg once daily for 5–10 days; CCr 10–30 mL/min– 1.6 mg/kg once daily for 5–10 days; CCr <10 mL/min or hemodialysis– 0.25 mg/kg once daily for 5–10 days.

IV: (Children 31–90 days): 8 mg/kg once daily for 5–10 days.

Renal Impairment
IV: (Children 31–90 days): CCr 31–49 mL/min– 2 mg mg/kg once daily for 5–10 days; CCr 10–30 mL/min– 1.3 mg/kg once daily for 5–10 days; CCr <10 mL/min or dialysis– 0.2 mg/kg once daily for 5–10 days.

IV: (Children birth–30 days): 6 mg/kg once daily for 5–10 days.

Renal Impairment
IV: (Children birth–30 days): CCr 31–49 mL/min– 1.5 mg/kg once daily for 5–10 days; CCr 10–30 mL/min– 1 mg/kg once daily for 5–10 days; CCr <10 mL/min or hemodialysis– 0.15 mg/kg once daily for 5–10 days.

Availability

Solution for IV use: 200 mg/ 20 mL vial

Assessment

  • Assess for signs and symptoms of influenza (fever, dyspnea, tachypnea, tachycardia, hypotension) prior to and at least daily during therapy.
  • Monitor for development of diarrhea; treat symptomatically.
  • Monitor for signs of bacterial infections. May require consultation with infectious disease specialist.
  • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
  • Monitor for signs of abnormal behavior. If neuropsychiatric symptoms occur, re-evaluate use of peramavir.

Lab Test Considerations: Monitor CBC with differential and metabolic profile (glucose, calcium, sodium, potassium, chloride, serum bicarbonate, creatinine, BUN) at initiation, on Day 3, and at end of therapy.

  • Monitor liver function tests (AST, ALT, alkaline phosphatase, total and direct bilirubin) at initiation and at completion of therapy if clinically indicated.
  • Obtain urinalysis upon initiation and at completion of therapy if clinically indicated. If proteinuria develops during therapy, assess 24–hr urine.
  • Assess renal function (serum creatinine) prior to initiation of dosing and during therapy as clinically indicated.
  • Patients with abnormal laboratory tests should have follow up and repeat assessment within 1–2 wks of completion of therapy to assess normalization.

Potential Diagnoses

Implementation

  • Completion of FDA MedWatch Form is mandatory to report all medication errors and adverse events during treatment with peramavir.

IV Administration

  • Intermittent Infusion: Diluent: 0.9% NaCl or 0.45% NaCl; do not dilute with solutions containing dextrose or other electrolytes. Transfer calculated dose to an empty container and add diluent. 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. Concentration: Not to exceed 6 mg/mL. Discard unused portion of single use vial. Maintain adequate records showing receipt, use, and disposition of medication.
  • Rate: For adults, infuse over 30 min at a rate not to exceed. For pediatric patients, infuse over 60 min at a rate not to exceed 40 mg/min; may be administered via syringe pump.
  • Y-Site Incompatibility: Do not administer simultaneously with any other medication.

Patient/Family Teaching

  • Explain purpose of peramavir to patient.
  • Advise patient to notify health care professional if diarrhea, anaphylaxis, changes in mood, or other adverse effects occur.

Evaluation/Desired Outcomes

Resolution of sign and symptoms of influenza.

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Citation

Quiring, Courtney, et al. "Peramavir." Davis's Drug Guide, 16th ed., F.A. Davis Company, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110526/12/peramavir.
Quiring C, Sanoski CA, Vallerand AH. Peramavir. Davis's Drug Guide. 16th ed. F.A. Davis Company; 2019. https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110526/12/peramavir. Accessed June 27, 2019.
Quiring, C., Sanoski, C. A., & Vallerand, A. H. (2019). Peramavir. In Davis's Drug Guide. Available from https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110526/12/peramavir
Quiring C, Sanoski CA, Vallerand AH. Peramavir [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2019. [cited 2019 June 27]. Available from: https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110526/12/peramavir.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - peramavir ID - 110526 A1 - Quiring,Courtney, AU - Sanoski,Cynthia A, AU - Vallerand,April Hazard, BT - Davis's Drug Guide UR - https://im.unboundmedicine.com/medicine/view/Davis-Drug-Guide/110526/12/peramavir PB - F.A. Davis Company ET - 16 DB - Medicine Central DP - Unbound Medicine ER -