Because of their accessibility, pharmacists often consult patients in community settings. They can answer questions and educate them about influenza, for example, when patients arrive with symptoms of the illness.

SYMPTOMS AND VULNERABLE POPULATIONS
When a patient complains of influenza symptoms, pharmacists should ask whether they have experienced cough, fever, muscle pains, or sore throat.

Medical history can affect risk, so it is important to ask patients if they have chronic conditions, such as asthma, breathing issues, diabetes, or heart failure, as these elevate risk. Moreover, if the patient’s medication list is unavailable, ask if they are taking any medication that affects the immune system, such as biologics or steroids.1

Young infants, immunocompromised patients, or older adults may be afebrile or have age-specific flu symptoms, according to the CDC,1 therefore pharmacists should ask caregivers or older adults about sudden confusion. Although patients can usually manage influenza at home, some signs and symptoms deserve immediate medical attention. (TABLE 1) lists situations that warrant a visit to the emergency department.1 Pharmacists should also refer patients for care if any other symptoms are concerning or severe.1



EVALUATION FOR ANTIVIRALS
Although most patients recover from influenza spontaneously, some develop severe complications, such as pneumonia. Pharmacists should evaluate patients for antiviral treatment to mitigate the risk of complications from and reduce the duration of influenza, asking them the following:2
  • Are you older than 65 years or younger than 2 years?
  • Are you pregnant, or do you have any chronic medical conditions?
  • Did your flu symptoms start within 2 days?
  • Are your symptoms worsening?
  • Even without a confirmed influenza test, if the patient answers yes to any of these questions, pharmacists can recommend antiviral therapy.2

CHOOSING AN ANTIVIRAL MEDICATION
Pharmacists should let patients know that antivirals may lessen their symptoms and reduce the duration of the illness by about a day. Additionally, they can tell them antivirals work best if started less than 2 days after symptoms begin and urge them not to wait to start.3 (TABLE 2) summarizes doses for influenza antivirals.4-7



Sometimes, caregivers have concerns about antiviral medica- tions for young patients. Pharmacists should assure them that antiviral drugs are safe in children and will help them recover faster.2

For children who cannot swallow oseltamivir capsules, 2 options exist:3
  • Ask the child’s provider to prescribe liquid oseltamivir.
  • Open the capsules and mix the drug powder with liquid. A thick sweet liquid (eg, chocolate) will cover the drug’s
  • taste best.
  • Some antiviral medications have special considerations. Peramivir requires infusion. The latest antiviral medication for flu, baloxavir, is not recommended for pregnant women, breastfeeding mothers, outpatients with complicated progressive illness, or hospitalized patients due to limited data.2 Oseltamivir can be prescribed for pregnant women.
  • Pharmacists should also inform patients that they only need 1 antiviral medication and must take it as directed.2
ADVICE FOR SYMPTOMATIC PATIENTS
If patients don’t need medical referrals, pharmacists should advise them to do the following3:
  • Stay at home and rest
  • Whenever possible, avoid close contact with others 
  • Drink plenty of water
  • Contact their provider if symptoms worsen
CONCLUSION
By educating patients on the correct use of influenza antivirals, pharmacists can lower the risk of complications from the illness as well as its severity in communities.
 
Xiaoyu (James) Lu is a PharmD candidate at the University of Connecticut School of Pharmacy in Storrs.


REFERENCES
  1. Flu symptoms & complications. CDC. Updated August 31, 2020. Accessed October 21, 2020. https://www.cdc.gov/flu/symptoms/symptoms.htm
  2. Uyeki TM, Bernstein HH, Bradley JS et al. Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemo- prophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019;68(6):895-902. doi:10.1093/cid/ciy874
  3. Flu treatment. CDC. Updated August 31, 2020. Accessed October 21, 2020. https:// www.cdc.gov/flu/treatment/index.html
  4. Rapivab. Prescribing information. BioCryst Pharmaceuticals Inc; 2020. Accessed October 21, 2020. https://www.rapivab.com/themes/rapivab/pdf/Rapivab-Prescribing- Information.pdf
  5. Relenza. Prescribing information. GlaxoSmithKline; 2018. Accessed October 21, 2020. https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/ Prescribing_Information/Relenza/pdf/RELENZA-PI.PDF
  6. Tamiflu. Prescribing information. Genentech, Inc; 2019. Accessed October 21, 2020. https://www.gene.com/download/pdf/tamiflu_prescribing.pdf
  7. Xofluza. Prescribing information. Genetech USA, Inc; 2019. Accessed October 21, 2020. https://www.gene.com/download/pdf/xofluza_prescribing.pdf