Amantadine, oseltamivir and zanamivir for the treatment of influenza

NICE technology appraisals [TA168] Published date:

This guidance updates and replaces NICE technology appraisal 58 (published in February 2003)

NICE has said that its recommendations about oseltamivir and zanamivir should not reduce efforts to give vaccination (also called the flu jab) to people for whom it is recommended in national guidelines.

The guidance does not cover widespread epidemics.

Oseltamivir and zanamivir are recommended as possible treatments for people with flu if all of the following apply:

  • the person is in an 'at-risk' group
  • the person has a 'flu-like illness' (see page 3) and can start treatment within 48 hours (36 hours for zanamivir treatment in children) of the first sign of symptoms.
  • the flu virus is known to be going around and it is likely that a flulike illness has been caused by the flu virus.

Healthcare professionals should discuss the choice of oseltamivir or zanamivir with the person being offered the drugs. The decision should take into account which drug the person would prefer and any possible unwanted effects. If all else is equal, the cheapest drug should be used.

If there is an outbreak of 'flu-like illness' in a long-term residential or nursing home, oseltamivir and zanamivir may be offered to treat residents in 'at-risk' groups who have symptoms of flu. This could happen even if the flu virus is not around in the wider community outside the home, but the healthcare team should be sure that the illness is flu.

Amantadine is not recommended to treat people with flu.

Get involved