From Flu Wiki 2

Forum: Tamiflu or Relenza

30 June 2006

glennk – at 10:19

This is a question for the Drs. or scientific research people in here. Which of these two anti-virals is the preferred buy these days and why? I seem to be reading conflicting information on this and would be extremely grateful if someone would clarify this for me.

anonymous – at 10:39

Tamiflu is more available and more tested. Relenza is (still ?) only available for respiratory usage. Intravenous is planned and preferred, because H5N1 enters not only the lungs. For prophylaxis or ealy usage Relenza could still be good.Later in the disease you had to switch to Tamiflu probably. Since there is also the danger of resistance in a pandemic, it could be good to have both. The expected resistances are probably independent of each other. I’m not a Dr. nor a research professional.

glennk – at 11:00

Ok, so let me get this right. Your saying that Tamiflu in pill form is atleast at present the one that has been tested and found useful? On the other hand relenza which I take it is in an inhaler might be ok? Or is it that Relenza if used early is the more effective? Or should I buy both if I can get them?

anonymous – at 11:58

Relenza is not approved in USA but in Europe AFAIK. Tamiflu was useful (though limited) against some strains if given early. Relenza is similar, probably not more effective (unless resistance). If you have both, you almost redoubled your chances in case of resistance.




Just some hypothetical numbers:
maybe 50% that NA-inhibitors work (50% reduced risk to die),
50% for resistance in a pandemic
so Tamiflu:25% that it works,
Relenza:25% Tamiflu+Relenza 37%.


It seems to me that prophylactic treatment is more promising, but also requires more doses and the risk to develope resistant strains so it’s dangerous for the rest of mankind.

galt – at 12:36

I believe that Relenza is approved in the US for both treatment and prevention of influenza; I believe that it is much less available in the US (or online) than is Tamiflu, particularly with latest stockpiling. I’m pretty sure that Relenza is not manufactured at anything like the volume of Tamiflu. It appears harder to use the Relenza inhaler than the Tamiflu pills for most folks. I believe that Tamiflu is generally considered to have a relatively low side effect profile (primarily nausea). Side effect profile listed for Relenza may be a bit more aggressive, particularly for individuals with existing lung or related damage/compliations (asthma, COPD, etc.). Listed/approved shelf-life for Relenza is shorter than that listed/approved for Tamiflu. Comparison shopping suggests that Relenza is less available and generally more expensive. I wonder if this makes it less likely as a target for counterfeiting (who knows?). Tamiflu is approved for treatment and prevention for adults and for children down to age one (I believe). The approved age for Relenza is much higher (I think age 12, but I am not sure). Tamiflu comes in a suspension form as well as capsules for children and/or for those with difficulty swallowing pills. To the best of my survey of the available data, much more research relevant to H5N1 has been done with Tamiflu in the lab (e.g., animal studies of potential effectiveness of Tamiflu).

Just a few thoughts on differences. For both drugs, there are websites that list their side effect profiles and effects/problems in clinical studies (just use google). Hope this info helps.

Galt

glennk – at 14:10

I’m going to try and buy both just to be on the safe side. Atleast until someone says something else is more effective. I’m also buying Nature Ways’ Elderbery extract which has shown to be effective against regular flu in studies. I’ll throw everything and anything at this monster if God forbid it arrives on my door step. I’m not going to allow myself or my family to go into the night quietly or passively. Thanks for the information both of you have given me. I was going to buy just Relenza but now I’m going for both. The problem I’ve run into so far is getting any Dr. to write me the necessary scripts. Most I’ve talked with are as much or more in denial about this diseases potential for global mayhem.

MAV in Colorado – at 16:21

glennk, “Im also buying Nature Ways Elderbery extract which has shown to be effective against regular flu in studies.” Could you point me toward those studies please? I didnt find anything on Nature’s Ways pages.

As I’m sure you’ve already heard-Be VERY careful buying Tamiflu online. Counterfit production everywhere.

glennk – at 16:39

Yes, I’ve heard that. Thanks. I’m going to try and buy it from a referred source only. The Elderberry study was done by an Israeli research org. I’ll look for the link and post.

glennk – at 17:37

Mav do u know of a safe site to buy Tamiflu through? if so could you post it or send it to me via e-mail?

anonymous – at 17:44

some time ago someone offered here a method, how to test tamiflu. Even offered to test Tamiflu sent to him, but later retracted.

glennk – at 18:03

People that counterfeit this stuff are lower then pond scum their killers.

anon_22 – at 20:03

Tamiflu and Relenza both belong to the same group of antivirals called neuraminidase inhibitors (NA inhibitors). They both work against H5N1, as far as we can tell, so far, although how well and at what dose is still subject to uncertainty.

The problem with NA inhibitors is that they act on preventing the release of virus from host cells AFTER they have already done at least one round of replication. In normal seasonal flu, this is not a big problem, but still you would not see instant cure, because of this. H5N1, however, characteristically replicates in the order of 1000′s times more than seasonal flu, so for the NA inhibitor to act AFTER one replication cycle, you are already at risk of not being able to stop the whole thing altogether. It’s like a competition where you give your opponent a lead every time.

That’s why taking it as early as possible and at high enough doses is the most important thing. This takes us to the differences between the two drugs. Relenza is delivered by inhalation, and the drug level is built up in the lungs quite rapidly, within about 1/2 hour, but it is poorly absorbed into the blood. Whereas tamiflu is absorbed after oral intake and takes a few hours to build up in the blood and other tissues, but it does not pass into the central nervous system CNS.

So if the biggest threat is the ability of H5N1 to replicate extremely efficiently, then taking Relenza would help to stop the replication at the primary site of infection, ie as early as possible in the infection cycle, thereby reducing the amount of virus that gets into the blood. For the same reason, Relenza is also good as prophylaxis, because you are giving it at the ‘first port of call’ of the virus.

However, since H5N1 causes a systemic infection, including CNS disease, then you would need tamiflu to deal with any that gets into the blood and the rest of the body, since Relenza will not do the job. In addition, since tamiflu CANNOT pass into the CNS, so the only option is to ensure a good blood level early on to PREVENT the virus getting in. Tamiflu is taken orally, so it takes a few hours for the blood level to build up.

As for availability, it tends to be different for different countries, so you should ask around.

Also a good idea to read summary of WHO guideline on antiviral use. It may be a good idea to everyone download and keep a copy from the WHO so you have it at hand if you need to refer to it.

MAV in Colorado – at 20:09

glennk sure, I use mooremedical.com for all my supplies/pharm. I am not a “believer” and have not purchased any but saw that they had it in their catalog. I sup[pose they could be out.

glennk – at 20:19

Mav thanks! As they say any port in a storm. Maybe, it won’t work and maybe it will ?

MAV in Colorado – at 20:20

glennk at 18:03

“People that counterfeit this stuff are lower then pond scum their killers.”

Yup! Anyone who sells drugs illegaly (ie without Rx) is just a drug dealer. Not anyone I would trust for meds.

glennk – at 20:47

Mav thanks again. Now the hard part convincing my various Drs. to give me scripts for these drugs. I’ll get pound away till I get 1 of them to come across with them. The Drs. are in just as much a state of denial regarding this issue as everyone else.

01 July 2006

anonymous – at 00:20

Yup! Anyone who sells drugs illegaly (ie without Rx) is just a drug dealer. Not anyone I would trust for meds.


what’s illegal in one country is legal in another. You want to transfer the decision who gets life-saving meds to the doctors ? So they can give it to who they like and refuse to prescribe it to those who they don’t like ? (e.g. because they oppose that prescription laws )

MAV in Colorado – at 02:56

anonymous at 00:20

Common sense, I think would say that these internet companies that “prey” on american consumers would not be high on my list of trusted phamaceutical suppliers when it come to obtaining quality meds.

nope, I’m not interested in “transfering” anything. I think Rx authority is best right where it is….in the hands of educated, trained professionals who are up to date with the indications and contradictions for the meds they write for.

If you are comfortable getting meds from sources that are illegaly selling drugs, have at it! Just don’t complain when they don’t work or when you suffer from a drug interaction or side effect.

you obviously have some sort of issue with the way things are- sorry for that. It really has nothing to do with who we like or don’t. Legally and ethically bound to only dispense when indicated.

anonymous – at 05:28

MAV,
and those doctors who won’t inform me correctly or just have no clue (but of course never admit) are not high on my list of trusted people. I prefer to get info from the web.

I pretend that I’m more educated concerning my disease - yet I get no licence to even prescribe my own Rx.

These doctors are hardly up to date with the indications and contradictions for the meds more than what you find on the web.

These “sources” are not illegally selling drugs.It’s perfectly legal in their country.

it often has to do with who you like. More or less directly. Of course it’s always easy to find another reason for not prescribing drugs.

Melanie – at 05:33

Y’all need to go back and re-read what anon_22 wrote at anon_22 at 20:03

Tamiflu and Relenza both belong to the same group of antivirals called neuraminidase inhibitors (NA inhibitors). They both work against H5N1, as far as we can tell, so far, although how well and at what dose is still subject to uncertainty.

The problem with NA inhibitors is that they act on preventing the release of virus from host cells AFTER they have already done at least one round of replication. In normal seasonal flu, this is not a big problem, but still you would not see instant cure, because of this. H5N1, however, characteristically replicates in the order of 1000′s times more than seasonal flu, so for the NA inhibitor to act AFTER one replication cycle, you are already at risk of not being able to stop the whole thing altogether. Its like a competition where you give your opponent a lead every time.

Thats why taking it as early as possible and at high enough doses is the most important thing. This takes us to the differences between the two drugs. Relenza is delivered by inhalation, and the drug level is built up in the lungs quite rapidly, within about 1/2 hour, but it is poorly absorbed into the blood. Whereas tamiflu is absorbed after oral intake and takes a few hours to build up in the blood and other tissues, but it does not pass into the central nervous system CNS.

So if the biggest threat is the ability of H5N1 to replicate extremely efficiently, then taking Relenza would help to stop the replication at the primary site of infection, ie as early as possible in the infection cycle, thereby reducing the amount of virus that gets into the blood. For the same reason, Relenza is also good as prophylaxis, because you are giving it at the first port of call of the virus.

However, since H5N1 causes a systemic infection, including CNS disease, then you would need tamiflu to deal with any that gets into the blood and the rest of the body, since Relenza will not do the job. In addition, since tamiflu CANNOT pass into the CNS, so the only option is to ensure a good blood level early on to PREVENT the virus getting in. Tamiflu is taken orally, so it takes a few hours for the blood level to build up.

As for availability, it tends to be different for different countries, so you should ask around.

Also a good idea to read summary of WHO guideline on antiviral use. It may be a good idea to everyone download and keep a copy from the WHO so you have it at hand if you need to refer to it. “

glennk – at 12:34

I guess then the really important thing then is to know if it’s BF your dealing with early on ? You don’t want to waste these meds. on the reg. flu or a cold. That’s going to be tricky since most of us including the Drs. have never seen a case of this thing up close and hope never to. Waiting for a test to come back won’t be an option with people dying all around us and the medical community buried under screaming paniced people. I fully expect our medical system to collapse as we’ve already way over loaded it on the bottom end. Oh, as usual the few will get great med care with emeg. facilites standing by just for them and their families. The rest of us will get mass graves and solemn rituals for the dead and dying. It’s called Triage and we all know how it’s going work. So, it’s going to take some education on our parts all the way there if need be. If the net stays up that’s going to be a great help and one way we could handle diagnosis here is to get our own Internet area here just for that when the time comes. Of course finding a Dr. that won’t be working 24/7 is going to be tough, maybe? We’ll still have each other and that’s something.

anon_22 – at 13:35

glennk,

“ I guess then the really important thing then is to know if its BF your dealing with early on?”

That would be a crucial thing, among many. I would say keep watching the clinical presentations of the disease as time goes on. At the moment, all patients have fever >38C as an early presentation. So if someone has definite history of exposure, eg known cases in community, then gets a temp then there may be a case to start treatment if no other tests are available. Close to 100% of patients have cough, but this may not happen as a first sign.

I’m not sure that any of the rapid flu tests will give you 100% accuracy, even if you have it. If you can do a blood count, a low white cell count and low platelets are the two things to look out for. They are not diagnostic, but suggestive, but IF this was H5N1 infection, a low white count especially low platelets is associated with ARDS so if it was me, I would assume this was H5N1 and go ahead with treatment.

glennk – at 16:09

Thanks anon 22 your posts are as usual to the pt. and thoughtful and I appreciate your advice and your insights.

02 July 2006

anonymous – at 04:08

BTW. there is also peramivir. When will it be available to the public ? And you will find a thread about Super-Relenza here or/and at curevents. It would be 1000 times more effective than Relenza - if it works. It might take 1–2 years until we know…

anon_22 – at 05:43

Peramivir is likely to be a good drug, but I don’t know how long it will take to get approval. I know that quite a few people are working on expedition of approval processes for various drugs and vaccines with regards to panflu, but I don’t remember hearing anything specific about peramivir.

04 July 2006

glennk – at 09:53

Rumour has it that Warren Buffet and the Gates foundation are also involved in funding some of these new drugs and experimental vaccines. Like I said it’s just a rumour but they sure have the $$ and the political power to make things roll. Let’s hope and pray they have entered the struggle to defeat this gathering threat.

Ceredwin – at 18:40

Relenza was recalled by the distributors from retail pharmacies in the US back in September, for stockpiling. I wouldn’t trust either Tamiflu or Relenza bought on line at this point.

Gates’ foundation is involved with existing vaccines for basic diseases such as measles, polio etc. for developing countries, as well as addressing malaria, diarrhea, TB, HIV/AIDS-no indications of BF vaccine research.

glennk – at 19:52

Ceredwin: if I can buy it with a prescrip. from my local pham. would u trust it then?

anon_22 – at 20:06

glennk,

Meds bought from licensed pharmacies with proper prescriptions should be fine.

glennk – at 20:46

Are there good licensed pharms online? Or are they all not to be trusted?

05 July 2006

MAV in Colorado – at 01:56

there are reputable sources out there. I have been getting meds and supplies for my practice for several years from mooremedical.com. Never a problem. But I never ordered vitamin “T” from them

doldrums – at 07:35

Anon_22 wrote:

I’m interested in why H5N1 replicates more - is this a characteristic of the virus or is it due to the fact that the host has absolutely no intrinsic immunity to it?

doldrums – at 07:36

.. correction - just no immunity - intrinsic, aquired or otherwise!

anon_22 – at 12:00

doldrums,

“Im interested in why H5N1 replicates more - is this a characteristic of the virus or is it due to the fact that the host has absolutely no intrinsic immunity to it?”

Probably the first, as other pandemic viruses eg 1957 or 1968 did not exhibit similar characteristics. Plus this propensity for extremely efficient replication is also seen in other species eg typicall a flock of infected chicken would ahow 100% death rate in 24 hours, which has never been reported in other strains.

glennk – at 14:01

This thing has the feel of the SUPER FLU in Stephen King’s “THE STAND.” Maybe that was Mother Abigail I dreamed of the other night after all?

glennk – at 19:01

I recieved a Catalog today from Moore Medical and they list Tamiflu. I think I’d feel pretty confident ordering it from these folks they don’t look like an outfit that has been around 58 by selling counterfeit drugs.

MAV in Colorado – at 19:27

glennk “around 58″

?

glennk – at 19:31

Sorry 58 yrs. in biz I meant.

MAV in Colorado – at 19:42

wow! I..did….not..know …..that. I have been using them for 6 or 7 years. they give “frequent flyer miles” for continuing customers. I think free shipping with min order. Not sure how it works if you just want to fill an Rx though. Should’t be difficult.

glennk – at 20:08

I went to their site 2 days ago and asked for a catalog and got it today! Looks like they have a helluva biz. Thanks again for suggesting them.

glennk – at 20:21

Just got this e-mail from Roche regarding availability in the US with a prescription.

Your Response From Roche Inbox

Medinfo, Nutley Dear Thank you for your interest in TAMIFLU (oseltamivir phospha… 2:13 pm (5 hours ago)

Glenn K to Nutley More options 7:59 pm (3 minutes ago) Thank you for the prompt reply.

On 7/5/06, Medinfo, Nutley <nutley.medinfo@roche.com> wrote:

Dear Mr.K

Thank you for your interest in TAMIFLU (oseltamivir phosphate). TAMIFLU is available by prescription and should be available through your local pharmacy. We apologize for the confusion regarding its availability. Consult your physician to det ermine if TAMIFLU is right for you.

Thank you for taking the time to contact us. We wish you the best of health.

www.tamiflu.com

02 September 2006

Closed - Bronco Bill – at 00:47

Closed to maintain Forum speed.

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