Peramivir
Anti-influenza agents
Anti-influenza agents
A neuraminidase inhibitor given intravenously as a single infusion for influenza A or B, mainly when oral treatment is not possible.
Quick facts
- Group
- Anti-influenza agents
- Target
- Influenza neuraminidase
- Key effects
- Diarrhoea · Constipation · Insomnia
- Monitor
- Kidney function before dosing
- ATC
- J05AH03
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows peramivir in the active site of an influenza A neuraminidase (N8 subtype); the active site is conserved across influenza A and B.
Peramivir is a transition-state analogue of sialic acid that blocks the active site of influenza A and B neuraminidase. Without neuraminidase, new virions stay stuck to the infected cell and to each other, so the infection spreads less. Its several contacts in the binding site give it some activity against strains with reduced susceptibility to other neuraminidase inhibitors, but cross-resistance exists.
- Neuraminidase cuts sialic acid to release new virions
- Peramivir blocks the neuraminidase active site
- New virions stay stuck to the cell surface
- The infection spreads less in the airway
Indications
- Acute uncomplicated influenza within two days of symptoms, in people aged six months and older Influenza (flu) →
- Considered for hospitalised patients who cannot take or absorb oral oseltamivir Influenza (flu) →
Adverse effects
Common
- Diarrhoea
- Constipation
- Insomnia
- Low neutrophil count
Contraindications
- Hypersensitivity to peramivir
Key interactions
- Live attenuated intranasal influenza vaccine
- Peramivir may make it less effective when given close in time
- CYP-metabolised drugs
- No clinically significant interactions are known
What is monitored
- Kidney function before dosing
- Allergic and skin reactions during and after the infusion
- Behaviour and mental status, especially in children
Administration and safety
- A single intravenous infusion given by a health professional
- Started as early as possible, ideally within two days of symptoms
- Not a substitute for the yearly influenza vaccine
Pregnancy and breastfeeding
Human data are limited; benefit and risk are weighed, as influenza is more dangerous in pregnancy.
Nursing care
- Check kidney function and allergies before the infusion
- Observe for rash, swelling or breathing difficulty during the infusion
- Teach families to watch for confusion or unusual behaviour
- Ask about recent intranasal influenza vaccination
Pharmacokinetics
- Absorption
- Intravenous only
- Metabolism
- Not significantly metabolised; not a CYP substrate
- Elimination
- Mostly unchanged in the urine; adjusted in reduced kidney function
- Half-life
- Long enough for a single infusion
Test yourself
Think of the answer, then tap the question to see it.
How is peramivir given?
As a single intravenous infusion.
Which enzyme does peramivir block, and what is the result?
Influenza neuraminidase; new virions cannot be released from infected cells.
Which organ function is checked before peramivir?
Kidney function, because it is excreted unchanged in the urine.
Connections
← Back to the class: Anti-influenza agents
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Peramivir Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Influenza Antiviral Medications: Summary for Clinicians (Centers for Disease Control and Prevention, 2025); N8 neuraminidase in complex with peramivir (RCSB Protein Data Bank, 2006).
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Representative model, for educational purposes only.