[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Anti-influenza agents](https://durgical.com/en/pharmacology/classes/anti-influenza-agents/) › Peramivir

# 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Anti-influenza agents](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

✂**Influenza neuraminidase**Peramivir

ⓘ 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.

**Target in 3D:** Influenza neuraminidase. PDB structure 2HTU (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/2HTU) · Drag to rotate · pinch to zoom

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) →](https://durgical.com/en/conditions/influenza/)
- Considered for hospitalised patients who cannot take or absorb oral oseltamivir [Influenza (flu) →](https://durgical.com/en/conditions/influenza/)

## Adverse effects

### Common

- Diarrhoea
- Constipation
- Insomnia
- Low neutrophil count

### Serious (rare, important)

- Serious skin reactions (e.g. Stevens-Johnson syndrome, erythema multiforme)
- Anaphylaxis
- Neuropsychiatric events such as delirium, hallucinations or abnormal behaviour, mainly in children

## 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

## Memory aid

PERA-mivir: «para» the vein, one shot for the flu.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/peramivir/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Oseltamivir](https://durgical.com/en/pharmacology/oseltamivir/)
- [Zanamivir](https://durgical.com/en/pharmacology/zanamivir/)
- [Baloxavir marboxil](https://durgical.com/en/pharmacology/baloxavir-marboxil/)

## Related conditions 1

- [Influenza (flu)](https://durgical.com/en/conditions/influenza/)

[← Back to the class: Anti-influenza agents](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a614062.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [Influenza Antiviral Medications: Summary for Clinicians](https://www.cdc.gov/flu/hcp/antivirals/summary-clinicians.html) (Centers for Disease Control and Prevention, 2025); [N8 neuraminidase in complex with peramivir](https://www.rcsb.org/structure/2HTU) (RCSB Protein Data Bank, 2006).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/peramivir/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/peramivir/