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Drug updated on 4/16/2024

Dosage FormInjection (intravenous: 200 mg/20 mL [10 mg/mL])
Drug ClassInfluenza virus neuraminidase inhibitors
Ongoing and
Completed Studies


  • Indicated for the treatment of acute uncomplicated influenza in patients 6 months and older who have been symptomatic for no more than two days.

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  • Peramivir (Rapivab) is indicated for the treatment of acute uncomplicated influenza in patients 6 months and older who have been symptomatic for no more than two days. It has shown superior efficacy in hastening recovery among young and middle-aged adults with seasonal influenza, significantly reducing the time to resumption of usual activities compared to placebo.
  • Ten studies provided insights into Rapivab's safety and effectiveness compared with other neuraminidase inhibitors such as baloxavir, laninamivir, oseltamivir, zanamivir.
  • In terms of overall effectiveness, peramivir ranked highly in reducing the time to alleviation of symptoms, often outperforming or demonstrating comparable efficacy with other treatments. However, some studies showed that baloxavir might have advantages over peramivir in specific outcomes like fever reduction and viral load decrease.
  • The incidence rate of adverse events was relatively similar between patients treated with peramivir versus those treated with other neuraminidase inhibitors, indicating a tolerable safety profile. Baloxavir, however, demonstrated non-significantly reduced adverse events, suggesting it may have a slightly favorable safety profile.
  • Both baloxavir and peramivir demonstrated similar safety profiles amongst high-risk patients without significantly increasing adverse event rates, making them suitable options across diverse patient groups, including hospitalized ICU patients suffering from respiratory failure due to influenza where higher doses did not alter outcomes compared to standard treatments.
  • Although detailed studies on pediatric populations were not included, the indication for use starting at six months old suggests potential applicability and effectiveness within this critical subgroup, considering their high burden from flu-related illnesses.

Product Monograph / Prescribing Information

Document TitleYearSource
Rapivab (peramivir) prescribing information.2022BioCryst Pharmaceuticals, Inc., Durham, NC

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Efficacy of pharmacotherapy for seasonal influenza in young and middle-aged adults: A systematic review and network meta-analysis. 2024Internal Medicine
Comparative effectiveness of neuraminidase inhibitors in patients with influenza: A systematic review and network meta-analysis.2022Journal of Infection and Chemotherapy
Efficacy and safety of single-dose antiviral drugs for influenza treatment: A systematic review and network meta-analysis.2022Journal of Medical Virology
Neuraminidase inhibitors and single dose baloxavir are effective and safe in uncomplicated influenza: A meta-analysis of randomized controlled trials.2022Expert Review of Clinical Pharmacology
Efficacy and safety of baloxavir marboxil versus neuraminidase inhibitors in the treatment of influenza virus infection in high-risk and uncomplicated patients - a Bayesian network meta-analysis.2021Current Medical Research and Opinion
Neuraminidase inhibitors are effective and safe in reducing influenza complications: Meta-analysis of randomized controlled trials.2021European Journal of Internal Medicine
Comparison of antiviral agents for seasonal influenza outcomes in healthy adults and children: A systematic review and network meta-analysis.2021JAMA Network Open
Alternative regimens of neuraminidase inhibitors for therapy of hospitalized adults with influenza: A systematic review of randomized controlled trials.2020Advances in Therapy
A meta-analysis comparing the efficacy and safety of peramivir with other neuraminidase inhibitors for influenza treatment.2020Medicina (Kaunas)
Comparing intravenous peramivir with oral oseltamivir for patients with influenza: A meta-analysis of randomized controlled trials.2020Expert Review of Anti-infective Therapy

Clinical Practice Guidelines

Document TitleYearSource
2020-2021 AMMI Canada guidance on the use of antiviral drugs for influenza in the setting of co-circulation of seasonal influenza and SARS-CoV-2 viruses in Canada.2020Journal of the Association of Medical Microbiology and Infectious Disease Canada