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Michael E. Klepser, PharmD, is an ambulatory-care pharmacist at Western Michigan University School of Medicine Clinics based in Kalamazoo, Michigan, and professor of pharmacy practice at Ferris State University in Big Rapids, Michigan.

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Trained in infectious diseases, Klepser has research interests in outpatient management of diseases and point-of-care testing.

The Clinical Advisor asked him about some of the points raised in his recent article, “Socioeconomic impact of seasonal (epidemic) influenza and the role of over-the-counter medicines” (Drugs. 2014;74[13]:1467-1479; available at link.springer.com/article/10.1007/s40265-014-0245-1).

The role of OTC medications in the flu epidemic

The Clinical Advisor: In your article, you say that over-the-counter (OTC) medications will play an important role in the course of the influenza epidemic. How so?

Michael Klepser: Even the prescription medications that we have now for the management of influenza, oseltamivir and zanamivir, are not highly effective. They’re not necessarily a cure for influenza; they simply shorten the duration. Once the patient gets infected these agents keep the virus from spreading through the body, but you’re still going to have to manage those symptoms.

The prescription antiviral medicines are only useful when they’re started within the first 48 hours of the onset of symptoms. Their only value is that they’ve been demonstrated to shorten the duration of symptoms by maybe 24 hours.

They might also have some role in reducing viral shedding. Regardless of that, even if these patients get treated they are still going to feel lousy, they’re still going to have the muscle aches, fever, and lethargy. So they are still going to need symptomatic relief.

And then there are all those patients who do not seek care within that first 48 hours. Really, these individuals are not even going to be candidates for prescription medications, and they most likely are going to be managed symptomatically as well. 

What about prophylactic use of prescription antivirals for the flu?

How are you most likely to treat a flu patient at low risk for drug interactions and complications?

Some prescribers may provide antiviral prophylaxis for family members living in a household where somebody has the flu, typically if one of those family members is at high risk for complications, is immunocompromised, or has a lot of comorbid illnesses.