Tamiflu is not the only flu treatment available. These other options can fly under the radar — and provide relief

When the flu strikes, it can feel relentless: a rising fever, cough, stuffy nose and sore throat. For many people, relief can come in the form of Tamiflu, a prescription antiviral drug used to treat and even prevent the disease.

But some people don’t realize that Tamiflu isn’t the only option.

Other flu treatments are available in the United States. These options sometimes fly under the radar, in part because some are aimed at specific populations. But Xofluza, a one-dose pill, is approved for people 5 years and older — and may be a stronger alternative for some people who may be prescribed Tamiflu.

Antiviral medications tend to work best when started within two days of the onset of symptoms, so having easy access to treatment options is important for the most effective treatment of the flu.

There are four antiviral drugs recommended by the US Centers for Disease Control and Prevention to treat the flu this season: Tamiflu or oseltamivir, Xofluza or baloxavir, Relenza or zanamivir, and Rapivab or peramivir.

Tamiflu is used to treat the flu in people 2 weeks of age and older and to reduce the risk of getting the flu in people 1 year of age and older. The drug is administered as a liquid or in capsules, and when used for flu treatment is usually taken twice a day for five days. When used for post-exposure prophylaxis, it is usually taken once daily for 10 days. Available generically or under the trade name Tamiflu, it can cost $50 or less without insurance. The most common side effects include nausea and vomiting.

As another option, Xofluza is administered as a single-dose tablet and is approved for ages 5 and older. It can be used to treat or prevent the flu, and it can cost about $200 without insurance, but eligible patients can use a coupon to lower the cost. The most common side effects include diarrhea and vomiting.

“The most common complaint I hear is vomiting from Tamiflu,” Dr. Ari Brown, a Texas pediatrician and author of the Baby 411 book series, said in an email. He referenced a 2023 study in which about 18% of people experience vomiting with Tamiflu versus 5% with Xofluza.

The study also found that about 5% of people taking Xofluza had diarrhea compared to no one taking Tamiflu. “I’ve also had some pediatric patients experience moodiness with Tamiflu, which has been reported in the literature,” she said.

“The biggest difference” between Tamiflu and Xofluza is that Xofluza can stop viral shedding in one day while Tamiflu can take about three days, Brown said.

That means the rest of the household may be less vulnerable to the flu and fewer people may come down with it, but “both antivirals will help shorten the duration of the illness by a few days,” Brown said. For example, with treatment, some people may experience five days of flu symptoms instead of seven.

Rapivab is one of the other prescription drugs approved to treat the flu. The drug is approved for 6 months or longer, once given as an intravenous infusion by a healthcare provider. It can cost up to about $1,000 without insurance, and the most common adverse reaction in adults tends to be diarrhea.

Finally, Relenza is another recommended flu medication. It is inhaled as a powder, and is usually administered using an inhaler device twice a day for five days. The prescription drug is approved to treat the flu in ages 7 and older, and for preventive use in ages 5 and older. It can cost up to about $90 without insurance. Side effects include allergic reactions, dizziness or nasal irritation, and it is not recommended for people with breathing problems such as asthma.

‘Xofluza is growing in popularity’

Among the recommended flu treatments, Tamiflu turns out to be the flu medicine for most patients. But Xofluza is becoming more widely used, Brown said.

However, it may not always be available in pharmacies, recommended by providers or covered by insurance.

“I think it’s region-dependent,” Brown said of access to treatment.

“When flu cases go up in one part of the country, there’s high demand. We haven’t had that problem in Austin,” she said. For example, this flu season, she only has one Xofluza prescription that she needed to send to another pharmacy because the first pharmacy was out of stock.

But overall, “Xofluza is growing in popularity more than Tamiflu,” Brown said.

“One dose. Fewer side effects. Most insurances are now covering the cost of it and the manufacturer’s coupons make it less expensive than in previous years,” she said, adding that she prefers it for her patients. “But all of the above factors — cost, pill-swallowing, availability — can affect that decision.”

Another factor that could affect decisions: There is growing concern about influenza viruses developing resistance to Xofluza.

“It’s more on the clinician’s mind — and I think that’s one of the reasons it’s not used more often — that influenza viruses can develop resistance to baloxavir, Xofluza, during treatment,” said Dr. William Schaffner said.

“It’s sometimes around 10% of the time, so it’s not trivial. And that’s why I think the long-term side of Tamiflu is — that and the side effect of diarrhea,” he said. “So, Tamiflu is prescribed more often, despite the fact that you have to take it for five days.”

Xofluza resistance is emerging more frequently in young children, said Dr. Tim Uyeki of the CDC’s Clinic Outreach and Communication Activity (COCA) said on a call earlier this month.

“This emergence of baloxavir resistance is associated with longer duration of symptoms,” Uyeki said during the call. “Fortunately, person-to-person transmission of baloxavir-resistant viruses is very, very limited. It has been reported, but it appears to be very uncommon and there is no circulation of baloxavir-resistant viruses or oseltamivir-resistant viruses in the general population.”

National influenza experts discussed at the COCA call whether Tamiflu or oseltamivir is preferred for treatment of hospitalized patients and progressive patients.

Xofluza is not recommended during pregnancy, breastfeeding, outpatients with complex or progressive disease, severely immunosuppressed individuals or hospitalized patients, as there is a lack of information on its use in these groups.

But there are conditions for which Xofluza may be preferred.

“For a patient with known or suspected influenza B, baloxavir is more effective against influenza B than oseltamivir,” Uyeki said during the call, adding that the drug “is generally well tolerated.”

“A single dose of baloxavir is not associated with many side effects and has fewer side effects than oseltamivir,” he said. “For patients, I think every patient would prefer a single oral dose of baloxavir, twice a day of oseltamivir treatment, over five days.”

At the end of the call, Uyeki added that researchers should continue to study the potential benefits of treating flu patients with a combination of antiviral drugs, especially those with severe disease.

“I think we need more data for treating influenza in hospitalized influenza patients, so severe influenza,” he said. “And for that we need more data for combination antiviral treatment, for example oseltamivir-plus-baloxavir.”

Create an account at CNN.com for more CNN news and newsletters