Limited Coverage Drugs - zanamivir

Generic Name / Strength / Form
zanamivir

Criteria Approval Period
  1. Treatment and prophylaxis of influenza A or B during an outbreak situation, among permanent residents of licensed long-term care facilities (i.e., PharmaCare Plan B), upon direction from the Provincial Health Officer or designate;
 2010/11 influenza season
  1. Treatment of patients at high risk* (see below) of complications from influenza, who have either:
    1. Laboratory-confirmed influenza A or B sensitive to zanamivir;
      OR
    2. Signs and symptoms of influenza A or B ONLY WHEN influenza is confirmed to be circulating in the local community and sensitive to zanamivir, as per the British Columbia Centre for Disease Control influenza bulletin at www.bccdc.ca/dis-cond/DiseaseStatsReports/influSurveillanceReports.htm;

    AND

    Initiation of treatment should be within 48 hours of symptom onset, as this optimizes the benefit of zanamivir.

 2010/11 influenza season

*Patients at high risk of complications from influenza are defined as follows:

  • Adults ≥ 65 years of age, with or without chronic health conditions;
  • Adults (including pregnant women) less than 65 years of age, and children and adolescents 6 months to 18 years with the following chronic health conditions:
    • Cardiac or pulmonary disorders (e.g., chronic obstructive pulmonary disease, bronchopulmonary dysplasia, cystic fibrosis, asthma);
    • Diabetes and other metabolic diseases;
    • Cancer, immunodeficiency (including human immunodeficiency virus [HIV] infection), immunosuppression due to underlying disease or therapy (e.g., severe rheumatoid arthritis requiring immunosuppressive therapies, transplant);
    • Chronic kidney disease;
    • Chronic liver disease, including hepatitis C;
    • Anemia and hemoglobinopathy;
    • Conditions that compromise the management of respiratory secretions and are associated with an increased risk of aspiration (e.g., cognitive dysfunction, spinal cord injury, seizure disorder, and neuromuscular disorders);
  • Children and adolescents 6 months to 18 years with conditions treated for long periods with acetylsalicylic acid;
  • Adults who are morbidly obese (BMI ≥ 40);
  • Healthy children age 6 to 23 months;
  • Pregnant women;
  • Aboriginal peoples (on and off reserve).

Practitioner Exemptions

  • Not applicable. No Special Authority form is required.

Special Notes

  1. PharmaCare coverage is intended for antiviral treatment that is initiated within 48 hours of influenza symptom onset in the community setting, as evidence suggests that early initiation results in optimal outcomes (Treanor JJ et al. JAMA 2000;283:1016-1024 and Nicholson KG et al. Lancet 2000;355:1845-1850).
  2. Due to the risk of inappropriate utilization leading to antiviral resistance, clinicians are advised to be selective and judicious in their assessment of patients. Clinicians are advised to check the British Columbia Centre for Disease Control influenza bulletin (updated regularly) at www.bccdc.ca/dis-cond/DiseaseStatsReports/influSurveillanceReports.htm for the most recent information on circulating influenza strains and resistance patterns.
  3. PharmaCare coverage is not intended for patients who do not have symptoms of Influenza A or B, nor for post-exposure prophylaxis.
  4. Influenza immunization is one of the most effective methods for preventing influenza infection and its complications, and should be promoted to the entire population whenever possible. Patients at high risk for complications from influenza should be immunized annually.
  5. Zanamivir is indicated for patients 7 years of age or older and those capable of using the inhalation device.

Special Authority Request Forms

No Special Authority Request form is required.