Posted on 08/04/2025 5:44:37 PM PDT by nickcarraway
Flu itself, not oseltamivir, was tied to serious neuropsychiatric events, analysis suggests
Key Takeaways
-Compared with untreated flu, oseltamivir treatment reduced the risk of serious neuropsychiatric events in children.
-Prescribing information for oseltamivir carries warnings about abnormal behavior in kids with flu based on case reports.
-Concerns about possible side effects may contribute to oseltamivir being underused in kids at high risk for flu complications.
-Treatment with the antiviral oseltamivir (Tamiflu) was tied to a reduced risk of serious neuropsychiatric events in children and adolescents, an analysis of Medicaid beneficiaries in Tennessee suggested.
Compared with untreated flu, the risk of serious neuropsychiatric events was lower in kids treated with oseltamivir during flu exposure periods (adjusted incidence rate ratio [IRR] 0.53, 95% CI 0.33-0.88) and post-treatment periods (adjusted IRR 0.42, 95% CI 0.24-0.74), reported James Antoon, MD, PhD, MPH, of Vanderbilt University in Nashville, Tennessee and colleagues.
Relative risks of neuropsychiatric events also were low during periods with neither flu exposure nor oseltamivir dispensing (adjusted IRR 0.08, 95% CI 0.06-0.11) and during oseltamivir prophylaxis periods (adjusted IRR 0.10, 95% CI 0.03-0.32) compared with untreated flu, the researchers wrote in JAMA Neurologyopens in a new tab or window.
"Influenza antivirals are safe and effective and should be used as early as possible during influenza illness. Yet, they are substantially underused, especially in children," Antoon said.
"Almost 40% of children at high risk for influenza complications do not receive antiviral treatment. One important reason for this is concern about possible neuropsychiatric side effects," he told MedPage Today.
"We found that influenza itself, rather than oseltamivir, is associated with neuropsychiatric events," Antoon stated. "In fact, oseltamivir treatment lowered the risk of neuropsychiatric events in children by about 50%."
The findings raise questions about warnings on oseltamivir's label. Postmarketing surveillanceopens in a new tab or window in 2005 suggested an increase in serious neuropsychiatric events among children using oseltamivir, prompting the FDA to change oseltamivir's warning label, Antoon and colleagues noted. Prescribing informationopens in a new tab or window for oseltamivir now states that some flu patients who receive the drug, particularly pediatric patients, may be at an increased risk of confusion or abnormal behavior early in their illness.
"It is important to note that these warnings were placed on the basis of case reports rather than studies on associated risks for these events," Antoon and co-authors wrote.
The CDCopens in a new tab or window and the American Academy of Pediatricsopens in a new tab or window recommend antiviral treatment with drugs like oseltamivir for children with suspected or confirmed influenza who are hospitalized or have severe or progressive disease, or those who have underlying conditions that increase their risk of complications.
In their analysis, Antoon and colleagues studied children ages 5 to 17 years who were enrolled in Tennessee Medicaid during the 2016 to 2017 and 2019 to 2020 flu seasons.
The primary outcome was a neuropsychiatric event requiring hospitalization. The primary comparison for the study was treated flu versus untreated flu.
Each person-day of follow-up was assigned to one of five mutually exclusive exposure groups: (1) untreated flu, (2) treated flu, (3) post-treatment period (between oseltamivir completion and end of flu period), (4) flu prophylaxis, and (5) no exposure.
The cohort included 692,295 children (median age 11 years and 50.3% girls) who experienced 1,230 serious neuropsychiatric events during 19,688,320 person-weeks of follow-up. Clinical characteristics were generally similar across exposure groups.
There were 129,134 children and 151,401 flu episodes. Among kids with a flu episode, 66.7% were dispensed oseltamivir; most were dispensed the drug the same day as their flu diagnosis. Among children at high risk for flu complications, 60.1% received an antiviral.
Overall, the most common serious neuropsychiatric events in the study were mood disorders (36.3%) and suicidal or self-harm behaviors (34.2%), followed by seizures (13.7%). Seizures (34.1%) were the most common events during flu exposure periods.
Secondary analyses suggested the study's findings were driven more by a reduction in neurologic events (adjusted IRR 0.45, 95% CI 0.25-0.83) than psychiatric events (adjusted IRR 0.80, 95% CI 0.34-1.88) among oseltamivir-treated children.
The analysis did not account for influenza strain or vaccination status, which are not reliably captured in databases, the researchers acknowledged.
The study focused on neuropsychiatric events that required hospitalization, they added. Findings might not apply to children outside of Tennessee's pediatric Medicaid population.
Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and more. Follow
That’s annoying. The same thing is happening with the antibiotic fearmongering. I am SO SICK of the false “extremes” that does nothing but lead to unnecessary pain and death.
Like: NO just because I don’t believe in a Covid mandate, doesn’t mean I an against ALL vaccines and herd immunity 🙄.
Just because one takes antibiotics for a week (low dose at that) doesn’t mean they’ve jeopardized their system forever.
Just because one takes Tylenol doesn’t mean they’re an opioid addict who abandons health and fitness.
Same goes for tamiflu. So ridiculous.
Did the kids have mood disorders, suicidal ideation or self-harming behavior prior to the vaccine and/or the flu?
The other example are the literal Nazi mommy wars over nursing vs. formula feeding. 🙄 Just get the baby fed, my goodness.
and we should be fighting disease BOTH holistically AND with the help of pharmaceutical drugs. Eastern AND Western medicine.
I've never heard anyone say taking Tylenol makes on an opioid addict. Where do you get that?
Tamiflu is not a vaccine, it's an antiviral.
What is the fearmongering about antibiotics?
Antibiotics are great and save lives, but almost everyone agrees they are irresponsibly prescribed. The problem is resistant bacteria because of this irresponsibility? Ever heard of MRSA? Why do doctors have to prescribe antibiotics for something antibiotics will never help?
The false dichotomy between holistic vs. medical interventionist crowd.
I agree. I went to an integrated doctor who went to a top medical school, but also used “alternate medicine,” although I’m not sure I like the term.
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