Drug vs. Drug

Tamiflu vs. Xofluza: Differences, similarities, and which one is better for you

By | November 8, 2019

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

When it comes time for flu season, it’s best to be prepared when knowing what your treatment options are. Besides getting a flu shot every year, which is highly recommended, there are medications available in case you come down with the flu. These drugs can help reduce the severity and duration of flu symptoms such as headache, fever, fatigue, and muscle or joint pain.

Two FDA-approved flu treatments include Tamiflu (oseltamivir) and Xofluza (baloxavir marboxil). Although both of these drugs can treat the flu, they work in different ways and have different side effects. Read on to find out how these drugs compare.

What are the main differences of Tamiflu vs. Xofluza?

Tamiflu is the brand name for oseltamivir, which was approved in 1999. It works as a neuraminidase inhibitor (NAI) that stops the release of the flu virus from infected cells. By doing this, it decreases the spread of the virus throughout the body. Tamiflu is usually given twice daily for five days.

Xofluza is the brand name for baloxavir marboxil, which was recently approved in 2018. This new drug works as a PA endonuclease inhibitor that stops the flu virus from making copies of itself. In this way, Xofluza works differently compared to other antiviral drugs like Tamiflu (oseltamivir) and Relenza (zanamivir). The drug only needs to be taken once as a single dose.

Tamiflu Xofluza
Drug class Antiviral

Neuraminidase inhibitor

Antiviral

Polymerase acidic (PA) endonuclease inhibitor

 

Brand/generic status Generic version available Generic version not currently available
What is the generic name?

Or

What is the brand name?

Brand name: Tamiflu

Generic name: Oseltamivir

Brand name: Xofluza

Generic name: Baloxavir marboxil

What form(s) does the drug come in? Oral tablet

Powder for oral suspension

Oral tablet
What is the standard dosage? Treatment of uncomplicated influenza:

13 years and older: 75 mg twice daily for 5 days

1 to 12 years old: Dosage depends on weight, twice daily for 5 days

2 weeks to less than 1 year old: 3 mg/kg twice daily for 5 days

Prevention of influenza:

13 years and older: 75 mg once daily for at least 10 days

1 to 12 years old: Dosage depends on weight, once daily for 10 days

Treatment of uncomplicated influenza:

12 years and older with a body weight of 90 to 180 lbs (40 to 80 kg): Two 20 mg tablets taken together as a single dose of 40 mg

12 years and older with a body weight of 90 to 180 lbs (40 to 80 kg): Two 40 mg tablets taken together as a single dose of 80 mg

How long is the typical treatment? Treatment: 5 days

Prevention: 10 days

*Preventative treatment during a community outbreak may last up to 6 weeks

Treatment: 1 day with a single dose

 

Who typically uses the medication? Treatment: 2 weeks of age and older

Prevention: 1 year and older

Treatment: 12 years of age and older

Conditions treated by Tamiflu and Xofluza

Both Tamiflu and Xofluza are used as treatments for influenza. They are most effective when given at the first sign of symptom onset and before you’ve experienced symptoms for more than 48 hours. While both drugs can treat the flu, Tamiflu can also prevent it in those with a high risk of flu complications. It may especially be useful in those who have had close contact with an infected individual, are living in an area with a viral outbreak, or have a compromised immune system due to underlying medical conditions.

Use the following table to compare the approved medical uses and off-label uses of Tamiflu and Xofluza.

  Tamiflu Xofluza
Influenza A/H1N1 treatment Yes Yes
Influenza A/H3N2 treatment Yes Yes
Influenza B treatment Yes Yes
Influenza A/H1N1, influenza A/H3N2, and influenza B prevention Yes Off-label
Avian influenza (Bird Flu) treatment Off-label Yes

Is Tamiflu or Xofluza more effective?

Both Tamiflu and Xofluza are effective at alleviating symptoms faster than if you were to take a placebo or nothing at all. According to clinical trials, Tamiflu and Xofluza were found to decrease symptoms faster compared to placebo. In a clinical review, when compared with a placebo, Tamiflu was found to reduce the time to symptom improvement by 1 to 2 days. In the capstone-1 trial for Xofluza, there was a shorter time to symptom relief (a 26.5-hour difference) with Xofluza versus placebo.

When Tamiflu and Xofluza were compared in a trial, Xofluza seemed to be more effective with a shorter time to symptom improvement: 73 hours with Xofluza versus 81 hours with Tamiflu. Xofluza also shortened the time of viral shedding, or being contagious, at 48 hours compared to less than 96 hours with placebo or Tamiflu. This trial enrolled over 2,000 participants and included patients aged 12 years and older.

While Xofluza appears to be more effective, viral resistance has become a concern. In Japan, some influenza strains were found to have resistance to Xofluza, making it less effective. This resistance has not yet been seen in the United States.

Coverage and cost comparison of Tamiflu vs. Xofluza

Tamiflu can be purchased with a prescription and is typically covered by insurance, Medicare, and Medicaid. It is available in both brand and generic versions. A 10-day supply of brand name Tamiflu capsules can cost between $155 to $170 without insurance. A 10-day supply of generic oseltamivir capsules can cost between $20 and $50. You can use a SingleCare discount coupons to save on Tamiflu at your nearest pharmacy.

Xofluza is also purchased with a prescription and is covered by insurance, Medicare, and Medicaid depending on the plan. It is only available as a brand name pill. Out-of-pocket costs for Xofluza can be between $150 and $180. Check to see if you can use a SingleCare discount coupon to save on Xofluza at your nearest pharmacy.

  Tamiflu Xofluza
Typically covered by insurance? Yes, depending on the plan Yes, depending on the plan
Typically covered by Medicare? Yes, depending on the plan Yes, depending on the plan
Standard dosage 30 mg, 45 mg, 75 mg oral capsules

 

360 mg powder for 6 mg/mL oral suspension

20 mg and 40 mg oral tablets
Typical Medicare copay $10 – $200 $30 – $170
SingleCare cost $30 $160

Common side effects of Tamiflu and Xofluza

Tamiflu and Xofluza share some similar side effects such as nausea and headache. Based on clinical trials, Tamiflu may have a higher occurrence of these side effects. Other common side effects of Tamiflu include vomiting and pain, according to the label from the U.S. Food and Drug Administration. Other common side effects of Xofluza include diarrhea, inflammation of the lung airways (bronchitis), and inflammation of the sinuses (sinusitis).

Tamiflu may cause more serious side effects such as skin or hypersensitivity reactions. These allergic reactions can start as rashes and become worse over time. There have also been reports of psychiatric events such as delirium, hallucinations, and abnormal behavior in those taking Tamiflu. These psychiatric events have mostly been reported in children in Japan.

Xofluza may also cause skin or hypersensitivity reactions. These reactions can be experienced as redness or itching. There is also a risk of bacterial infections when taking Xofluza.

  Tamiflu Xofluza
Side Effect Applicable? Frequency Applicable? Frequency
Nausea Yes 8-10% Yes 2%
Vomiting Yes 2-8% No
Headache Yes 2-17% Yes 1%
Diarrhea No Yes 3%
Bronchitis No Yes 3%
Sinusitis No Yes 2%

Source: DailyMed (Tamiflu), DailyMed (Xofluza).

Drug interactions of Tamiflu and Xofluza

Both Tamiflu and Xofluza can interact with the flu vaccine, specifically the live attenuated influenza vaccine. Because these drugs are antivirals, they can affect how well the flu vaccine works and reduce its efficacy. Therefore, the live influenza vaccine should not be given within 14 days before or two days after Tamiflu or Xofluza administration.

Xofluza may interact with medications that contain polyvalent cations. These medications can include laxatives, antacids, or supplements that contain calcium, iron, magnesium, zinc, and selenium. When used with Xofluza, these drugs can decrease the level of Xofluza in the body and decrease its effectiveness.

  Tamiflu Xofluza
Live attenuated influenza vaccine Yes Yes
Polyvalent cation-containing medications (products containing calcium, iron, magnesium, selenium, zinc, etc.) No Yes 

Warnings of Tamiflu and Xofluza

Tamiflu should be monitored in those with kidney problems. This is because kidney impairment may result in higher levels of Tamiflu in the body, leading to possible adverse events. Xofluza is not affected by kidney functions. However, its safety and effectiveness have not been studied in those weighing less than 40 kilograms.

Tamiflu and Xofluza are not recommended for anyone who has a known allergy to their active ingredients. Tamiflu and Xofluza have not been heavily studied in pregnancy. Their use in pregnancy should be evaluated by a healthcare provider as the benefits may outweigh the possible risks.

Frequently asked questions about Tamiflu vs Xofluza

What is Tamiflu?

Tamiflu (oseltamivir) is an antiviral medication used to treat or prevent the flu. It works as a neuraminidase inhibitor that blocks the spread of influenza A and B in the body. Using Tamiflu can shorten the time it takes for flu symptoms to improve. It is usually taken twice daily for five days.

What is Xofluza?

Xofluza (baloxavir marboxil) is an antiviral medication that can treat the flu. It is a PA endonuclease inhibitor that stops the influenza virus from copying itself in the body. Like Tamiflu, it can shorten the time to symptom improvement. Xofluza was developed by Shionogi Pharma and is prescribed as a single dose.

Are Tamiflu and Xofluza the same?

Tamiflu and Xofluza are both antiviral medications. But they are not the same. Although they both improve flu symptoms, they work differently and have different side effects.

Is Tamiflu or Xofluza better?

Tamiflu and Xofluza are both effective against the influenza virus. Xofluza is a newer drug that has been shown to improve flu symptoms faster than Tamiflu. It also only needs to be taken once, which some people may prefer. It’s important to discuss these options with a doctor to determine the best treatment for you.

Can I use Tamiflu or Xofluza while pregnant?

There is not enough clinical data to show that Tamiflu and Xofluza are safe in pregnant women. Although the evidence for use is lacking, their benefits may outweigh the risks of an influenza infection. Consult a doctor when deciding which medication to use if you are pregnant.

Can I use Tamiflu or Xofluza with alcohol?

There is no information on the drug labels that describe the effects of Tamiflu or Xofluza with alcohol. However, drinking alcohol can weaken the immune system and make it harder to fight the flu. Therefore, it’s not generally recommended to drink alcohol while sick.

Can you take Xofluza with Tamiflu?

No. It is not usually recommended to take Xofluza and Tamiflu together. These drugs are prescribed as separate, individual options for the flu. Depending on your medical history and overall condition, one drug may be prescribed over the other.