Helen Macdonald on side effects, Tamiflu, and the swine flu hotline

Helen Macdonald A hundred and five thousand people with flu symptoms were prescribed Tamiflu via the new hotline last week. But there are some unintended consequences. Although consultation rates for flu like symptoms are levelling, Pulse magazine reports on a new problem. Now patients are making appointments to see their GP complaining of the side effects of Tamiflu.

Dr Nigel Watson, chief executive of Wessex LMCs and a GP in New Milton, Hampshire told Pulse: “On balance, the swine flu line has taken a lot of the queries off, but there are people presenting with the side effects. It’s not the innocuous drug that the general public seem to think it is.”

There may be problems with misdiagnosis too via the hotline. In the same article another GP, Dr Mark Aley, reported seeing three patients in one day who had taken Tamiflu, although it was clear to him another diagnosis was behind their symptoms – such as tonsillitis.

“There are loads of people being misdiagnosed because of all the hype,” he said.

The side effects of antivirals have hit the headlines of the national press. Some newspapers report the findings of a cross-sectional survey study about the side effects of Oseltamivir in three London schools, published in Eurosurveillance.

103 respondents (40% response rate) took prophylactic medication in April or May. 53% experienced one or more side effect, 40% had gastrointestinal side effects, and 18% had mild neuropsychiatric effects, such as nightmares. 48% finished the course. These results broadly reflect other evidence emerging.

Speaking to The Times about the findings, Peter Holden, the British Medical Association’s lead on swine flu, suggested that antivirals were being overused. He said: “The National Pandemic Flu Service has been a great success, and was needed to take the pressure off GPs, but the threshold for getting Tamiflu should be quite high. For patients who are not in the high-risk groups this virus typically causes mild symptoms and does not require a course of Tamiflu. Patients in the at-risk groups should be referred to their GP, who will use their clinical judgment.”

The Medicines and Healthcare Products Regulatory Agency (MHRA) told Pulse magazine that it will continue to monitor the safety of Tamiflu and Relenza as their use increases.

Helen Macdonald is editorial registrar, BMJ.