Baloxavir Marboxil

Class and Category
Pharmacologic Class: Polymerase acidic endonuclease inhibitor
Therapeutic Class: Influenza antiviral

Indications and Dosages
To treat acute uncomplicated influenza in patients who have been symptomatic for no more than 48 hours and who are otherwise healthy, or at high risk of developing influenza-related complications.

Adults and children 12 years and over weigh at least 80 kg (176 lb). 80 mg as a single dose.
Adults and children 12 years and over weighing 40 kg (88 lb) to less than 80 kg (176 lb). 40 mg as a single dose.

Mechanism of Action
Inhibits the endonuclease activity of the polymerase acidic protein, an influenza virus-specific enzyme required for viral gene transcription. This action prevents the influenza virus from being replicated.

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Antacids, laxatives, oral supplements, and other polyvalent cation-containing products (e.g., calcium, iron, magnesium, selenium, or zinc): Possibly decreased plasma concentrations of baloxavir which may reduce its effectiveness live attenuated intranasal influenza vaccine: Possibly decreased effectiveness of vaccination

Calcium-fortified beverages, dairy products: Possibly decreased effectiveness of baloxavir.

Adverse Reactions
CNS: Abnormal behavior, delirium, hallucinations, headache
EENT: Nasopharyngitis, sinusitis
GI: Bloody diarrhea, colitis, diarrhea, nausea, vomiting
RESP: Bronchitis
SKIN: Erythema multiforme, rash, urticaria
Other: Anaphylaxis, anaphylactic shock, angioedema

Childbearing Considerations

It is not known if drugs can cause fetal harm.
Use with caution only if the benefit to the mother outweighs the potential risk to a fetus.

It is not known if the drug is present in breast milk.
The patient should check with the prescriber before breastfeeding.

Nursing Considerations
  1. Be aware that baloxavir is not effective in treating infections other than influenza.
  2. Know that baloxavir should be administered to patients who have had flu symptoms for no more than 48 hours.
  3. Do not administer baloxavir with calcium-fortified beverages, dairy products, or drugs that contain cation-containing products such as calcium, iron, magnesium, selenium, or zinc.
WARNING: Monitor the patient closely for hypersensitivity reactions that could be life-threatening. Be prepared to provide emergency treatment per institutional protocol.

  1. Inform patient that baloxavir will be administered only once.
  2. Instruct patient that drug must not be taken with a calcium-fortified beverage or a meal containing dairy products. Also, tell patient to alert prescriber if he is taking any drugs that contain calcium, iron, magnesium, selenium, or zinc, because baloxavir may not be as effective when taken with such drugs.
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