What To Do If You Contract Influenza
Including H1N1 (Swine) Flu or the Common Cold

Quadruple Antiviral Drug Therapy

If one develops common influenza or the swine flu, it would make sense to immediately initiate Tamiflu® (oseltamivir) antiviral drug therapy in the normal dose of 75 mg twice a day (for five continuous days). In treating severe swine flu infections, ask your doctor to consider prescribing as high as double the recommended dose of Tamiflu®, which would be 150 mg twice a day, and to do this for five continuous days.

Life Extension® members were informed about Tamiflu® in June 2003. Now that the media has made H1N1 (swine) flu headline news stories, Tamiflu® has become a household word. In reaction to the avian flu scare in 2005, there was a shortage of Tamiflu®. We reminded members back then that another antiviral drug called Relenza® (zanamivir) is available and may have certain advantages over Tamiflu®.

Relenza® functions by the same antiviral mechanism as Tamiflu®. The advantage of Relenza® is that it is administered as an inhalant and delivered directly into the lungs. Since the H1N1 (swine) virus inflicts its lethal effects primarily in the lungs, Relenza® might be more effective than Tamiflu® in combating H1N1-induced pneumonia.

The problem with using only Relenza® is that swine flu rapidly can progress to a systemic illness. While Relenza® does exert some systemic effects, it might be best suited to eradicate swine flu viral replication in the lungs. Thus, one would still want the additional systemic antiviral benefits of Tamiflu®.

Relenza® and Tamiflu® interfere with viral infections by blocking the active site of the influenza viral enzyme called neuraminidase. Drugs that inhibit neuraminidase cause influenza viruses to aggregate at the body’s cell surface and reduce the number of viruses released from infected cells. Since Relenza® and Tamiflu® are both neuraminidase inhibitors, doctors often believe that a person should only take one of these drugs (i.e., Relenza® or Tamiflu®) when treating swine or other influenza viral infections.

Those seriously infected with swine flu may ask their doctors to consider 75 mg twice a day of oral Tamiflu®, along with the inhaled dose of 5 mg of Relenza® twice a day. Relenza® and Tamiflu® have both been used at higher doses without apparent toxicity.

As with most currently available antiviral drugs, treatment with Relenza® or Tamiflu® should start in the first 48 hours after the onset of symptoms. (Refer to the attached addendum before initiating Relenza® therapy.)

The drug ribavirin inhibits viruses via mechanisms that are different than those of Tamiflu® and Relenza®. One of these mechanisms is to disrupt viral RNA synthesis, causing viruses to self-destruct. Ribavirin is available as a 200 mg oral capsule and in inhalant form. If one contracts a severe case of swine flu, it would appear logical to ingest 800-1,200 mg a day of ribavirin in oral capsule form, in addition to Tamiflu® and/or Relenza®.

If you are in a hospital setting, it might be appropriate to find a lung specialist (pulmonologist) who will consider prescribing and then administering ribavirin in an aerosolized liquid spray via a nebulizer. By inhaling ribavirin, it may be possible to adequately inhibit viral replication in the lungs. You may need to find a cooperative pediatrician to arrange this because aerosolized ribavirin is only approved to treat infants and small children with severe forms of pneumonia. Your doctor will have to calculate a higher dose of aerosolized ribavirin based on your weight and clinical condition.

I use the term “consider” when asking a doctor to prescribe aerosolized ribavirin since there are no studies in which inhaled Relenza® and aerosolized inhaled ribavirin have been used together. There is always a possibility of adverse interactions between these two inhaled drugs. On the flip side, if you are stricken with a severe case of swine flu, your doctor should be more willing to consider unproven therapies that have a logical basis of efficacy.

Amantadine is a drug approved by the FDA to treat influenza A. This drug functions by inhibiting the activity of the M2 protein in a way that precludes the influenza virus from replicating once it is inside a cell. As with other antiviral drugs, treatment should be initiated within 48 hours. When amantadine is administered later in the course of a viral infection, it is virtually useless as the body is already overwhelmed with viral particles.

Amantadine was extensively given to chickens over the past decades to treat avian flu. Chickens have since developed a resistance to this drug. That does not mean, however, that amantadine might not be effective in a human who contracted the swine or other forms of influenza. Since amantadine works via mechanisms that are different than Tamiflu®/Relenza® and ribavirin, it might be logical to add 100 mg a twice a day of amantadine in addition to ribavirin and Relenza® and Tamiflu®. (If you are over age 65, the recommended dose of amantadine is 100 mg a day or less.)

One concern with amantadine is that influenza viruses often develop rapid resistance to amantadine. In a swine influenza pandemic, amantadine might rapidly become ineffective. That does not mean, however, that those who contracted the first human transmitted cases of swine flu might not benefit from amantadine.

Obtaining Physician Cooperation

My fear is that as the current swine flu pandemic progresses, people will needlessly die because of physician ignorance. I know that persuading your physician to prescribe quadruple antiviral drug therapy, in the event severe influenza manifests, will be a challenge.

Amantadine is considered worthless by most doctors because they have seen it fail most of the time. As I stated earlier, antiviral drug therapy should be initiated within 48 hours of the symptoms manifesting. Doctors are used to seeing patients only after they have suffered with flu symptoms for many days after the onset of symptoms. When doctors prescribe amantadine to these advanced influenza patients, it usually fails, just like Tamiflu® will fail if it is not quickly prescribed. Few doctors have any experience with either oral or inhaled ribavirin and will therefore be reluctant to prescribe it.

My objective is to not allow any member of the Life Extension Foundation® to succumb to influenza because of physician inflexibility. If you are a Life Extension® member and contract severe influenza, please call us so that one of our doctors can attempt to persuade your physician to implement the aggressive treatments described in this article.

Keeping You Informed

The US Centers for Disease Control & Prevention indicate that anywhere from 5% to 20% of the U.S. population contracts influenza each year, an average of about 36,000 people per year in the United States die from influenza, and more than 200,000 will be admitted to the hospital as a result of influenza.121

I have written this article based on numerous inquiries made by Foundation members. There are additional strategies that may be considered to combat common cold-flu infections, but I wanted to convey what I do personally when confronted with a virus.

The fact that the recommendations made at the beginning of this article have worked for me does not mean they will work for you. There is a scientific rationale, however, to using cimetidine, garlic, and other readily available and inexpensive agents when confronted with a viral illness. The FDA, of course, does not approve any of these approaches.

If one contracts an influenza virus, the immediate initiation of aggressive antiviral (and anti-cytokine) therapies is paramount. Whether or not you actually contract swine flu, it makes sense to initiate aggressive actions if you contract flu-like symptoms. Early treatment of common cold or typical flu viruses can result in rapid eradication of the virus from your body.

As a Life Extension® member, please be assured that we are committed to providing you and your doctor with scientifically backed information to most logically combat influenza viruses.

Caution: If you are taking any medications or have serious health problems, you must first consult with your own health care professional before following this strategy. Those with certain hormone-sensitive cancers, for example, may not want to take DHEA. This article is for informational purposes only and not intended as a substitute for advice from your physician or other health care professional. There are side effects to all of the drugs discussed in this letter, making it crucial that you have a knowledgeable health professional overseeing your treatment.

Antiviral Drug Addendum

The FDA approved Relenza® (zanamivir)123 is an antiviral drug for persons aged seven years and older for the treatment of uncomplicated influenza virus. This product is approved to treat type A and B influenza, the two types most responsible for flu epidemics. Clinical studies show that for the drug to be effective, patients needed to start treatment within two days of the onset of symptoms. The drug seemed to be less effective in patients whose symptoms weren’t severe or didn’t include a fever. Relenza®is a powder (5 mg) that is inhaled twice a day for five days from a breath-activated plastic device called a Diskhaler®. Patients should get instruction from a healthcare practitioner in the proper use of the Diskhaler®, including a demonstration when possible. Relenza® has not been shown to be effective, and may carry risk, in patients with severe asthma or a lung condition called chronic obstructive pulmonary disease. Some patients with mild or moderate asthma experienced bronchospasm (marked by shortness of breath) after using Relenza®. When treating influenza, a seven-day course of Relenza® may be considered.

Some patients have had bronchospasm (wheezing) or serious breathing problems when they used Relenza®. Many but not all of these patients had previous asthma or chronic obstructive pulmonary disease. Relenza® has not been shown to shorten the duration of influenza in people with these diseases. Because of the risk of side effects and because it has not been shown to help them, Relenza® is not generally recommended for people with chronic respiratory disease. Anyone who develops bronchospasm-worsening respiratory symptoms such as wheezing and shortness of breath should stop taking the drug and call their healthcare provider. Patients with underlying respiratory disease should have a fast-acting inhaled bronchodilator available when taking Relenza®.

Ribavirin is “probably a teratogen,” so women even remotely likely to become pregnant should be very careful when using it.

Ribavirin stays in the body up to six months after a course (it builds up in red cells and doesn’t leave the body until all of them have been replaced), so women should be aware that its reproductive dangers will last that long as well.

There are warnings about all the drugs mentioned in this article that should be reviewed before any individual considers using them.

If you have any questions on the scientific content of this article, please call a Life Extension® Health Advisor at 1-866-864-3027.