Probenecid with Oseltamivir for Human Influenza A (H5N1) Virus Infection?

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     To the Editor: Probenecid is an inexpensive medication that was widely used when penicillin was in short supply. Owing to the current easy access to abundant supplies of penicillin, this approach is primarily of historical interest. In light of the limited supply of oseltamivir, however, it may be time to revisit the use of probenecid as adjunctive therapy for human influenza A (H5N1) virus infection. Coadministration of oseltamivir and probenecid has resulted in a reduction in the clearance of oseltamivir by approximately 50 percent and a corresponding doubling of the plasma levels of oseltamivir.1 Therefore, part of the planning for an H5N1 pandemic might well include consideration of ready access to probenecid. Existing supplies of oseltamivir might, arguably, be effectively doubled with the use of this approach. Further investigation might clarify any possible benefits and the optimal use of probenecid in this setting.

    Joseph C. Howton, M.D.

    Portland Adventist Medical Center

    Portland, OR 97201

    joehowton@wepmg.com

    References

    Hill G, Cihlar T, Oo C, et al. The anti-influenza drug oseltamivir exhibits low potential to induce pharmacokinetic drug interactions via renal secretion-correlation of in vivo and in vitro studies. Drug Metab Dispos 2002;30:13-19.

    http://www.100md.com/html/DirDu/2007/01/01/33/09/38.htm