Neuraminidase inhibitor

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Neuraminidase inhibitors are a class of drugs which block the neuraminidase enzyme. They are commonly used as antiviral drugs because they block the function of viral neuraminidases of the influenza virus, by preventing its reproduction by budding from the host cell. Oseltamivir (Tamiflu) a prodrug, Zanamivir (Relenza), Laninamivir (Inavir), and Peramivir belong to this class. Unlike the M2 inhibitors, which work only against the influenza A, neuraminidase inhibitors act against both influenza A and influenza B.[1][2][3][4] The neuraminidase inhibitors oseltamivir and zanamivir were approved in the US and Europe for treatment and prevention of influenza A and B.

The efficacy was highly debated in recent years.[citation needed] The benefits of neuraminidase inhibitors in those who are otherwise healthy do not appear to outweigh its risks.[citation needed] The combination of diagnostic uncertainty, the risk for virus strain resistance, possible side effects and financial cost outweigh the small benefits of oseltamivir or zanamivir for the prophylaxis and treatment of healthy individuals.[5] No benefit of treatment, on hospitalization, complications or risk of death has been found in randomized trials in those people at high risk for complications or the elderly.[5][6][7] The United States Centers for Disease Control continues to recommend the use of oseltamavir treatment for people at high risk for complications and the elderly and those at lower risk who present within 48 hours of first symptoms of infection.[8]

Common side effects include nausea and vomiting. For oseltamivir there were neuropsychiatric effects and for zanamivir bronchoconstriction occurred.

Specific neuraminidase inhibitors[edit]

Structures of the Viral neuraminidase inhibitors in use[edit]

Viral neuraminidase inhibitors in use
Zanamivir structure.svg Oseltamivir.svg Peramivir.svg Laninamivir.svg
Zanamivir Oseltamivir Peramivir Laninamivir

Natural products[edit]

See also[edit]


  1. ^ Smith, B. J.; McKimm-Breshkin, J. L.; McDonald, M.; Fernley, R. T.; Varghese, J. N.; Colman, P. M. (2002). "Structural Studies of the Resistance of Influenza Virus Neuramindase to Inhibitors". Journal of Medicinal Chemistry 45 (11): 2207. doi:10.1021/jm010528u. PMID 12014958. 
  2. ^ Gubareva, Larisa V (2004). "Molecular mechanisms of influenza virus resistance to neuraminidase inhibitors". Virus Research 103 (1-2): 199–203. doi:10.1016/j.virusres.2004.02.034. 
  3. ^ This flash animation shows the mode of action of oseltamivir (Tamiflu).
  4. ^ Replication of influenza virus.
  5. ^ a b Jefferson, Tom; Michiels, Barbara; Van Puyenbroeck, Karolien; Verhoeven, Veronique; Vermeire, Etienne; Coenen, Samuel (2013). "The Value of Neuraminidase Inhibitors for the Prevention and Treatment of Seasonal Influenza: A Systematic Review of Systematic Reviews". PLoS ONE 8 (4): e60348. doi:10.1371/journal.pone.0060348. ISSN 1932-6203. PMC 3614893. PMID 23565231. 
  6. ^ Ebell, MH; Call, M; Shinholser, J (April 2013). "Effectiveness of oseltamivir in adults: a meta-analysis of published and unpublished clinical trials". Family practice 30 (2): 125–33. doi:10.1093/fampra/cms059. PMID 22997224. 
  7. ^ Jefferson T, Jones MA, Doshi P, et al. (April 2014). "Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children". Cochrane Database Syst Rev 4: CD008965. doi:10.1002/14651858.CD008965.pub4. PMID 24718923. 
  8. ^ "CDC Online Newsroom - "Have You Heard?" Archive: 2014 - Influenza A Variant Virus". 
  9. ^ Swaminathan K, Dyason JC, Maggioni A, von Itzstein M, Downard KM (2013). "Binding of a natural anthocyanin inhibitor to influenza neuraminidase by mass spectrometry". Anal Bioanal Chem. 405 (20): 6563–72. doi:10.1007/s00216-013-7068-x. PMID 23748498.