Zanamivir alternatives: what to use for the flu

Zanamivir (Relenza) is an inhaled antiviral that works well for some people, but it’s not the only option — and sometimes it’s not the best one. If you have asthma, COPD, trouble using inhalers, or simply prefer a pill, there are solid alternatives that treat influenza effectively.

Quick note: antivirals work best when started within 48 hours of symptoms. If you’re high-risk (young kids, pregnant, elderly, immunocompromised, or with chronic health problems), call your provider early — treatment can still help even after 48 hours in some cases.

Top prescription alternatives

Oseltamivir (Tamiflu) is the most common alternative. It’s an oral neuraminidase inhibitor like zanamivir but taken as a capsule or liquid. Doctors prescribe it for mild to severe influenza and for prevention in exposed people. Many like it because it’s easy to take and works across most flu strains.

Baloxavir marboxil (Xofluza) is a newer oral option with a different mechanism — it blocks viral replication at an earlier step. One big plus: it’s a single dose for uncomplicated flu in otherwise healthy people. That can be handy if adherence is a concern, but it may not be right for everyone, so check with your clinician.

Peramivir (Rapivab) is given as a single intravenous dose and is used mainly in hospitals or for patients who can’t take oral or inhaled drugs. It’s useful for severe cases or when vomiting prevents oral meds from staying down.

Other choices and practical tips

Some countries also use favipiravir for flu in certain situations. It’s an oral antiviral with a different action and is often used where other options are limited. Monoclonal antibodies and newer agents are in development, but those are usually for severe cases or special groups.

If you can’t or don’t want antivirals, focus on symptom care: rest, fluids, fever control (acetaminophen or ibuprofen), and staying isolated to avoid spreading the virus. Over-the-counter cough medicines, throat lozenges, and humidifiers can ease symptoms but don’t shorten the illness.

One important point: zanamivir isn’t safe for people with reactive airway disease because inhaling the drug can trigger wheeze or bronchospasm. That’s a common reason clinicians pick oseltamivir or baloxavir instead.

Resistance can happen with any antiviral. Your doctor will consider recent local flu strains, resistance patterns, your health history, and practical issues like swallowing or hospitalization when choosing a drug.

If you’re unsure which option fits your situation, call your healthcare provider or local clinic. For quick access, many clinics can test and prescribe the right antiviral the same day. Early action matters — simple choices now can cut symptoms and complications later.