A Cross-Sectional Study of Psychiatric Manifestations Following Oseltamivir Administration for Suspected Patients with H1N1 Swine Influenza Infection

Document Type : Original Article


1 Department of Respiratory Medicine, Bangalore Medical College & Research institute, Bangalore, India.

2 Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore, India.

3 Department of Medicine, Bangalore Medical College & Research Institute, Bangalore, India.


Introduction: Oseltamivir is an antiviral drug used to treat H1N1 influenza. FDA added a warning to the label of oseltamivir drawing attention to the risk of developing neuropsychiatric adverse events. There are some case reports reported psychiatric symptoms on oseltamivir intake. However, data is scarce on the emergence of psychiatric symptoms following oseltamivir administration.
Materials and Methods: Sixty patients, who received oseltamivir for prophylaxis or treatment for H1N1 swine influenza in the preceding six months, were enrolled in this study. The mini neuropsychiatric screener for DSM4 and a semi-structured proforma was applied that included socio-demographic information of patients, past psychiatric history, medical comorbidities, use of concomitant medication, dose and duration of use of oseltamivir. T-test and chi-square test were used to compare parametric data and categorical data respectively. P-value ≤ 0.05 was used for statistical significance.
Results: Of 60 patients, 22(36.67%) patients had developed psychiatric symptoms after receiving oseltamivir. 11(50%) patients had sleep issues, and there were 6(27%) patients with delirium, 3(9%) with depression and 3(9%) with anxiety and 1(5%) with psychosis. Among 22 patients, 4 subjects had past history of psychiatric illness (p-value = 1.00) and 15 had past medical illness (p-value = 0.003). Patients who developed psychiatric manifestations were significantly older (p-value: 0.05) and had lower years of education (p-value: 0.01).
Conclusions: 36.67% of patients developed psychiatric side effects following oseltamivir use. Predominant symptoms included sleep issues and delirium. Those who developed psychiatric symptoms had a significant background history of medical illness. Therefore, it is recommended that those who receive oseltamivir regularly be screened for psychiatric symptoms.


  1. Chen R, Fang Z, Huang Y. Neuropsychiatric events in an adult patient with influenza a (H3N2) treated with oseltamivir (Tamiflu): a case report. BMC infectious diseases. 2019 Dec;19(1):1-4.
  2. Shun-Shin M, Thompson M, Heneghan C, Perera R, Harnden A, Mant D. Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. Bmj. 2009 Aug 10;339.
  3. Whitley RJ, Hayden FG, Reisinger KS, Young N, Dutkowski R, Ipe D, et al. Oral oseltamivir treatment of influenza in children. The Pediatric infectious disease journal. 2001 Feb 1;20(2):127-33.
  4. Shaik AB, Prabhu M, Shenoy S, Thomson SR. Oseltamivir-induced neuropsychiatric symptoms. Journal of Pharmacology and Pharmacotherapeutics. 2018 Jan 1;9(1):43.
  5. Dalvi PS, Singh A, Trivedi HR, Mistry SD, Vyas BR. Adverse drug reaction profile of oseltamivir in children. Journal of pharmacology & pharmacotherapeutics. 2011 Apr;2(2):100.
  6. Haque SF, Nizami S. Neuropsychiatric symptoms in the pediatric population after administration of oseltamivir. American Journal of Psychiatry Residents' Journal. 2017 Feb 1;12(2):18-9.
  7. Nakamura K, Schwartz BS, Lindegårdh N, Keh C, Guglielmo BJ. Possible neuropsychiatric reaction to high-dose oseltamivir during acute 2009 H1N1 influenza A infection. Clinical Infectious Diseases. 2010 Apr 1;50(7):e47-9.
  8. Jeon SW, Han C. Psychiatric symptoms in a patient with influenza A (H1N1) treated with oseltamivir (Tamiflu): a case report. Clinical Psychopharmacology and Neuroscience. 2015 Aug;13(2):209.
  9. Matheson NJ, Harnden A, Perera R, Sheikh A, Symmonds‐Abrahams M. Neuraminidase inhibitors for preventing and treating influenza in children. Cochrane Database of Systematic Reviews. 2007(1).
  10. Yoshino T, Nisijima K, Shioda K, Yui K, Kato S. Oseltamivir (Tamiflu®) increases dopamine levels in the rat medial prefrontal cortex. Neuroscience letters. 2008 Jun 13;438(1):67-9.
  11. Morimoto K, Nagaoka K, Nagai A, Kashii H, Hosokawa M, Takahashi Y, et al. Analysis of a child who developed abnormal neuropsychiatric symptoms after administration of oseltamivir: a case report. BMC neurology. 2015 Dec;15(1):1-5.
  12. Chung S, Joung YS. Oseltamivir (tamiflu) induced depressive episode in a female adolescent. Psychiatry investigation. 2010 Dec;7(4):302.
  13. Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of clinical psychiatry. 1998 Jan 1;59(20):22-33.
  14. Han N, Oh JM, Kim IW. Assessment of adverse events related to anti-influenza neuraminidase inhibitors using the FDA adverse event reporting system and online patient reviews. Scientific reports. 2020 Feb 20;10(1):1-8.
  15. Lan CC, Liu CC, Chen YS. Acute exacerbation of psychiatric symptoms during influenza treatment with oseltamivir in chronic schizophrenia. Journal of the Chinese Medical Association. 2015 Jun 1;78(6):374-6.
  16. Çiftçi E, Karbuz A, Kendirli T. Influenza and the use of oseltamivir in children. Turkish Archives of Pediatrics/Türk Pediatri Arşivi. 2016 Jun;51(2):63.
  17. Treanor JJ. Influenza viruses, including avian influenza and swine influenza. Principles and practice of infectious diseases. Philadelphia: Churchill Livingstone. 2010:2265-88.
  18. Rothberg MB, Haessler SD. Complications of seasonal and pandemic influenza. Critical care medicine. 2010 Apr 1;38:e91-7.
  19. Toovey S, Rayner C, Prinssen E, Chu T, Donner B, Thakrar B, et al. Assessment of neuropsychiatric adverse events in influenza patients treated with oseltamivir. Drug Safety. 2008 Dec;31(12):1097-114.
  20. Lan CC, Liu CC, Chen YS. Acute exacerbation of psychiatric symptoms during influenza treatment with oseltamivir in chronic schizophrenia. Journal of the Chinese Medical Association. 2015 Jun 1;78(6):374-6.