Case Report

By Dr. Alka Sharma , Mr. Ramanpreet Dua , Mr. Pushpendra Verma , Mr. Vishal Sharma
Corresponding Author Mr. Vishal Sharma
University College of Medical Sciences, - India
Submitting Author Mr. Vishal Sharma
Other Authors Dr. Alka Sharma
University college of medical sciences, - India

Mr. Ramanpreet Dua
University college of Medical sciences, - India

Mr. Pushpendra Verma
University college of Medical sciences, - India


Influenza, Oseltamavir, Adverse Effect, Epistaxis, H1N1

Sharma A, Dua R, Verma P, Sharma V. Epistaxis With Oseltamavir. WebmedCentral GENERAL MEDICINE 2010;1(9):WMC00599
doi: 10.9754/journal.wmc.2010.00599
Submitted on: 11 Sep 2010 04:57:47 PM GMT
Published on: 12 Sep 2010 12:22:28 AM GMT


Oseltamavir is now being used on a large scale across the globe and this will contribute to the advancement of knowledge about side-effects and adverse events associated with use of oseltamivir. We would like to share our experience with regard to occurrence of epistaxis in two patients who were put on oseltamivir therapy for treatment of infection with novel strain of influenza (H1N1).

Case Report(s)

A 28 year old male presented with history of cough, nasal congestion and high grade fever for 2 days. He had developed dyspnoea for one day. He was febrile; had a respiratory rate of 32/min and his oxygen saturation on ambient air was 82%. He was otherwise hemodynamically stable. Auscultation of his chest revealed crackles in right infra-scapular region. Chest roentgenogram revealed infiltrates in right lower zone. Other investigations revealed a TLC of 12,000/mm3, Platelets-1.8 million/mm3, PT-13 seconds (control-12), and blood cultures were sterile. Swabs for H1N1 were returned positive by RT-PCR. He was put on oxygen inhalation, oseltamivir 75 mg BD, ceftriaxone. The patient improved with therapy. However on day four he developed epistaxis. The epistaxis was mild and no nasal packing was needed. We continued oseltamivir and patient was discharged after five days of therapy.
A 30 year old lady presented with history of fever, sore throat, running nose and cough for 4 days. She had no dyspnoea, tachypnea and maintained normal oxygen saturation on ambient air. Nasopharyngeal and oropharyngeal swabs for H1N1 were taken and the patient was put on Tab. Oseltamivir 75 mg BD for 5 days. The patient was advised home quarantine. The RT-PCR was positive for H1N1. On day three of the therapy, the patient informed that she had mild epistaxis which resolved on pinching the nose. We continued oseltamivir without recurrence of epistaxis.


Epistaxis has been noted in paediatric trials in a similar percentage as in placebo group.[1] The exact mechanism is not known. In these two adult patients, the epistaxis was self-abating and patients needed no active treatment.


Oseltamavir can cause epistaxis although the mechanism responsible is not clear.


TLC- Total leukocyte count

RT-PCR- Reverse transcriptase polymerase chain reaction.



Authors contribution(s)

AS and RD drafted the manuscript while VS and PV reviewed it. All authors were involved in management of the patient.


1. Buck ML. Oseltamivir: A New Option for the Management of Influenza in Children. Medscape med students. [serial on the Internet]. 2001 Jan [ Cited 2010 Jan 6] Avalaible at

Source(s) of Funding


Competing Interests



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Epistaxis with oseltamivir
Posted by Dr. Sourabh Aggarwal on 12 Sep 2010 02:44:11 AM GMT

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