- - Tamiflu isn’t the only flu treatment available. These other options may fly under the radar – and provide relief

Jacqueline Howard, CNNDecember 26, 2025 at 5:40 PM

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A woman blows her nose while lying on the couch. - Guido Mieth/Moment RF/Getty Images/File

When the flu strikes, it can feel relentless: rising fever, hacking cough, stuffy nose and sore throat. For many people, relief can come in the form of Tamiflu, a prescription antiviral medication used to treat and even prevent the illness.

But some people may not realize that Tamiflu isn’t the only option.

Other flu treatments are available in the United States. These alternatives sometimes fly under the radar, in part because some are targeted for specific populations. But Xofluza, a one-dose pill, is approved for people 5 years and older – and can be a strong alternative for some people who may otherwise be prescribed Tamiflu.

Antiviral medications tend to work best when started within two days after symptoms begin, so having easy access to treatment options is key for treating the flu most effectively.

To treat flu this season, there are four antiviral drugs recommended by the US Centers for Disease Control and Prevention: Tamiflu or oseltamivir, Xofluza or baloxavir, Relenza or zanamivir, and Rapivab or peramivir.

Tamiflu is used to treat flu in people ages 2 weeks and older, and to reduce the chance of getting the flu in people 1 year and older. The medicine is administered in liquid form or capsules, and typically must be taken twice daily for five days when used for flu treatment. When used for prevention after exposure, it is typically taken once daily for 10 days. Available as a generic or under the trade name Tamiflu, it may cost about $50 or less without insurance. The most common side effects include nausea and vomiting.

As another option, Xofluza is administered as a single-dose tablet and approved for ages 5 and older. It can be used to treat or prevent the flu, and it may cost nearly $200 without insurance, but eligible patients can use coupons to lessen costs. The most common side effects include diarrhea and vomiting.

“The most common complaint I hear about is vomiting from Tamiflu,” Dr. Ari Brown, a pediatrician based in Texas and author of the Baby 411 book series, said in an email. She referenced a 2023 study that showed about 18% of people experience vomiting with Tamiflu versus 5% with Xofluza.

The study also found that about 5% of people get diarrhea with Xofluza compared with none taking Tamiflu. “I’ve also had a few pediatric patients experience moodiness with Tamiflu, which is reported in the literature,” she said.

The “biggest difference” between Tamiflu and Xofluza is that Xofluza can stop viral shedding in one day while Tamiflu may take about three days, Brown said.

That means the rest of the household may have less exposure to the flu and fewer people may come down with it, but “both antivirals will help reduce the duration of the misery by a couple of days,” Brown said. For instance, with treatment, some people may experience five days of flu symptoms instead of seven.

Rapivab is one of the other prescription medications approved to treat flu. The drug is approved for ages 6 months and older, given once as an intravenous infusion by a health care provider. It may cost up to about $1,000 without insurance, and the most common adverse reaction in adults tends to be diarrhea.

Lastly, Relenza is the other recommended flu medication. It is inhaled in powder form, and typically administered using an inhaler device twice a day for five days. The prescription drug is approved to treat flu in ages 7 and older, and for preventive use in ages 5 and older. It may cost up to about $90 without insurance. Side effects include allergic reaction, dizziness or irritation of the nose, and it is not recommended for people with breathing problems, such as asthma.

‘Xofluza is rising in popularity’

Among the recommended flu treatments, Tamiflu tends to be the go-to flu medication for most patients. But Xofluza is becoming more widely used, Brown said.

However, it may not always be available in pharmacies, recommended by providers or covered by insurance.

“I suspect it is region-dependent,” Brown said about access to treatment.

“When one part of the country has surging flu cases, there is higher demand. We have not encountered this issue in Austin,” she said. For instance, this flu season, she has only had one Xofluza prescription that she needed to send to a different pharmacy because the first pharmacy was out of stock.

But overall, “Xofluza is rising in popularity over Tamiflu,” Brown said.

“One dose. Fewer side effects. More insurances are covering the cost of it now and manufacturer coupon makes it less expensive than in previous years,” she said, adding that she prefers it for her patients. “But all of the factors above–cost, ability to swallow a pill, availability can impact that decision.”

Another factor that may impact decisions: There is a growing concern about the influenza virus developing resistance to Xofluza.

“This is more in the minds of the practitioner – and I think it has been one of the reasons it hasn’t been used more frequently – the influenza virus can develop resistance to baloxavir, to Xofluza, during the course of treatment,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center.

“That happens sometimes around 10% of the time, so it’s not trivial. And that’s why I think the longer-term Tamiflu continues to be favored – that and the side effect of diarrhea,” he said. “So, Tamiflu tends to be recommended more frequently, despite the fact that you do have to take it for five days.”

Xofluza resistance has appeared to occur even more frequently in younger children, Dr. Tim Uyeki, chief medical officer of the influenza division at the CDC’s National Center for Immunization and Respiratory Diseases, said during a call earlier this month of the CDC’s Clinician Outreach and Communication Activity (COCA).

“This emergence of baloxavir resistance is associated with a longer duration of symptoms,” Uyeki said during the call. “Fortunately, transmission of a baloxavir-resistant virus from person to person has been very, very limited. It’s been reported, but it appears to be very uncommon and there’s no circulation of baloxavir-resistant viruses or oseltamivir-resistant viruses in the general population.”

National influenza experts discussed on the COCA call that Tamiflu or oseltamivir is preferred for treating hospitalized patients and people with progressive illness.

Xofluza is not recommended during pregnancy, while breastfeeding, for outpatients with complicated or progressive illness, severely immunosuppressed people or hospitalized patients, because of the lack of information on its use for these groups.

But there are situations for which Xofluza may be preferred.

“For a patient with known or suspected influenza B, baloxavir has much greater efficacy against influenza B compared to oseltamivir,” Uyeki said during the call, adding that the medication is “generally well tolerated.”

“A single dose of baloxavir is not associated with many side effects and fewer side effects compared to oseltamivir,” he said. “For patients, I think every patient would prefer a single oral dose of baloxavir versus five days, twice-daily of oseltamivir treatment.”

At the end of the call, Uyeki added that researchers should continue studying the potential benefits of treating flu patients with a combination of antiviral medications, especially those with severe disease.

“I think we need more data for treatment of influenza in hospitalized influenza patients, so severe influenza,” he said. “And for that we need more data for a combination antiviral treatment, for example oseltamivir-plus-baloxavir.”

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