Neuropsychiatric Effects of Oseltamivir in an Older Adult With End-Stage Renal Disease: A Case Report

Oseltamivir is a renally cleared antiviral medication that is highly effective and often prescribed for influenza prophylaxis in nursing home (NH) settings. We present the case of a 74-year-old man with a history of end-stage renal disease (ESRD) on hemodialysis (HD) and vascular dementia who received prophylactic oseltamivir during an influenza outbreak at his NH and subsequently developed acute neuropsychiatric symptoms. A comprehensive work-up for an acute reversible cause was not identified other than the introduction of the new medication, oseltamivir. The patient’s symptoms resolved after cessation of the medication. To our knowledge, we are the first to report a case of oseltamivir-induced delirium in an older adult receiving ESRD-dosed prophylactic oseltamivir. Our case highlights the need for providers to be vigilant regarding the potential neuropsychiatric side effects of oseltamivir among older adults receiving influenza prophylaxis. Older adults living with ESRD or dementia may be particularly vulnerable.