In March 2007 the Japanese authorities advised against prescribing oseltamivir (Tamiflu, Roche) to adolescents aged 10-19 years.1 This unusually severe measure resulted from the separate suicides of two 14 year olds who jumped to their deaths while taking oseltamivir; 52 other deaths (14 in children or adolescents) have been associated with the same drug. So far, similar action has not followed in Europe. When a regulatory authority warns doctors not to prescribe a drug but decides not to retract its marketing authorisation prescribers and patients are entitled to be concerned and a little confused.

Oseltamivir is a sialic acid analogue that inhibits influenza type A and type B neuraminidase, the viral enzyme that allows the release of virus from infected cells. Its main licensed indications are the treatment of flu, short term postexposure prophylaxis after contact with a diagnosed case of flu, and more prolonged (up to six weeks) “seasonal” prophylaxis when flu is circulating in the community. The licence was extended in 2005 to include …