Peramivir Trihydrate is a trihydrate of the anti-infection agent peramivir (RWJ-270201,BCX-1812) which is a transition-state analogue and a potent, specific influenza viral neuraminidase inhibitor with an IC50 of median 0.09 nM.
In vivo:Peramivir protects mice against severe disease outcomes following infection with highly pathogenic avian influenza and multi-dose treatment was efficacious in ferrets.  Peramivir combined with Oseltamivir perform better than suboptimal doses of each compound alone to treat influenza infections in mice.  Peramivir (30 mg/kg) is effective in promoting the survival of mice infected with systemically replicating H5N1 virus. Peramivir is 30% protective against H1N1 virus in mice at 0.5 mg/kg/d, but ineffective at lower doses when used as monotherapy. Peramivir combined with favipiravir increases the numbers of survivors by 10-50% when the 0.025 mg/kg/d, 0.05 mg/kg/d, and 0.1 mg/kg/d doses of Peramivir are combined with 20 mg/kg/d Favipiravir and when all doses of Peramivir are combined with 40 mg/kg/d Favipiravir. Peramivir combined with favipiravir results in an increase in lifespan, improved body weight and significant reductions in lung hemorrhage score and lung weight in H1N1 infected mice. Peramivir (1 mg/kg/d) combined with Rimantadine (5 mg/kg/d and 10 mg/kg/d) produces weight losses of 1.69 and 0.69, respectively, whereas the combination of 3.0 mg/kg/d Peramivir with 10 and 30 mg/kg/d Rimantadine does not show any weight loss in sub-lethal influenza A (H3N2) virus mouse model.

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