Tamiflu children's dosages run out

Pharmacists meet need by converting adult capsules to liquid By Christina E. Sanchez • THE TENNESSEAN • September 23, 2009 Public demand for a prescription drug that lessens the symptoms and duration of the H1N1 or swine flu virus has caused a shortage of the children's dosage. Pharmacies have run out of Tamiflu in the liquid form, often given to children and adults who can't swallow a pill. The shortage is nationwide. Until more of the liquid prescription can be manufactured, pharmacists must convert the adult dosage capsules into a liquid by following FDA-approved guidelines on mixing. Health officials are concerned that if more liquid is not commercially made soon, the items needed for the makeshift version also could run short. All pharmacists are equipped to make the compound, and the mixing takes about 15 minutes, said Baeteena Black, executive director of the Tennessee Pharmacists Association. "There is no need to panic," Black said. "Roche (the manufacturer) is working diligently to get some more made. "Customers do need to be patient. It takes longer to make, obviously, than if you pulled a commercially prepared bottle off the shelf." Tamiflu has become a hot item since a resurgence of H1N1 cases in the late summer as students returned to school. Just how many people have contracted the virus is unknown because health officials no longer track the numbers. In some cases, when one family member gets the virus, doctors prescribe a five-day cycle of the drug for the whole family. It probably will remain popular until the H1N1 vaccine begins to be available in October. Not everyone with flu needs drug Not everyone who has the flu needs an antiviral medicine. The Centers for Disease Control and Prevention recommends that Tamiflu and Relenza, another flu drug, be given on a case-by-case basis, and primarily reserved for people who are hospitalized and groups at high risk for complications. At-risk populations include children younger than 5, pregnant women, people with chronic conditions and illnesses, and the elderly. The drugs should be given within the first 48 hours from the onset of symptoms to be most effective. Common symptoms include fever, chills, headache, cough, sore throat, runny nose, and sometimes diarrhea and vomiting. "If it is a healthy individual and it's been going on more than 48 hours since symptoms appeared, it is not going to be helpful to put them on Tamiflu," said Dr. Mark Krakauer, who practices internal medicine and pediatrics at Saint Thomas Hospital. He also said that if one person in an overall healthy family gets the flu, he might not prescribe Tamiflu for everyone. Most people should ride out the flu at home, getting plenty of rest and fluids, he said. "Most people do not need to see the doctor," Krakauer said. "If they are healthy, they are going to get over it." Making sure the antiviral medicine is started within the first 48 hours is important to prevent the virus from replicating inside the body, said Paul Peterson, a pharmacist and strategic national stockpile coordinator for the state health department. "The drug inhibits the virus from releasing new virus in the body," Peterson said. Antivirals can shorten the length of illness by about two days. Duration of the flu varies; it can last three to seven days. Drug can be costly Vanderbilt University Medical Center is making the compound version of Tamiflu in batches of about 25 prescriptions at a time to provide the liquid prescription to Vanderbilt patients who need it, said Michael O'Neal, procurement manager for the hospital. The crushed adult capsule of Tamiflu is mixed with one of two liquids, Ora-Sweet or cherry syrup — items federal health officials worry also could run out. Vanderbilt fills prescriptions only for its patients, so O'Neal recommends that non-Vanderbilt patients call around to retail pharmacies before going. Roche Pharmaceuticals is the only manufacturer of Tamiflu. Relenza is available from a different company, but because it comes in the form of an inhalant powder, it is not recommended for all patients. No generic brands are available, which can make the prescription costly. Whether a person has insurance and what it covers can cause the cost of Tamiflu for the customer to vary. TennCare, the state version of Medicaid, estimates that the cost it picks up for a Tamiflu capsule prescription is about $84, the Tamiflu liquid is about $74, and Relenza is about $60. Adults on TennCare will have a co-pay of $3 unless they are pregnant, under hospice care, in an institution or on home care. Children do not have co-pays. Nancy McGinnity, a Nashville parent, had to buy Tamiflu for each of the six members of her family and had no trouble finding a pharmacy to fill the liquid prescription for her 11-year-old and 8-year-old sons. That was Labor Day. McGinnity, her husband and two older sons, ages 14 and 13, took the pill. Her portion of the bill — at a co-pay of $20 each — came to $120. "The doctor offered it as a preventative medicine for the rest of us," she said.