Update on Antiviral Availability
At this time, CDC discussions with the antiviral supply chain (manufacturers, distributors and retailers) indicate that supplies of adult formulation (75 mg) oseltamivir (Tamiflu®) and zanamivir (Relenza®) are meeting current demand for this product. However, the Food and Drug Administration (FDA) and Roche (maker of Tamiflu®) have acknowledged that commercial and stockpiled supplies of Tamiflu® oral suspension are limited.
Pharmacies should be aware of the importance of providing patients with these influenza medications as quickly as possible when they are prescribed. Both Tamiflu® and Relenza® work best when administered within 48 hours of onset of symptoms. Having product at the pharmacy store level, including doses of oseltamivir and zanamivir and supplies to compound Tamiflu® if necessary,
will be critical to ensuring that patients needing treatment receive it as quickly as possible.
Alternatives to Tamiflu® Oral Suspension for Pediatric Patients
FDA has a statement on their website (
Influenza (Flu) Antiviral Drugs and Related Information) reminding health care providers and pharmacists of
the FDA-approved instructions for the emergency compounding of an oral suspension from Tamiflu® 75mg capsules as described in the FDA approved manufacturer package insert for oseltamivir (Tamiflu ®).
Compounding an oral suspension from Tamiflu® 75mg capsules provides an alternative when commercially manufactured oral suspension formulation is not readily available. Tamiflu® capsules 75 mg may be compounded using either of two vehicles: Cherry Syrup (Humco®) or Ora-Sweet® SF (sugar-free) (Paddock Laboratories). Other supplies needed to compound include mortar and pestle and amber glass or amber polyethyleneterephthalate (PET) bottle.
In addition, for children who may not be able to swallow capsules, Tamiflu® capsules may be opened and mixed with sweetened liquids, such as regular or sugar-free chocolate syrup, if oral suspension is not available.
Note on Tamiflu Oral Suspension Syringe
Pharmacists with access to Tamiflu® oral suspension should be aware that an oral dosing dispenser with 30 mg, 45 mg, and 60 mg graduations is provided in the packaging for the manufacturer’s product rather than graduations in milliliters (mL) or teaspoons (tsp). There have been cases where the units of measure on the prescription dosing instructions (mL, tsp) do not match the units on the dosing device (mg), which can lead to patient or caregiver confusion and dosing errors. When dispensing commercially manufactured Tamiflu® oral suspension, pharmacists should ensure the units of measure on the dosing instructions match the dosing device provided. If dosing instructions specify administration using mL or tsp the device included in the Tamiflu® product package should be removed and replaced with an appropriate measuring device. When dispensing Tamiflu® oral suspension for children younger than 1 year of age, the oral dosing dispenser that is included in the product package should always be removed and replaced with an appropriate measuring device.
(The Food and Drug Administration has issued an Emergency Use Authorization (EUA) for the use of Tamiflu in pediatric patients younger than 1 year of age.)
CDC will provide additional information and updates as needed.
