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Demand Spikes for Liquid Tamiflu

Widespread cases of swine flu in children across the country are increasing pressure on pharmacies to keep up with demand for a liquid form of Tamiflu, which many pharmacies have been making on their own because the manufacturer's version is in short supply.

Shortages of liquid Tamiflu, which can reduce the severity of illness, have persisted despite the fact that the Centers for Disease Control and Prevention released 300,000 doses Oct. 1. The CDC announced Friday that it was releasing 234,000 more doses of liquid Tamiflu from its medication stockpile.

Tamiflu is readily available in a capsule form that's easier for the drug's maker to produce but can be difficult for children to swallow or contain too high a dose for them. Many pharmacies have been compounding their own liquid form of the drug. The process, which involves combining the contents of capsules with a sweet syrup, is an emergency measure approved by the Food and Drug Administration.

The shortage means @parents of children sick with H1N1 flu may have to hunt for a place to fill prescriptions.

"This is an unusual situation," said Carmen Catizone, executive director of the National Association of Boards of Pharmacy. "We're probably seeing more pharmacy compounding now than since the introduction of modern pharmacy."

As long as pharmacists know how to compound the product correctly, the mixture is safe, Catizone said.

Not all pharmacies are willing to make the mixture. Even those that do are having periodic difficulty getting enough of the sweet syrup to make it, said Cheryl Slavinsky, a spokeswoman for Rite Aid, the nation's third-largest pharmacy chain.

Paddock Laboratories, maker of the Ora-Sweet liquid used by Rite Aid and many other pharmacies, said it has gone from producing 50,000 bottles a year to making that many in a week to meet demand. By this week, the Minneapolis-based company should be able to make 100,000 bottles a week, CEO Michael Graves said. "We've been working around the clock to keep up with demand," he said.

The Institute for Safe Medication Practices, a group that runs a national medication-error reporting program, has received some reports of dosing errors involving compounded Tamiflu liquid, said Michael Cohen, a pharmacist and the group's president.

Directions call for pharmacists to make their liquid version at a higher concentration than the solution commercially manufactured by Swiss drugmaker Roche.

Roche is working with federal officials to remind health care professionals to carefully follow dosing instructions, spokesman Terry Hurley said.

If the child gets too low a dose, the drug won't be effective. Too high a dose brings an increased risk of nausea, vomiting and diarrhea, said Henry Bernstein, a member of the American Academy of Pediatrics.

Roche is making more liquid Tamiflu, but it won't reach pharmacies until December, Hurley said.

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