Children's Tamiflu in short supply: Pharmacists are mixing contents of adult capsules with sweet syrup to substitute

CHARLESTON, W.Va. -- Local pharmacies are running out of the liquid form of Tamiflu and are working to mix compound forms from the antiviral's pill version.

"There is a shortage," Sam Arco, a pharmacist in charge of Fruth Express in downtown Charleston, said Thursday. "Most of the pharmacies have been advised that we can compound the liquid from the capsules, and we do that based on body weight. We can adjust the strength and everything the doctor requires."

Many pharmacies are using cherry syrup or Ora-Sweet to dissolve some of the powder in the capsules, Arco said.

"We've got an alternative, thank goodness," Arco said. "We're well-stocked with the Tamiflu capsules."

Liquid Tamiflu typically is given to children because of its lower strength and because it is easier to swallow.

The three largest wholesalers in the country are out of the liquid form, said Brac Brown, pharmacist and owner of the Poca Valu-Rite and Cross Lanes Family Pharmacy.

Brown's pharmacies have been out of liquid Tamiflu since earlier this week, he said.

"We're making up a liquid ourselves, basically using the capsules and compounding the liquid for different age groups," Brown said. "A lot of the independent pharmacies are."

Pharmaceutical organizations that specialize in compounds are providing recipes and instructions to mix a stable and somewhat palatable product, Brown said.

"We do all the mixing at the pharmacy," he said.

Compounding has been a somewhat common practice for some pharmacies.

Trivillian's Pharmacy in Charleston has taken transfer orders from other pharmacies to mix the compound, pharmacist Erica Hutton said.

"It's actually not too complex of a compound to make," Hutton said.

The pharmacy has run into some problems with insurance coverage of the compound version regarding Medicaid patients where prior authorization is required, Hutton said, but she added that the issues generally are resolved with the insurance company.

While Trivillian's has been out of liquid Tamiflu for a couple of weeks, requests for it -- and the need to provide compound versions -- really started to pick up this week, she said.

Trivillian's saw one or two customers needing the Tamiflu compound on Monday, but on Tuesday the pharmacy had five requests in a half hour, Hutton said, and "Wednesday we were bombarded."

Thursday was not quite so busy, but requests were coming.

"There's still definitely a need for it out there," she said. "It almost comes in waves."

Tamiflu works to stop the virus from reproducing itself, and it can reduce symptoms in flu patients and reduce the likelihood of healthy people living with flu patients from getting the virus, Hutton said.

While there are worries about flu strains developing a resistance to Tamiflu, Hutton said she had not heard much from local doctors about that at this time.

Meanwhile, pharmacists are reminding people of all the preventative measures heard since childhood regarding influenza.

"We just tell patients, to prevent the flu wash your hands, cover your mouth when you cough, all those sanitary things," Hutton said.

Meanwhile, Arco urged people getting Tamiflu in any form -- liquid, pill or compound -- to go over dosage instructions with their pharmacist and make sure they know the right amount to take or administer.

"Be vigilant about going over directions," Arco said.

Contact writer Michelle Saxton at michelle.saxton@dailymail.com or 304-348-4843.