Solving the low children’s supply

Tamiflu, the antiviral drug that shortens and lessens bouts of flu, is in the news again after U.S. Centers for Disease Control announced it is releasing the last of the liquid Tamiflu from its medication stockpile. 
This is yet another chapter in the H1N1 saga that has Americans focusing on a worldwide flu pandemic and potential illness for themselves and family. Tamiflu, in capsule and liquid form, is a first-line defense against the swine flu.
Many pharmacies across the country — and on the Mississippi Coast — are out of the liquid form of Tamiflu designated for small children or adults who can’t swallow the pill form. 
COURTESY ROCHERoche, the Swiss manufacturer of Tamilfu, with production plants in several other countries, uses extracts of shikimic acid from the pods of the star anise plant. The pods look like stars.
Parents, already concerned that the H1N1 flu targets the young much quicker than seasonal flu, now worry that children’s Tamiflu might be difficult to find. The Swiss manufacturer, Roche, has said there won’t be more liquid Tamiflu until December. 
This news, however, is not as bad as it might seem. Pharmacists are honing their skills at an old-fashioned technique called suspension compounding, used before everything was neatly dosaged.
Luckily, there is no shortage of the capsule Tamiflu used by adults. 
Through compounding, the capsule powder can be formulated into a suspension, or liquid, in a specific dosage prescribed by a doctor and flavored so children will accept it.
“If you are trained in how to do it, the formula to make a suspension from the capsule powder is not really difficult,” said Larry Krohn, pharmacist-owner of Beach Pharmacy in Gulfport.
“Several years ago before Hurricane Katrina, we had a bad seasonal flu winter and ran out of the liquid Tamiflu. We used the capsules to make a suspension and have been doing it ever since.”
The Tamiflu manufacturer offers pharmacists a formula for converting the capsule into the liquid form, but some rely on their training. 
The work is exacting because too low a suspension dose can be ineffective and too high a dose increases risk of nausea.
“We cannot predict what will happen because the H1N1 flu is a new ball game,” said Krohn. “Usually we don’t get many prescriptions for Tamiflu until mid-October, but with the swine flu, a run began in August. It’s been ‘steady’ ever since.”
Not all pharmacies make the liquid formula, but many will, including large chains such as Walgreens, Wal-Mart and Target, and independents, such as French Drug Co. in Gulfport.
“A month ago we had a lot of the manufactured suspension Tamiflu stockpiled and went through that, but right know, there isn’t the same demand,” said French’s pharmacist-owner David Lawrence.
Instructions are twice daily for five days, preferably within 48 hours of symptoms. One prescription is about $100.
“Tamiflu is a fairly effective anti viral agent that interferes with the reproduction of the flu virus in the body,” said Lawrence. “What we’ve seen here is that people use it after they have flu symptoms or as a prophylactic if they have been exposed.”
The shortage is caused by the complex manufacturing process that takes six to eight months and involves extracts of shikimic acid, usually from pods of the star anise plant. 
Tamiflu, introduced in 1999, targets proteins that live on flu virus cells and allow them to infect other cells. 
The patented drug took on new importance when worries of a worldwide avian flu pandemic surfaced in 2004-05 and governments began stockpiling it.