Tamiflu Compounding

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DrSassyPants

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Hey guys,
I'm a floater in the Dallas area for Target and the store I was at today had Tamiflu compounded in bulk 15mg/ml...... not what the emergency compounding instructions for it suggests, but certainly helpful when every other prescription dropped off is for it. The outbreak around here seems pretty bad. Anyway, just wondering how you guys have seen it being done? Thanks!
 
two words:


back order



btw im in cali
 
we cooould compound it...but we dont have all the stuff to do it with. so i guess we cant. i heard some of the stuff was on back order too. and with a really busy store and plenty of places that will do it, i dont lose sleep knowing we dont
 
I work at a compounding Walgreen's. We make tons of it.
 
we have an insane H1N1 problem here right now. We've been compounding 2 of the big orange bottles every day.
 
I hope y'all are compounding the stuff or attempting to be able to...those high risk kids need it.
 
I think we give entirely way too much of it out. People are acting like it's a cure.
 
We've been compounding it. It's a pain in the butt to make. It doesn't seem to dissolve properly.
 
it dissolves in the cherry syrup pretty well. make sure you triturate it first, and make into a paste, and then qs. a fellow rph skipped the paste part and it was a little lumpy.
 
btw, you guys have any flu shots left. i'm tired of getting 50+ calls a day demanding flu shots. since nobody really goes to target pharmacy, i've been telling people to go there and kroger. but the guy at kroger said they are out and the company won't be getting anymore until nov.

DrSassyPants said:
Hey guys,
I'm a floater in the Dallas area for Target and the store I was at today had Tamiflu compounded in bulk 15mg/ml...... not what the emergency compounding instructions for it suggests, but certainly helpful when every other prescription dropped off is for it. The outbreak around here seems pretty bad. Anyway, just wondering how you guys have seen it being done? Thanks!
Click to expand...
 
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SoonerPharmD said:
it dissolves in the cherry syrup pretty well. make sure you triturate it first, and make into a paste, and then qs. a fellow rph skipped the paste part and it was a little lumpy.
Click to expand...

We use the sugar free stuff. I don't know if it already has a flavor or not. I don't believe it does since we've been flavoring all of them. Anyways, I make it into a paste and then add the rest of the liquid. It reminds me of snot. Very gross looking.
 
How are you all billing your compounded tamiflu? As a compound or as something else? Or are you just running it through as cash?
 
It looks like a lot of insurance companies are paying for it. We bill it as a compound, but it looked kinda weird from what I saw.....depending on the insurance and your pharmacy software, you might have to bill it as teaspoonfuls (i checked a few that we had to put quantity "8" on for 40 mL)

but yeah, i'm wondering how many of these people actually take it within 48 hours of their initial symptoms. most people are getting a placebo effect from it i bet.


ethyl said:
How are you all billing your compounded tamiflu? As a compound or as something else? Or are you just running it through as cash?
Click to expand...
 
depends on the state, here in TX target has a third party coming in and doing flu shots during 2 Saturdays in October. some states though they're doing pharmacist-administered vaccines, but i'm not sure how their supply is. aren't the phone calls ridiculous? some days i need an extra tech just to answer the phone about flu shots.

SoonerPharmD said:
btw, you guys have any flu shots left. i'm tired of getting 50+ calls a day demanding flu shots. since nobody really goes to target pharmacy, i've been telling people to go there and kroger. but the guy at kroger said they are out and the company won't be getting anymore until nov.
Click to expand...
 
DrSassyPants said:
depends on the state, here in TX target has a third party coming in and doing flu shots during 2 Saturdays in October. some states though they're doing pharmacist-administered vaccines, but i'm not sure how their supply is. aren't the phone calls ridiculous? some days i need an extra tech just to answer the phone about flu shots.
Click to expand...

I turned the ringers down on all the phones and we stopped answering them during peak times. It goes to voice mail after 3 cycles of ring backs. Every hour or so we check it and delete the 20 calls asking about flu shots and call the other 2 people back who are to stupid to figure out how to enter thier refills automatically.

Its a great to be a retail pharmacist!!!!
 
Can we just have roving squads of RNs drive around town and administer flu shots to anyone they encounter for free please?
 
meister said:
Can we just have roving squads of RNs drive around town and administer flu shots to anyone they encounter for free please?
Click to expand...

Don't joke....It would not surprise me one bit if they have pharmacists in the parking lot giving shots next year. Have a little cart like a hot dog vendor. I can see it know. Stuck out in the heat and then cold and rain with a sandwich board that says "Get you flu shot NOW!!!! No waiting!!!." We will of course do this with no extra hours or help. Every 30 minutes I will have to run inside and fill as many prescrptions as I can and they run back out to the parking lot.
 
I'm not sure why this is confusing. We had some kids d/c from our hospital go to FOUR diff pharmacies who all said they were out of Tamiflu suspension and they would NOT compound it for them! :-(

What gives? There are instructions in Lexi-Comp on exactly how to make the suspension.
 
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DrSassyPants said:
Hey guys,
I'm a floater in the Dallas area for Target and the store I was at today had Tamiflu compounded in bulk 15mg/ml...... not what the emergency compounding instructions for it suggests, but certainly helpful when every other prescription dropped off is for it. The outbreak around here seems pretty bad. Anyway, just wondering how you guys have seen it being done? Thanks!
Click to expand...


Actually, I was emailed this from the CDC:

.This is an official.​
.CDC Health Update...​
. .
.*Please acknowledge receipt of this HAN by following the link at the bottom of the update. ...
. .
.Distributed via Health Alert Network ...
.September 25, 2009, 13:51 EST (1:51 PM EST)...
.CDCHAN-00298-09-09-25-UPD-N...
. .
.Updated Pediatric.. ..Antiviral Dosing Syringe and Compounding Information for 2009 H1N1 and Seasonal Flu...​
. ...
.Background..
As of September 25, 2009 influenza activity is increasing in the United States with 26 states reporting widespread influenza activity. So far, ninety-nine percent of all subtyped influenza viruses being submitted to CDC are 2009 influenza A (H1N1) viruses..
. .
.The current situation will likely ..affect pharmacies as a greater number of people than usual seek to fill prescriptions for influenza antiviral drugs or antibiotics to treat secondary bacterial infections, in addition to seeking advice on over-the-counter flu medications. This may affect supplies and availability of antiviral medications and other materials that may be needed to fill prescriptions..
. .
.Pharmacists and physicians who care for pediatric patients should be aware of two issues: (1) the possible need to compound Tamiflu® on site if commercially manufactured pediatric oral suspension formulation is not available, and (2) the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match. .
. .
.These situations are addressed in the updated interim recommendations issued by CDC on September 22, 2009 for the use of antivirals in the treatment and prevention of influenza which can be found at ..http://www.cdc.gov/H1N1flu/recommendations.htm.. and in the 2009-2010 Influenza Season: Information for Pharmacists available at ..http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm....
. ...
.Alternatives to Tamiflu® Oral Suspension for Pediatric Patients..
If pediatric formulations of Tamiflu are not available, pharmacists may compound Tamiflu® 75 mg capsules into an oral suspension onsite. For the FDA -approved instructions for the emergency compounding of an oral suspension from Tamiflu® 75mg capsules, see the FDA approved manufacturer package insert for oseltamivir (Tamiflu), available on the FDA Web site at ..http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM147992.pdf.. ...
. .
.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® (30mg, 45mg and 75mg)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..
The second issue that pharmacists and physicians may face is the need to ensure that the units of measure on the dosing dispenser and the dosing instructions match. An oral dosing dispenser with 30 mg, 45 mg, and 60 mg graduations of Tamilfu® is provided in the packaging for the manufacturer’s product rather than graduations in milliliters (mL) or teaspoons (tsp).This 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 prescription instructions specify administration using mL or tsp, then the device included in the Tamiflu® product package should be removed and replaced with an appropriate measuring device, such as an oral syringe if the prescribed dose is in milliliters (mL). 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. Pharmacists and health care providers should provide an oral syringe that is capable of accurately measuring the prescribed milliliter (mL) dose, and counsel the caregiver how to administer the prescribed dose. Oseltamivir is authorized for emergency use in children younger than 1 year of age under an Emergency Use Authorization (EUA) issued by FDA. For the EUA, see ..http://www.cdc.gov/h1n1flu/eua/pdf/tamiflu-hcp.pdf......
. ...
.For More Information:.. .
.2009-2010 Influenza Season: Information for Pharmacists:.. ..http://www.cdc.gov/H1N1flu/pharmacist/pharmacist_info.htm.. .
. .
.Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season:.. ..http://www.cdc.gov/H1N1flu/recommendations.htm...
. .
.Questions & Answers: Antiviral Drugs, 2009-2010 Flu Season:http://www.cdc.gov/h1n1flu/antiviral.htm .
. .
.Updated Interim Recommendations for Obstetric Health Care Providers Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season:.. ..http://www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm...
. .
.Antiviral Drugs: Summary of Side Effects:.. ..http://www.cdc.gov/flu/protect/antiviral/sideeffects.htm.. .
. .
.For the FDA page on antiviral influenza drugs:..
..http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm100228.htm.. .
. .
.For the FDA-approved package insert with instructions for the emergency compounding of an oral suspension from Tamiflu® 75mg capsules see ..http://www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/UCM147992.pdf...
. .
.For the FDA public health alert regarding Tamiflu (oseltamivir) for Oral Suspension: Potential Medication Errors see ..http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm183714.htm....
. .
.For additional information, you can also call CDC’s toll-free hotline, 800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, which is available 24 hours a day, every day..
. .
.____________________________________________________________________________________...
.Categories of Health Alert messages:...
.Health Alert .. conveys the highest level of importance; warrants immediate action or attention....
.Health Advisory.. provides important information for a specific incident or situation; may not require immediate action....
.Health Update .. provides updated information regarding an incident or situation; unlikely to require immediate action....
.##This Message was distributed to State and Local Health Officers, Public Information Officers, Epidemiologists and HAN Coordinators as well as Clinician organizations##.​
. .
.====================================================...​
.You have received this message based upon the information contained within our emergency notification data base. If you have a different or additional e-mail or fax address that you would like us to use p..lease contact your State-based Health Alert Network program at your State or local health department....
.====================================================...​
 
AvocadoLover said:
I'm not sure why this is confusing. We had some kids d/c from our hospital go to FOUR diff pharmacies who all said they were out of Tamiflu suspension and they would NOT compound it for them! :-(

What gives? There are instructions in Lexi-Comp on exactly how to make the suspension.
Click to expand...

Sweetheart, you come on over to my happy pill room and whip up a batch for me. Do it as the only pharmacist on duty filling 200 plus prescriptions, giving 30 flu shots in between, counseling, questions, bitching customers, answering the phone that never stops ringing. All of this on a 12 hour shift where you barely get to sneak out for 5 minutes to take a piss let alone think about a real break or having enough time to eating anything.

I guess you wouldn't understand. It is easy to arm chair quarterback while you are sitting on your ass in the basement of some hospital pharmacy shoving Twinkies in your mouth.
 
MountainPharmD said:
Sweetheart, you come on over to my happy pill room and whip up a batch for me. Do it as the only pharmacist on duty filling 200 plus prescriptions, giving 30 flu shots in between, counseling, questions, bitching customers, answering the phone that never stops ringing. All of this on a 12 hour shift where you barely get to sneak out for 5 minutes to take a piss let alone think about a real break or having enough time to eating anything.

I guess you wouldn't understand. It is easy to arm chair quarterback while you are sitting on your ass in the basement of some hospital pharmacy shoving Twinkies in your mouth.
Click to expand...

Flu shots? but you don't work at WAGs...
 
you still giving flu shots? WAGS has been out for over a week in ft worth area. i've been sending them to target, kroger, and tom thumb. and some of those guys are just doing flu clinics instead of walk-ins.
 
SoonerPharmD said:
you still giving flu shots? WAGS has been out for over a week in ft worth area. i've been sending them to target, kroger, and tom thumb. and some of those guys are just doing flu clinics instead of walk-ins.
Click to expand...

My store has done almost 600 shots and I still have 250 in the fridge. I guess the word is getting out we still have shots. I did 24 shots in 3 hours yesterday along with filling prescriptions and everything else.
 
AvocadoLover said:
I'm not sure why this is confusing. We had some kids d/c from our hospital go to FOUR diff pharmacies who all said they were out of Tamiflu suspension and they would NOT compound it for them! :-(

What gives? There are instructions in Lexi-Comp on exactly how to make the suspension.
Click to expand...

What if you don't have Cherry Syrup or Ora-Sweet. Then you can't make it. I've floated to many stores that don't have either
 
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we turned 10 boxes of tamiflu into suspension the other day. i figured it would last us a week or so. i was wrong. it only lasted half a day. we dispensed something like 30 tamiflu scripts in one day. i think if people even scream sniffles or runny nose they get tamiflu. its crazy.
 
vardenafil said:
we turned 10 boxes of tamiflu into suspension the other day. i figured it would last us a week or so. i was wrong. it only lasted half a day. we dispensed something like 30 tamiflu scripts in one day. i think if people even scream sniffles or runny nose they get tamiflu. its crazy.
Click to expand...

ridiculous. the last thing i saw, it's supposed to be commercially available in full supply again in November or December.....crossing my fingers it's November...
 
Cherry syrup and Ora sweet sf are on back order. What else can we use to compound? Regular Ora sweet(not sugar free) should be ok right?

Anything else?
 
MountainPharmD said:
Sweetheart, you come on over to my happy pill room and whip up a batch for me. Do it as the only pharmacist on duty filling 200 plus prescriptions, giving 30 flu shots in between, counseling, questions, bitching customers, answering the phone that never stops ringing. All of this on a 12 hour shift where you barely get to sneak out for 5 minutes to take a piss let alone think about a real break or having enough time to eating anything.

I guess you wouldn't understand. It is easy to arm chair quarterback while you are sitting on your ass in the basement of some hospital pharmacy shoving Twinkies in your mouth.
Click to expand...

Hmm... Sorry to offend. You are right that I don't work in retail and I know that your life can get hectic. I also understand that patients need these meds and it is our job to provide them. However, I wasn't aware that some stores actually do not have the ingredients to do it and that was what I was here wondering- why it couldn't be made.

Also to clarify: 1) I have a desk on the renal unit, so no I don't sit in the basement 2) Twinkies are yucky, I am more likely to be found eating almonds or grapes 3) You can call me sweetheart, that's fine

Sorry again for offending you, it was not by objective.
 
AvocadoLover said:
2) Twinkies are yucky, I am more likely to be found eating almonds or grapes .
Click to expand...

Everyone likes Twinkies! Hell at the state fair here in Texas these crazy rednecks fry them and eat 'em.



AvocadoLover said:
3) You can call me sweetheart, that's fine

Sorry again for offending you, it was not by objective.
Click to expand...

No offence. I just got home from work when I replied. Always a bad time to post things. I used sweet heart because I figured you are a girl. I can't see a guy using the name AvocadoLover but you are from California so anything is possible.
 
museabuse said:
Cherry syrup and Ora sweet sf are on back order. What else can we use to compound? Regular Ora sweet(not sugar free) should be ok right?

Anything else?
Click to expand...

Yeah, Regular Ora Sweet is available. Not sure about anything else...
 
SoonerPharmD said:
it dissolves in the cherry syrup pretty well. make sure you triturate it first, and make into a paste, and then qs. a fellow rph skipped the paste part and it was a little lumpy.
Click to expand...
Yup! I made my first batch tonight and it wasn't nearly as bad as I anticipated.
 
i refuse to compound it

whose gonna fill the 400 when i step away? and once you do one, word gets out and every1 will come....pass on that
 
lorain said:
i refuse to compound it

whose gonna fill the 400 when i step away? and once you do one, word gets out and every1 will come....pass on that
Click to expand...

800ml cherry syrup 128 75 mg capsule, bam! You have 800 ml of 12mg/ml suspension good for 35 days in refridge. Not that hard make it on down time or god forbid stay 1/2 hour late to make it and make your life easy, and help sick babies, karma pts!
 
MountainPharmD said:
My store has done almost 600 shots and I still have 250 in the fridge. I guess the word is getting out we still have shots. I did 24 shots in 3 hours yesterday along with filling prescriptions and everything else.
Click to expand...

The amount of work you have to do could easily be reduced if the damn government would let interns do the flu shots. Hell, I could just do flu shots for 10 hour straight and not be bored.
 
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Interns can in Texas and Colorado. We have stores doing thousands of flu shots because they have interns helping out. If I am still here next year I will have an intern during flu shot time.
 
Anyone have any experience with the PCCA formulation for the tamiflu suspension?

We've got the opposite problem, Tamiflu caps are easy to be had, but the suspending vehicles are getting backordered.
 
SomeGuy said:
Anyone have any experience with the PCCA formulation for the tamiflu suspension?

We've got the opposite problem, Tamiflu caps are easy to be had, but the suspending vehicles are getting backordered.
Click to expand...

It's WAY easier to get the caps... They are easy to open - get yourself a sugar free base syrup and open them up (use glycerin as a wetting agent if you are feeling frisky).

You get precise dosing for peds and just may help the bottom dollar as well.
 
The suspension doesn't take THAT long to compound.

Why is it that so many pharmacists are chronic complainers?

You're getting paid to do this, you're doing something you've been trained to do apart from staring at the TV for the entirety of your shift and you might actually help someone.

I did 80+ flu shots last Thursday and 70-some on Friday.

If you don't like it, quit and stop polluting the world with your negativity.
 
aelephant said:
The suspension doesn't take THAT long to compound.

Why is it that so many pharmacists are chronic complainers?

You're getting paid to do this, you're doing something you've been trained to do apart from staring at the TV for the entirety of your shift and you might actually help someone.

I did 80+ flu shots last Thursday and 70-some on Friday.

If you don't like it, quit and stop polluting the world with your negativity.
Click to expand...

I don't think that you get the message. I firmly believe that given enough help most pharmacists will not hesitate to do compound. But as previous person has said, retail can get hectic. If you have the strength to do it, that's good for you but not for pharmacy as a profession. You should realize that you are being taken advantage of by greedy corporate. What should be done by two pharmacists has been cut down to one. For most pharmacists, medication error is a no-no. They don't want to jeopadize other people's med by rushing and do compound at the same time. It's an inconvenience for a few patients, but a great protection for a majority of patients.
I think you should fight for your profession rather than bashing your fellow pharmacists when you are not in their shoes.
 
litetigre said:
I don't think that you get the message. I firmly believe that given enough help most pharmacists will not hesitate to do compound. But as previous person has said, retail can get hectic. If you have the strength to do it, that's good for you but not for pharmacy as a profession. You should realize that you are being taken advantage of by greedy corporate. What should be done by two pharmacists has been cut down to one. For most pharmacists, medication error is a no-no. They don't want to jeopadize other people's med by rushing and do compound at the same time. It's an inconvenience for a few patients, but a great protection for a majority of patients.
I think you should fight for your profession rather than bashing your fellow pharmacists when you are not in their shoes.
Click to expand...

I second that. I would do all compounds if my company would give me the tools and the help to do it. I've turned away numerous becasue I just can't do it correctly. This weekend, I sent a Tamiflu compound to a slower store and it wasn't becasue I was a bad pharmacist. It was because I had 1 no-show tech and a lot of junk to get done
 
aelephant said:
The suspension doesn't take THAT long to compound.

Why is it that so many pharmacists are chronic complainers?

You're getting paid to do this, you're doing something you've been trained to do apart from staring at the TV for the entirety of your shift and you might actually help someone.

I did 80+ flu shots last Thursday and 70-some on Friday.

If you don't like it, quit and stop polluting the world with your negativity.
Click to expand...

You must be a close relative of the guy who started the thread about getting everyone in the pharmacy headsets so they can be just like McDonalds. That guy was so proud of himself and all he did was take one step closer to the complete destruction of the profession.

You wonder why so many pharmacists are chronic complainers? I wonder why so many pharmacists are like you. Passive sheep marching to slaughter with nary a word said in protest. There will come a day for you my friend when you have so little help and so much to do that a serious medication error will knock you on your ass. So you keep right on marching.
 
Anyone in the hospital setting getting any MD requests for peramivir? Apparently we have some for what i'm guessing are ICU pts, and to me at least it seems pretty crazy that the CDC/FDA are really fast-tracking this drug into clinical investigational use. I can't knock them for doing their job and working quickly but I'm pretty cynical so it doesn't "seem" right.

Would love to see it work though, ARDS 2/2 h1n1 doesn't sound very fun 🙁
 
psychoandy said:
Anyone in the hospital setting getting any MD requests for peramivir? Apparently we have some for what i'm guessing are ICU pts, and to me at least it seems pretty crazy that the CDC/FDA are really fast-tracking this drug into clinical investigational use. I can't knock them for doing their job and working quickly but I'm pretty cynical so it doesn't "seem" right.

Would love to see it work though, ARDS 2/2 h1n1 doesn't sound very fun 🙁
Click to expand...

It's still unapproved, and as far as I know, there isn't a compassionate-use protocol set up yet (should be within a few days, though). Sounds like an awesome drug though...24 hour half-life? It might actually help a few people.
 
Is there any updated info on how Tamiflu is doing against the swine flu? Is it doing anything besides the expected 24h reduction in symptoms?
 
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