Dosing By Weight

Directions for the Emergency Compounding of an Oral Suspension from Tamiflu 75-mg Capsules (Final Concentration 6 mg/mL)

These directions are provided for use only during emergency situations when Tamiflu for Oral Suspension is not commercially available in a pharmacy. These directions are not intended for use if the FDA-approved, commercially manufactured Tamiflu for Oral Suspension is readily available from wholesalers or the manufacturer. Compounding an oral suspension with this procedure will provide 1 patient with enough medication for a 5-day course of treatment or a 10-day course of prophylaxis.

Commercially manufactured Tamiflu for Oral Suspension (6 mg/mL) is the preferred product:

In the event that the commercially manufactured Tamiflu for Oral Suspension is not available, the pharmacist may compound a suspension (6 mg/mL) from Tamiflu 75-mg capsules using one of these vehicles: Cherry Syrup (Humco®), Ora-Sweet® SF (sugar-free) (Paddock Laboratories), or simple syrup. Other vehicles have not been studied. This compounded suspension should not be used for convenience or when the FDA-approved Tamiflu for Oral Suspension is commercially available.

Compounding instructions

First, calculate the total volume of oral suspension needed to be compounded and dispensed for each patient. The total volume required is determined by the patient’s weight (see chart below).

Table 1: Volume of Oral Suspension (6 mg/mL) Needed to Be Compounded Based Upon the Patient's Body Weight
Table 2 in the Prescribing Information

Compounding Tamiflu by Weight

Second, determine the number of capsules and the amount of water and vehicle (Cherry Syrup, Ora-Sweet® SF, or simple syrup) that are needed to prepare the total volume of compounded oral suspension (6 mg/mL) by using the chart below.

Table 2: Number of Tamiflu 75-mg Capsules and Amount of Vehicle (Cherry Syrup, Ora-Sweet® SF, or Simple Syrup) Needed to Prepare the Total Volume of a Compounded Oral Suspension (6 mg/mL)
Table 3 in the Prescribing Information

Compounding Oral Tamiflu Chart

Third, follow the procedure below for compounding the oral suspension (6 mg/mL) from 75-mg Tamiflu capsules:

  1. Place the specified amount of water into a polyethylene terephthalate (PET) or glass bottle (see Table 2 above).
  2. Carefully separate the capsule body and cap, and pour the contents of the required number of 75-mg Tamiflu capsules into the PET or glass bottle. Weighing paper may also be used to hold capsule contents for transfer into bottle.
  3. Gently swirl the suspension to ensure adequate wetting of the Tamiflu powder for at least 2 minutes.
  4. Slowly add the specified amount of vehicle to the bottle.
  5. Close the bottle using a child-resistant cap and shake well for 30 seconds to completely dissolve the active drug and to ensure homogeneous distribution of the dissolved drug in the resulting suspension. (Note: The active drug, oseltamivir phosphate, readily dissolves in the specified vehicles. The suspension is caused by inert ingredients of Tamiflu capsules that are insoluble in these vehicles.)
  6. Put an ancillary label on the bottle indicating “Shake Well Before Use.”
  7. Instruct the parent or caregiver that any unused suspension remaining in the bottle following completion of therapy must be discarded by either affixing an ancillary label to the bottle, or adding a statement to the pharmacy label instructions.
  8. Place an appropriate expiration date on the label according to storage conditions below.

Storage of the emergency compounded suspension

Note: The storage conditions are based on stability studies of compounded oral suspensions, using the aforementioned vehicles, which were placed in glass and polyethylene terephthalate (PET) bottles. Stability studies have not been conducted with other vehicles or bottle types.

Place a pharmacy label on the bottle that includes the patient’s name, dosing instructions, and drug name and any other required information to be in compliance with all state and federal pharmacy regulations.

Oral dosing device

Consider dispensing the suspension with an oral dosing device (a graduated oral syringe or spoon) suitable for measuring the suspension. If possible, mark or highlight the graduation corresponding to the appropriate dose (5 mL, 7.5 mL, 10 mL, or 12.5 mL) on the oral syringe or spoon for each patient.

For further information, please refer to the Emergency Compounding Reference located here.

Please see the Tamiflu full Prescription Information for complete safety information.

Did you know?

In a clinical study, children aged 1-12 years who received Tamiflu within 48 hours of first flu symptoms recovered up to 26% (36 hours) faster than those who didn't receive Tamiflu.8

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Indications

TAMIFLU is indicated for the treatment of uncomplicated influenza caused by viruses types A and B in patients 1 year and older who have been symptomatic for no more than 2 days.

TAMIFLU is also indicated for the prophylaxis of influenza in patients 1 year and older.

Efficacy of TAMIFLU in patients who begin treatment after 48 hours of symptoms has not been established.

TAMIFLU is not a substitute for early and annual vaccination as recommended by the Centers for Disease Control’s Advisory Committee on Immunization Practices (ACIP).

There is no evidence for efficacy of TAMIFLU in any illness caused by agents other than influenza viruses Types A and B.

Influenza viruses change over time. Emergence of resistance mutations could decrease drug effectiveness. Other factors (for example, changes in viral virulence) might also diminish clinical benefits of antiviral drugs. Prescribers should consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use Tamiflu.

Important Safety Information1

TAMIFLU is contraindicated in patients who have had severe allergic reactions such as anaphylaxis or serious skin reactions such as toxic epidermal necrolysis, Stevens-Johnson syndrome, or erythema multiforme to any component of TAMIFLU.

In postmarketing experience, rare cases of anaphylaxis and serious skin reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiforme, have been reported with TAMIFLU. Tamiflu should be stopped and appropriate treatment instituted if an allergic-like reaction occurs or is suspected.

Influenza can be associated with a variety of neurologic and behavioral symptoms, which can include events such as hallucinations, delirium and abnormal behavior, in some cases resulting in fatal outcomes. These events may occur in the setting of encephalitis or encephalopathy but can occur without obvious severe disease. There have been postmarketing reports (mostly from Japan) of delirium and abnormal behavior leading to injury, and in some cases resulting in fatal outcomes, in patients with influenza who were receiving TAMIFLU. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made but they appear to be uncommon based on TAMIFLU usage data. These events were reported primarily among pediatric patients and often had an abrupt onset and rapid resolution. The contribution of TAMIFLU to these events has not been established. Patients with influenza should be closely monitored for signs of abnormal behavior. If neuropsychiatric symptoms occur, the risks and benefits of continuing treatment should be evaluated for each patient.

Serious bacterial infections may begin with influenza-like symptoms or may co-exist with or occur as complications during the course of influenza. TAMIFLU has not been shown to prevent such complications.

Treatment efficacy in subjects with chronic cardiac and/or respiratory disease has not been established. No difference in the incidence of complications was observed between the treatment and placebo groups in this population. No information is available regarding treatment of influenza in patients at imminent risk of requiring hospitalization.

Efficacy of TAMIFLU has not been established in immunocompromised patients.

The concurrent use of TAMIFLU with live attenuated influenza vaccine (LAIV) intranasal has not been evaluated. However, because of the potential for interference between these products, LAIV should not be administered within 2 weeks before or 48 hours after administration of TAMIFLU, unless medically indicated.

Adverse events that occurred more frequently in patients treated with TAMIFLU than in patients taking placebo and occurred in ≥2% of patients were (TAMIFLU %, placebo %):

  • Treatment in adults - nausea (10%, 6%), vomiting (9%, 3%), bronchitis (2%, 2%)
  • Treatment in pediatrics - vomiting (15%, 9%), abdominal pain (5%, 4%), epistaxis (3%, 3%), ear disorder (2%, 1%)
  • Prophylaxis of adults - headache (18%, 18%), nausea (7%, 3%), diarrhea (3%, 2%), vomiting (2%, 1%), abdominal pain (2%, 1%)
  • Prophylaxis of pediatrics - vomiting (10%, 2%), abdominal pain (3%, 0%), nausea (4%, 1%)

Please see the TAMIFLU full Prescription Information for complete safety information.


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