Tamiflu is one of the drugs currently recommended by the CDC to treat the swine flu. Its generic name is oseltamivir. (Pronounced: os el TAM ih veer)

There is however a shortage of pediatric Tamiflu.

The drug is very effective and is being used for both treatment of active flu cases and as a prophylaxis (prevention) of the flu. Tamiflu needs to be started in those with the active flu within 48 hours of the influenza symptoms occurring. Because the test for swine flu takes two days the CDC is recommending that doctors treat all flu like illnesses with Tamiflu when the patient sees the doctor.

Tamiflu does have some side effects but the risks of the swine flu are much greater in most people than the side effects.

The dose for Tamiflu in adults is 75mg twice daily for 5 days for active cases and 75mg daily for 10 days for prophylaxis. The capsules should be taken with a full glass of water. The following is the recommended Tamiflu pediatric dosing.

Influenza A H1N1 2009 (swine flu) treatment

Over 1 year; and less than 15 kg Dose: 30 mg orally twice daily for 5 days Over 1 year and 15-23 kg Dose: 45 mg orally twice daily for 5 days Over 1 year and 23-40 kg Dose: 60 mg orally twice daily for 5 days Over 1 year and over 40 kg Dose: 75mg twice daily for 5 days

All treatment should start as soon as possible after the onset of symptoms

Influenza A H1N1 2009 (swine flu) prophylaxis (prevention)

1-12 years old under 15 kg Dose: 30 mg orally once daily 1-12 y/o 15-23 kg Dose: 45 mg orally once daily 1-12 y/o 23-40 kg Dose: 60 mg orally once daily

1 kg equals 2.2 pounds

CDC recommends continuing throughout exposure period and for 10 days after

Currently the biggest problem with the pediatric dose of Tamiflu is availability. As of now the only source of Tamiflu is the adult 75 mg capsules which comes 10 capsules per blister pack. Many hospitals have the pediatric Tamiflu liquid because they stockpiled the drug, and although some hospitals have doses that are labeled as expired the government has sent out letters advising that the drug is still good and can be dispensed for another year.

For those pharmacies that can not get the pediatric dose, the pharmacist must compound the medication. The package insert with the adult dose recommends to calculate the number of capsules needed to achieve the prescribed dose and mix with simple syrup or cherry syrup. This compound is effective but to get a second dose down the child may be difficult.

The medication is horribly bitter.

Pharmacist have been modifying the compounding with the use of a bitterness suppressing agent and a sweetening enhancer with a flavoring of the child’s choice. The compounded suspension should be shaken well and kept refrigerated to preserve the drug and help mask the bad taste. Discard any unused suspension after 10 days. It is also recommended to have the child drink some juice immediately after taking the drug to wash the bitterness out of the mouth.

To assure accurate dosing the parent should use a dosing syringe and not a teaspoon. ( household teaspoons can vary in size from 3.5ml to 7 ml). If you do not have a syringe ask your pharmacist. The child should be given the medication for the duration prescribed. Tamiflu may be given with or without food. If the medication upsets the stomach, it may help to give with food or milk.

Parents are reporting that as early as the next day the children are asking for something to eat.

If a dose is missed it should be taken as soon as remembered but not if less than 2 hours away from the next dose. Just skip the missed dose and continue the therapy. DO NOT take extra medication to make up for the missed dose.

The following are the Contraindication/Cautions.

Hypersensitivity (allergy) to the drug Patients under one year old Caution if renal (kidney) impairment Caution if hepatic (liver) impairment
The following are the Drug Interactions.

Clopidogrel (Plavix) Influenza nasal vaccines, live

Clopidogrel may decrease the Tamiflu efficacy because of competitive liver metabolizing and thus decrease the conversion of oseltamivir to the active metabolite.

Nasal vaccines which have been given less than 2 weeks before or less than 48 hours after antiviral treatment may result in inadequate immunologic vaccine response.

The following are the serious and common reactions with Tamiflu. Stop taking Tamiflu and get emergency medical help if any of these “signs of an allergic reaction” occur: hives, difficulty breathing, swelling of the face, lips, tongue, or throat; a red and blistering rash or peeling skin rash..

Serious Reactions

delirium behavioral disturbances self-injury, incl. fatal anaphylaxis Stevens-Johnson syndrome toxic epidermal necrolysis erythema multiforme
Common Reactions

nausea vomiting diarrhea abdominal pain headache epistaxis ear disorder

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