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 Pharmacy Technician's Practice Pearl from Pharmacy Technician's Letter

Practice Pearl - November 2009

     Making Tamiflu suspension or Relenza solution for flu patients is leading to problems and errors.
     Infants and young kids need the liquid Tamiflu...but there's a shortage. Roche is focusing on making the capsules since they're faster to produce, and is behind on filling orders for the liquid.
     You can compound Tamiflu suspension from the caps...but watch for some common errors with the compounded AND commercial forms.
     Compounded Tamiflu suspension is 15 mg/mL...instead of 12 mg/mL like the commercial suspension.
     Most prescribers will write for Tamiflu in milliGRAM doses.
     Convert the "mg" dose to the appropriate "mL" dose of compounded Tamiflu...and dispense a dosing syringe marked in mLs.
     Keep any extra compounded Tamiflu refrigerated for up to 35 days.
     Commercial Tamiflu susp comes with a dispenser marked in milliGRAMS.
     If this dispenser is used, put the dose in milliGRAMS on the label.
     If needed, convert doses written in "mLs" or "tsps" to milliGRAMS.
     The Tamiflu dispenser can't measure doses less than 30 mg. Convert smaller doses to milliLITERS and dispense an appropriate syringe.
     See how to set up the ratios for these types of dose conversions in our newest Technician Training Tutorial: Non-Sterile Compounding.
     Some expired Tamiflu suspension is OKAY for you to dispense...under an FDA emergency use authorization.
     Before you return any outdated Tamiflu suspension, check the lot number on our Detail-Document: Tamiflu Expiration Date Extension to see if the date has been extended. Some dates have been extended by 2 to 3 years for this health emergency...even though this isn't shown on the label.
     Use the new dates for the shelf life...and continue to put a 10-day expiration date on the label once the suspension is mixed.
     You'll also see a warning not to reformulate Relenza.
     Some people are removing the powder from the blister packs and dissolving it to make a solution for nebulizers or ventilators.
     Use Relenza only with its inhaler. Making a solution might cause the lactose in it to "gum up" and obstruct the ventilator.

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Pharmacy Technician's Letter: November 2009; Vol: 3, No. 11
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