Atlanta—If your pharmacy is located in an area with especially high influenza activity, you might find that your supplies of antivirals are running low—or are completely out. 

The CDC says it is aware of the situation and offers some advice on how to handle it. A webpage with information also includes manufacturer contact information.

“CDC has received reports of anti-viral drug shortages in some places that are experiencing high influenza activity. However, the manufacturers say there is product available,” said CDC acting Director Anne Schuchat, MD. “Pharmacists may want to increase supply on their shelves and patients may have to call more than one pharmacy to fill their prescription.”

In the advisory at the end of January, public health officials point out that shortages seem to occur most often with generic versions of oseltamivir capsules and suspension in some locations experiencing high influenza activity. 

The CDC recommends that, when commercially manufactured liquid suspension formulation is not readily available, pharmacists should compound an oral suspension from oseltamivir 75-mg capsules as described in the manufacturer package inserts as an alternative.

It also suggests that pharmacies attempting to make bulk purchases of influenza antiviral drugs contact more than one distributor or manufacturer to locate medications available for purchase in the short term.

With flu activity remaining widespread across the nation, Scott Gottlieb, MD, commissioner of the FDA, said his agency also is monitoring the situation closely in partnership with the CDC.

“We’re continuing to take steps to help ensure that people with the flu have access to critical medical products, including antivirals, saline and other supportive care drugs and devices,” Gottlieb said in a statement.

The FDA director reiterated that, while spot shortages of some antivirals as well as flu assays exist in some areas, “at this time, there is no nationwide shortage of these products. The FDA is carefully monitoring the situation and we will provide updates as needed. Along with antivirals and device products we are also monitoring influenza vaccine supplies. While there have been some reported spot shortages, flu vaccines are still available.”

He also discussed some supply issues of special interest to hospital pharmacists.  “This year’s flu season has been particularly challenging, with a notable number of cases leading to hospitalization,” he emphasized. “The season started earlier than usual and seemed to spread across many states quickly. H3N2, the predominant strain of the influenza A virus this season, has led to health complications that are more severe than those seen during an H1N1-predominant season. We recognize that managing the thousands of flu-related hospitalizations has increased the demand for certain saline products—which are commonly used to both hydrate and deliver medications via intravenous routes.”

Gottlieb said a shortage of IV saline bags, for which supply issues have been a problem, has worsened because of hurricanes and the serious influenza season. “Although the saline shortage is improving, this year’s worse-than-normal flu season and workarounds deployed by healthcare providers in the wake of this shortage have increased demand for saline and other products,” he explained.

Products in short supply include: 
• Large-volume saline bags typically used to hydrate patients 
• Small-volume IV saline bags (generally in 50- and 100-mL sizes) that are often used to deliver other medicines
• Empty IV containers of varying sizes that are being used by many healthcare providers to compound their own IV saline solutions by filling these empty containers 

The FDA is working to resolve the shortages and has extended the expiration dates of certain products, including some 500-mL size saline bags, “after carefully examining the data submitted by the company to ensure that it meets the FDA’s quality and safety standards,” Gottlieb said.

As for the light at the end of the tunnel, Schuchat shared some positive information, stating, “There is a little good news this week. For the second week in a row, there are signs that activity in the west may be easing up. However, we are by no means out of the woods. Most seasons last up to 20 weeks and we’ve probably got several weeks left of increased flu.”

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