January 14, 2015
Flu Hits Hard; Spot Shortages of Tamiflu Only Temporary

Atlanta—The current influenza season has hit hard and early, according to the CDC, and pharmacists are dealing with some of the repercussions.

As of late December, at least half the country was experiencing high levels of flu activity. In fact, according to the CDC, the proportion of deaths attributed to pneumonia and influenza (P&I) reached the epidemic threshold by late December.

Public health officials said that while antiviral drugs may be prescribed to non-high-risk patients with flu, all high risk patients presenting with flu symptoms should receive the medications. High risk patients include those 65 and older, children younger than 5 years (and especially those younger than 2 years), pregnant women, and any person with a variety of health conditions such as asthma, neurological and neurodevelopment conditions, chronic lung disease, heart disease, blood disorders, diabetes and other endocrine disorders, kidney disorders, liver disorders, metabolic disorders, weakened immune systems, morbid obesity, as well as patients younger than 19 on long-term aspirin therapy.

As a result, some pharmacies already have experienced Tamiflu (oseltamivir phosphate) shortages, and the manufacturer has released reserve stock of Tamiflu 75 to ensure continuous supply.

“With the addition of these reserve supplies, we anticipate having sufficient supply of Tamiflu capsules to meet demand for this flu season,” according to a media statement from Genentech.

While the formulation from the reserve stock is the same as medication currently being distributed, the packing differs from what is now on the market in the United States, the company pointed out.

“There are some differences in the appearance of the external carton packaging (notably, the reserve stock has Roche branding instead of Genentech branding). Importantly, the reserve stock carton includes an older version of the package insert that pharmacists have been directed to replace with the most current information which can be found at The most current version of the prescribing information can also be obtained by contacting 1 (855) 424-4358,” according to the statement.

A healthcare provider letter offers information about the differences in the packages and a side-by-side comparison.

“Flu activity is unpredictable and, as the manufacturer of Tamiflu, we do our best each season to anticipate flu spikes and work with our network of national distributors and pharmacies to provide Tamiflu to those areas of the country that need it most,” an earlier Genentech statement notes.

The company recommends that pharmacies work with authorized distributors to obtain additional supply of Tamiflu capsules and Tamiflu Oral Suspension. 

With widespread influenza in the U.S., supplies of Tamiflu Oral Suspension may be limited in certain areas, Genentech said. Tamiflu OS is typically prescribed for children under the age of 13 and patients who have difficulty swallowing.

“We are working to expedite new shipments of Tamiflu OS to distributors as new supplies of this formulation become available,” the company reported.

Genentech also pointed out that, if Tamiflu Oral Suspension is unavailable, pharmacists may mix Tamiflu 75 mg capsules into an oral suspension for patients who need it. The current healthcare provider instructions for dosing and compounding are found in the Tamiflu package, and also may be accessed at the Tamiflu website.

Two other antiviral drugs are approved and recommended for use this season: zanamivir (Relenza) and peramivir (Rapivab), an intravenous formulation approved for use by the FDA this season for people 18 and older.

While antivirals work best when started within two days of the onset of influenza symptoms, patients with high-risk conditions can benefit even when antiviral treatment is started later, according to the CDC.

In addition, flu vaccination continues to be recommended even when there are drifted viruses circulating, as is the case this year, because the vaccine can still prevent infection as well as serious flu-related complications.

Public health officials are urging vaccination for anyone 6 months old or older who has yet to receive one. That includes patients who already have had a bout with the flu this season because the vaccine protects against three or four different viruses.

“It’s fairly common for there to be two waves of flu activity during a season,” the CDC stated. “The second wave is often caused by an influenza B virus.”

As of early December, more than 145 million doses of seasonal flu vaccine had been distributed, but only 40% of people in the U.S. had reported getting a flu vaccine as of early November.

Last year, the vaccination rate for adults was just under 60% and slightly more than 40% for children.

U.S. Pharmacist Social Connect