Tamiflu Caution For Usage

Special Instructions for Use, Handling and Disposal: Commercially manufactured Tamiflu for oral suspension (6 mg/mL) is the preferred product for pediatric and adult patients who have difficulty swallowing capsules or where lower doses are needed. In the event that Tamiflu for oral suspension is not available, the pharmacist may compound a suspension (6 mg/mL) from Tamiflu capsules.
If the commercially manufactured Tamiflu oral suspension and the pharmacy compounded suspension are not available, Tamiflu suspension may be prepared from Tamiflu capsules at home (see Emergency Home Preparation of an Oral Suspension from Tamiflu Capsules as follows).
For administering the pharmacy compounded suspension, syringes of appropriate volume and grading should be requested from the pharmacy. When the appropriate capsule strengths are not available for the dose needed, instructions for home preparation and syringes of appropriate volume and grading can be requested from the health care professional, such as a pharmacist).
Preparation of Tamiflu Powder for Oral Suspension (6 mg/mL): It is recommended that Tamiflu powder for oral suspension be constituted by the pharmacist prior to dispensing to the patient (see Dosage & Administration): 1. Tap the closed bottle several times to loosen the powder.
2. Measure 55 mL of water. Use the measuring cup (where provided) and fill it to the indicated level.
3. Add all 55 mL of water for constitution to the bottle and shake the closed bottle well for 15 seconds.
4. Remove the child-resistant cap and push bottle adapter into neck of bottle.
5. Close bottle with child-resistant cap tightly. This will assure the proper seating of the bottle adapter in the bottle and child-resistant status of the cap.
The patient instruction sheet and an oral dispenser should be dispensed to the patient. It is recommended to write the date of expiration of the constituted suspension on the bottle label.
Emergency Compounding of an Oral Suspension from Tamiflu Capsules (Final Concentration 6 mg/mL): Preparation of the pharmacy-compounded suspension (6 mg/mL): This procedure describes the preparation of a 6 mg/mL suspension that will provide one patient with enough medication for a 5-day course of treatment.
The pharmacist may compound a suspension (6 mg/mL) from Tamiflu 30 mg, 45 mg or 75 mg capsules using water containing 0.05% w/v sodium benzoate added as a preservative.
First, calculate the Total Volume needed to be compounded and dispensed for each patient. The Total Volume required is determined by the weight of the patient according to the recommendation in the table as follows: See Table 6.

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Second, determine the number of capsules and the amount of vehicle (water containing 0.05% w/v sodium benzoate added as a preservative) that is needed to prepare the Total Volume (calculated from the previous table: 25 mL, 30 mL, 50 mL, 75 mL, 100 mL, or 125 mL) of pharmacy compounded suspension (6 mg/mL) as shown in the table as follows: See Table 7.

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Third, follow the procedure as follows for compounding the suspension (6 mg/mL) from Tamiflu capsules: 1. Transfer the contents of the stated amount of Tamiflu capsules into the bottle and add the stated amount of sodium benzoate solution (previous table).
2. Close the bottle with the cap and shake for two minutes.
3. Put an ancillary label on the bottle indicating "Shake Gently Before Use".
4. Instruct the parent or caregiver to discard any remaining solution after the patient has completed the full course of therapy.
5. Place an appropriate expiration date label according to storage condition (see as follows).
Storage of the pharmacy-compounded suspension (6 mg/mL): Room temperature storage conditions: Stable for 3 weeks (21 days) when stored at room temperature "do not store above 25°C".
Refrigerated storage conditions: Stable for 6 weeks when stored at 2°C-8°C.
Place a pharmacy label on the bottle that includes the patient's name, dosing instructions, use by date, drug name and any other required information to be in compliance with local pharmacy regulations.
Dosing of the pharmacy-compounded suspension (6 mg/mL): Refer to Dosage & Administration for the dosing instructions.
The appropriate dose must be mixed by the caregiver with an equal quantity of sweet liquid food, such as sugar water, chocolate syrup, cherry syrup, dessert toppings (like caramel or fudge sauce) to mask the bitter taste.
Dispense the suspension with a graduated oral syringe for measuring small amounts of suspension.
Emergency Home Preparation of an Oral Suspension from Tamiflu Capsules: If the commercially manufactured Tamiflu oral suspension (6 mg/mL) is not available and the pharmacy compounded suspension is also not available, Tamiflu suspension may be prepared at home if directed by the healthcare provider.
When appropriate capsule strengths are available for the dose needed (75 mg, 45 mg and 30 mg), the dose is given by opening the capsule and mixing its contents with no more than one teaspoon of a suitable sweetened food product (e.g. chocolate syrup, cherry syrup, sugar water, dessert toppings). The mixture should be stirred and given entirely to the patient.
The mixture must be swallowed immediately after its preparation.
When only 75 mg capsules are available, and doses of 30 mg or 45 mg are needed, and or for younger children and infants who may need a Tamiflu dose <30 mg, the home preparation of the Tamiflu suspension involves additional steps. Instructions for home preparation and syringes of appropriate volume and grading can be requested from the health care provider, such as the pharmacist. Refer to Dosage & Administration for the proper dosing instructions.
Incompatibilities: Not applicable.
Disposal of Unused/Expired Medicines: The release of pharmaceuticals in the environment should be minimized. Medicines should not be disposed of via wastewater and disposal through household waste should be avoided.
Any unused medicinal product or waste materials should be disposed of in accordance with local requirements.