* Supplies of liquid Tamiflu are limited * Roche advises pharmacies to use capsules to make liquid * Process must be done for each prescription individually By Jessica Wohl CHICAGO, Sept 25 (Reuters) - Pharmacists may soon rekindle the traditional art of mixing medications as a shortage of liquid flu medicine leads them to crush capsules for young children and others who cannot swallow pills. Pharmacists are taught to mix medications, a process known as compounding, in pharmacy school. While some pharmacists compound medications each day, such drugs now account for a small percentage of the millions of U.S. prescriptions filled each year. "Years ago this was the predominant way that medications were made," said Nimesh Jhaveri, executive director of pharmacy operations at Walgreen Co <WAG.N>. Now, at the the start of what could be a major flu season, Roche <ROG.VX> has a limited supply of the liquid form of its flu symptom drug Tamiflu, or oseltamivir. "They had a significant amount of it ... waiting just in case we needed it, and all of that went out of date, essentially. So they're having to replace that supply," said Rod Shafer, a pharmacist and the chief executive of the International Association of Compounding Pharmacists. The H1N1 swine flu became a pandemic in June and has already infected millions of people in the United States. Tamiflu and rival drug Relenza, made by GlaxoSmithKline <GSK.L>, can reduce the symptoms of flu, save the lives of patients with very severe symptoms and sometimes prevent influenza, all if taken early enough. The World Health Organization and the U.S. Centers for Disease Control and Prevention currently advise saving the drugs for those most at risk of severe complications, such as pregnant women, people with chronic diseases such as diabetes and children with asthma. Roche has advised pharmacies on how to compound capsules, which are in ready supply, into a liquid form. "It's not as simple as taking some capsules and throwing them in a liquid and giving it a shake," Shafer said. LIQUID TAMIFLU STOCK DWINDLING The supply of manufactured liquid Tamiflu is expected to come back shortly, so the chances of pharmacies actually having to do this are pretty small, Shafer said. Still, drugstores are preparing. Walgreen, the largest U.S. chain, said it can rework the capsules to give patients the medication in liquid form at its more than 7,000 locations. The active ingredients from the capsules must be combined with liquid, and pharmacists need to ensure that the ingredients are stable and keep their effectiveness. "Think of it as a recipe," said Walgreen's Jhaveri, himself a licensed pharmacist. "This is truly the art of pharmacy." The 15 to 20 minute process must be done each time a prescription needs to be filled. Pharmacies cannot make batches since that would be considered manufacturing, he said. Walgreen still has the liquid version of Tamiflu in stock in the majority of its stores, but "that stock is dwindling quickly," Jhaveri said. The biggest demand for Tamiflu has been seen in the Southeast, and supply is dwindling faster there. "We trying to be proactive, we know that this potentially could be a serious issue," Jhaveri said. Liquid Tamiflu received a fresh dose of attention this week in a letter from doctors published in the New England Journal of Medicine. They advised that the dosage written in prescribing instructions does not always match up with the doses listed on the syringe used to dispense the product. Roche sent a letter to healthcare professionals to remind them to follow the dosing instructions and make sure that the measurements match up on the prescription and the device used to give the medicine. (Reporting by Jessica Wohl, editing by Matthew Lewis)
Chief Executive Officer of Chris Veihbacher of French drugs group Sanofi Aventis speaks during a news conference in Paris, September 24, 2009. Sanofi announced the results of the collaborative AIDS vaccine ...
