The Institute for Safe Medication Practices recently issued a special alert regarding oseltamivir (Tamiflu®) dosing errors. Due to a shortage of the commercially available Tamiflu® suspension, pharmacies may be forced to compound an oral suspension for patients who cannot swallow capsules. However, the compounded suspension contains oseltamivir 15 mg/mL while the commercially available Tamiflu® suspension contains 12 mg/mL. Prescribers must specify the dose in mg (not volume) on all outpatient prescriptions to avoid dosing errors. Follow the recommended dosing guidelines and do not try to “guess” which product the patient will receive – community pharmacies will contact prescribers if adjustments are needed. The concentration of Tamiflu® suspension in the inpatient prescriber order entry system will be adjusted as needed to reflect the product the inpatient pharmacy supplies. The ambulatory electronic medical record was adjusted to require the Tamiflu® suspension dose in milligrams instead of volume.
The Food & Drug Administration issued an Emergency Use Authorization to allow use of peramivir IV to treat adult and pediatric patients with suspected or laboratory confirmed H1N1 virus infection. Peramivir, a neuraminidase inhibitor, is an unapproved drug that is being evaluated in adults in phase 3 clinical trials. The safety and efficacy of peramivir IV in pediatrics has not been evaluated though a few pediatric patients have received the drug under emergency IND procedures. For this reason, use of peramivir IV at Nationwide Children’s Hospital requires approval from the Infectious Diseases Department.