"What is the 2009 H1NI (swine flu) vaccine?
The Food and Drug Administration (FDA) recently approved the H1N1 vaccine as an injection and an intranasal spray made by CSL, Sanofi Pasteur, MedImmune and Novartis.
Treatment of Influenza
TAMIFLU is indicated for the treatment of acute, uncomplicated illness due to influenza infection in patients 2 weeks of age and older who have been symptomatic for no more than 2 days.
Prophylaxis of Influenza
TAMIFLU is indicated for the prophylaxis of influenza in patients 1 year and older.
Limitations of Use
The following points should be considered before initiating treatment or prophylaxis with TAMIFLU:
- Efficacy of TAMIFLU in patients who begin treatment after 48 hours of symptoms has not been established.
- TAMIFLU is not a substitute for early influenza vaccination on an annual basis as recommended by the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices.
- There is no evidence for efficacy of TAMIFLU in any illness caused by agents other than influenza viruses types A and B.
- Influenza viruses change over time. Emergence of resistance mutations could decrease drug effectiveness. Other factors (for example, changes in viral virulence) might also diminish clinical benefit of antiviral drugs. Prescribers should consider available information on influenza drug susceptibility patterns and treatment effects when deciding whether to use TAMIFLU.
DOSAGE AND ADMINISTRATION
Dosing for Treatment and Prophylaxis of Influenza
Treatment with TAMIFLU should begin within 2 days of onset of symptoms of influenza or following close contact with an infected individual.
TAMIFLU may be taken with or without food [see CLINICAL PHARMACOLOGY]. However, when taken with food, tolerability may be enhanced in some patients.
For patients who cannot swallow capsules, TAMIFLU for oral suspension is the preferred formulation. If the oral suspension product is not available, TAMIFLU capsules may be opened and mixed with sweetened liquids such as regular or sugar-free chocolate syrup, corn syrup, caramel topping, or light brown sugar (dissolved in water). If the appropriate strengths of TAMIFLU capsules are not available to mix with sweetened liquids and the oral suspension product is not available, then a pharmacist may compound an emergency supply of oral suspension from TAMIFLU 75 mg capsules.
Treatment of Influenza
Adults and Adolescents (13 years of age and older)
The recommended oral dose of TAMIFLU for treatment of influenza in adults and adolescents 13 years and older is 75 mg twice daily for 5 days. TAMIFLU for oral suspension may be used by patients who cannot swallow a capsule (12.5 mL of TAMIFLU for oral suspension [6 mg/mL] delivers 75 mg).
Pediatric Patients (2 weeks to 12 years of age)
The recommended oral dose of TAMIFLU for treatment of influenza in pediatric patients 1 to 12 years of age is shown in Table 1.
The recommended oral dose of TAMIFLU for treatment of influenza in pediatric patients 2 weeks to less than 1 year of age is 3 mg/kg twice daily for 5 days (shown in Table 1).
Prophylaxis of Influenza
Adults and Adolescents (13 years of age and older) The recommended oral dose of TAMIFLU for prophylaxis of influenza in adults and adolescents 13 years and older following close contact with an infected individual is 75 mg once daily for at least 10 days. The recommended dose for prophylaxis during a community outbreak of influenza is 75 mg once daily. Safety and efficacy have been demonstrated for up to 6 weeks in immunocompetent patients. The duration of protection lasts for as long as dosing is continued. Safety has been demonstrated for up to 12 weeks in immunocompromised patients. TAMIFLU for oral suspension may also be used by patients who cannot swallow a capsule (12.5 mL of TAMIFLU for oral suspension [6 mg/mL] delivers 75 mg).
Pediatric Patients (1 to 12 years of age)
The recommended oral dose of TAMIFLU for prophylaxis of influenza in pediatric patients 1 to 12 years of age based on body weight is shown in Table 1. Prophylaxis in pediatric patients following close contact with an infected individual is recommended for 10 days. For prophylaxis in pediatric patients during a community outbreak of influenza, dosing may be continued for up to 6 weeks.
The safety and efficacy of TAMIFLU for prophylaxis of influenza have not been established in infants less than 1 year of age.
Table 1 : Treatment (twice daily dosing for 5 days)
and Prophylaxis (once daily dosing for 10 days) Dosing of Oral TAMIFLU for
Influenza in Pediatric Patients
|Weight (kg)||Treatment Dosing for 5 days||Prophylaxis Dosing for 10 days||Volume of Oral Suspension (6 mg/mL) for each Dose**||Number of Bottles of Oral Suspension to Dispense||Number of Capsules and Strength to Dispense§|
|Patients from 2 Weeks to less than 1 Year of Age|
|Any weight||3 mg/kg twice daily||Not applicable*||0.5 mL/kgf||1 bottle||Not applicable|
|Patients 1 to 12 Years of Age Based on Body Weight|
|15 kg or less||30 mg twice daily||30 mg once daily||5 mL||1 bottle||10 Capsules 30 mg|
|15.1 kg thru 23 kg||45 mg twice daily||45 mg once daily||7.5 mL||2 bottles||10 Capsules 45 mg|
|23.1 kg thru 40 kg||60 mg twice daily||60 mg once daily||10 mL||2 bottles||20 Capsules 30 mg|
|40.1 kg or more||75 mg twice daily||75 mg once daily||12.5 mL‡‡||3 bottles||10 Capsules 75 mg|
|*TAMIFLU is not approved for
prophylaxis of patients less than 1 year of age
**A 10 mL oral dosing dispenser is provided with the oral suspension. In the event that the dispenser provided is lost or damaged, another dosing dispenser may be used to deliver the volumes.
†For patients less than 1 year of age, remove the provided 10 mL oral dosing dispenser from the packaging, and provide an appropriate dosing device that can accurately measure and administer small volumes.
‡‡Delivery of this TAMIFLU for Oral Suspension dose requires administering 10 mL followed by another 2.5 mL. §Oral Suspension is the preferred formulation for patients who cannot swallow capsules.
Data are available on plasma concentrations of oseltamivir carboxylate following various dosing schedules in patients with renal impairment [see CLINICAL PHARMACOLOGY].
Treatment of Influenza
Dose adjustment is recommended for adult patients with creatinine clearance between 10 and 30 mL/min receiving TAMIFLU for the treatment of influenza. In these patients it is recommended that the dose be reduced to 75 mg of TAMIFLU once daily for 5 days. No recommended dosing regimens are available for patients with end-stage renal disease undergoing routine hemodialysis or continuous peritoneal dialysis treatment.
Prophylaxis of Influenza
For the prophylaxis of influenza, dose adjustment is recommended for adult patients with creatinine clearance between 10 and 30 mL/min receiving TAMIFLU. In these patients it is recommended that the dose be reduced to 75 mg of TAMIFLU every other day or 30 mg TAMIFLU every day. No recommended dosing regimens are available for patients undergoing routine hemodialysis and continuous peritoneal dialysis treatment with end-stage renal disease.
No dose adjustment is recommended for patients with mild or moderate hepatic impairment (Child-Pugh score ≤ 9) [see CLINICAL PHARMACOLOGY].
Preparation of TAMIFLU for Oral Suspension
It is recommended that TAMIFLU for oral suspension be constituted by the pharmacist prior to dispensing to the patient:
- Tap the closed bottle several times to loosen the powder.
- Measure 55 mL of water in a graduated cylinder.
- Add the total amount of water for constitution to the bottle and shake the closed bottle well for 15 seconds.
- Remove the child-resistant cap and push bottle adapter into the neck of the bottle.
- 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.
Label the bottle with instructions to Shake Well before each use.
The constituted TAMIFLU for oral suspension (6 mg/mL) should be used within 17 days of preparation when stored under refrigeration or within 10 days if stored at controlled room temperature; the pharmacist should write the date of expiration of the constituted suspension on a pharmacy label. The patient package insert and oral dispenser should be dispensed to the patient.
Emergency Compounding of an Oral Suspension from 75 mg TAMIFLU Capsules (Final Concentration 6 mg/mL)
The following directions are provided for use only during emergency situations. These directions are not intended to be used if the FDA-approved, commercially manufactured TAMIFLU for oral suspension is readily available from wholesalers or the manufacturer.
Compounding an oral suspension with this procedure will provide one patient with enough medication for a 5day course of treatment or a 10-day course of prophylaxis.
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 75 mg using one of these vehicles: Cherry Syrup (Humco®), Ora-Sweet® SF (sugar-free) (Paddock Laboratories), or simple syrup. Other vehicles have not been studied. This compounded suspension should not be used for convenience or when the FDA-approved TAMIFLU for oral suspension is commercially available.
First, determine the dose of TAMIFLU for the patients then determine total volume of an oral suspension needed to be compounded based on Table 2.
Table 2 : Volume of an Oral Suspension (6 mg/mL)
Needed to be Compounded Based Upon the Patient's TAMIFLU Dose
|TAMIFLU Dose*||Total Volume to Compound per Patient (mL)|
|15 mg or less||37.5 mL|
|30 mg||75 mL|
|45 mg||100 mL|
|60 mg||125 mL|
|75 mg||150 mL|
|* If the TAMIFLU dose is between the doses listed, the total volume of oral suspension to compound should default to the next greater dose listed.|
Second, determine the number of capsules and the amount of water and vehicle (Cherry Syrup, Ora-Sweet® SF, or simple syrup) that are needed to prepare the total volume (determined from Table 2: 37.5 mL, 75 mL, 100 mL, 125 mL, or 150 mL) of compounded oral suspension (6 mg/mL) (see Table 3).
Table 3 : Number of TAMIFLU
75 mg Capsules and Amount of Vehicle (Cherry Syrup, Ora-Sweet® SF, or
Simple Syrup) Needed to Prepare the Total Volume of a Compounded Oral
Suspension (6 mg/mL)
|Total Volume of Compounded Oral Suspension to be Prepared||37.5 mL||75 mL||100 mL||125 mL||150 mL|
|Number of TAMIFLU 75 mg Capsules*||3 capsules (225mg oseltamivir)||6 capsules (450 mg oseltamivir)||8 capsules (600 mg oseltamivir)||10 capsules (750 mg oseltamivir)||12 capsules (900 mg oseltamivir)|
|Amount of Water||2.5 mL||5 mL||7 mL||8 mL||10 mL|
|Volume of Vehicle Cherry Syrup (Humco®) OR Ora-Sweet® SF (Paddock Laboratories) OR simple syrup||34.5 mL||69 mL||91 mL||115 mL||137 mL|
|*Includes overage to ensure all doses can be delivered|
Third, follow the procedure below for compounding the oral suspension (6 mg/mL) from TAMIFLU capsules 75 mg:
- Place the specified amount of water into a polyethyleneterephthalate (PET) or glass bottle (see Table 3).
- Carefully separate the capsule body and cap and pour the contents of the required number of TAMIFLU 75 mg capsules into the PET or glass bottle.
- Gently swirl the suspension to ensure adequate wetting of the TAMIFLU powder for at least 2 minutes.
- Slowly add the specified amount of vehicle to the bottle.
- Close the bottle using a child-resistant cap and shake well for 30 seconds to completely dissolve the active drug and to ensure homogeneous distribution of the dissolved drug in the resulting suspension. (Note: The active drug, oseltamivir phosphate, readily dissolves in the specified vehicles. The suspension is caused by inert ingredients of TAMIFLU capsules which are insoluble in these vehicles.)
- Put an ancillary label on the bottle indicating “Shake Well Before Use.”
- Instruct the parent or caregiver that any unused suspension remaining in the bottle following completion of therapy must be discarded by either affixing an ancillary label to the bottle or adding a statement to the pharmacy label instructions.
- Place an appropriate expiration date on the label according to storage conditions below.
Storage of the Emergency Compounded Suspension
- Refrigeration: Stable for 5 weeks (35 days) when stored in a refrigerator at 2° to 8°C (36° to 46°F).
- Room Temperature: Stable for five days (5 days) when stored at room temperature, 25°C (77°F).
Note: The storage conditions are based on stability studies of compounded oral suspensions, using the above mentioned vehicles, which were placed in glass and polyethyleneterephthalate (PET) bottles. Stability studies have not been conducted with other vehicles or bottle types.
Place a pharmacy label on the bottle that includes the patient's name, dosing instructions, and drug name and any other required information to be in compliance with all State and Federal Pharmacy Regulations.
Dosing of the Compounded Suspension (6 mg/mL)
Refer to earlier Dosage and Administration sections and Table 1 for the proper dosing instructions for the pharmacy label.
Dosage Forms And Strengths
Capsules: 30 mg, 45 mg, 75 mg
- 30-mg capsules (30 mg free base equivalent of the phosphate salt): light yellow hard gelatin capsules. “ROCHE” is printed in blue ink on the light yellow body and “30 mg” is printed in blue ink on the light yellow cap.
- 45-mg capsules (45 mg free base equivalent of the phosphate salt): grey hard gelatin capsules. “ROCHE” is printed in blue ink on the grey body and “45 mg” is printed in blue ink on the grey cap.
- 75-mg capsules (75 mg free base equivalent of the phosphate salt): grey/light yellow hard gelatin capsules. “ROCHE” is printed in blue ink on the grey body and “75 mg” is printed in blue ink on the light yellow cap.
For Oral Suspension: 6 mg/mL (final concentration when constituted)
- White powder blend for constitution to a white tutti-frutti–flavored suspension. After constitution, each bottle delivers a usable volume of 60 mL of oral suspension equivalent to 360 mg oseltamivir base (6 mg/mL).
Storage And Handling
TAMIFLU Capsules 30-mg capsules (30 mg free base equivalent of the phosphate salt): light yellow hard gelatin capsules. “ROCHE” is printed in blue ink on the light yellow body and “30 mg” is printed in blue ink on the light yellow cap. Available in blister packages of 10 (NDC 0004-0802-85).
45-mg capsules (45 mg free base equivalent of the phosphate salt): grey hard gelatin capsules. “ROCHE” is printed in blue ink on the grey body and “45 mg” is printed in blue ink on the grey cap. Available in blister packages of 10 (NDC 0004-0801-85).
75-mg capsules (75 mg free base equivalent of the phosphate salt): grey/light yellow hard gelatin capsules. “ROCHE” is printed in blue ink on the grey body and “75 mg” is printed in blue ink on the light yellow cap. Available in blister packages of 10 (NDC 0004-0800-85).
Store the capsules at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F) [See USP Controlled Room Temperature].
TAMIFLU for Ora l Suspension
Supplied as a white powder blend in a glass bottle. After constitution, the powder blend produces a white tuttifrutti–flavored oral suspension. After constitution with 55 mL of water, each bottle delivers a usable volume of 60 mL of oral suspension equivalent to 360 mg oseltamivir base (6 mg/mL). Each bottle is supplied with a bottle adapter and a 10 mL oral dispenser (NDC 0004-0820-09).
Store dry powder at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F) [See USP Controlled Room Temperature].
Store constituted suspension under refrigeration for up to 17 days at 2° to 8°C (36° to 46°F). Do not freeze. Alternatively, store constituted suspension for up to 10 days at 25°C (77°F); excursions permitted to 15° to 30°C (59° to 86°F) [See USP Controlled Room Temperature].
Distributed by: Genentech, Inc. A Member of the Roche Group., 1 DNA Way South San Francisco, CA 94080-4990. Licensor: Gilead Sciences, Inc. Foster City, California 94404. Revised: 12/2012
Last reviewed on RxList: 1/9/2013
This monograph has been modified to include the generic and brand name in many instances.
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