Geez, and it's only October. We are compounding a lot of Tamiflu suspension these days because of the shortage of the commercial product. It takes a little longer but I feel pressured to speed it up just to get the sick person out of the pharmacy. For myself, I alternate between soap and water, hand sanitizer and the foamy stuff (which is kind of wet and sticky but more fun to use). It's probably going on 2 years since I've had even a cold --- I'm thankful for that but it makes me nervous that I'm overdue for something nasty.
This guy is waiting for prescriptions for himself and his kid. We're busy and going as fast as we can. He comes up to the counter TWICE and loudly asks if it's ready yet. I really don't appreciate that especially when he's sitting there watching us run around like maniacs. We told you we would call you up as SOON as it's ready. It's not just a matter of pulling the next cheeseburger off the grill, you know what I mean? Finally I go to ring him up. All of a sudden he's asking about adding flavoring for the kid's antibiotic liquid. Oh really? NOW you're gonna tell me you want it flavored, huh? Well guess what, it comes already flavored. Whatever it is, your kid's gonna love it. Mr. In-a-Hurry-and-it's-taking-too-long. Now YOUR time is up. I don't know why this irritates me so, but damn, it really does.
By the way, that Tamiflu suspension I have to compound? ---- No, it's not available in banana, watermelon or bubble gum flavor. There are 2 vehicles that the manufacturer tells us we can use --- cherry flavor, no substitutions. For crying out loud, if my kid really needed Tamiflu I would be glad it's available to me and I would get it into my child no matter what flavor it was....
In a similar vein, I'm annoyed when I hear news reports about the government's 'sputtering' response to the production of H1N1 vaccine. Growing virus to make a vaccine is not something we can do in our kitchen sinks. I'm thankful to live in a country that has the capability and scientific know-how to produce MILLIONS of doses of a vaccine in a few months' time. The people at high risk are getting it first, and the rest of us will follow.
There are an awful lot of places around the world where, if a pandemic breaks out, the people are pretty much on their own. I think we take it for granted sometimes.
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We've been having a helluva time getting the suspension to form properly. Are you using the exact guidelines or is there some kind of trick to your method?
I've heard that it makes a better suspension in the Humco Cherry Syrup rather than the Ora Sweet SF.
Otherwise, triturate the heck out of it and add a small amt. of the diluent at a time (not 1/3 like it says.) Apparently the suspended stuff is inert capsule ingredients.
It does compound better in the Cherry Syrup. Not great, but better. Just don't forget to triturate the powder BEFORE you add any suspension vehicle. I forgot once, and had a clumpy mess. And I tasted the stuff. Just a little bit from the mortar after I was finished compounding. It was AWFUL - no cherry flavor really. Just overwhelming bitterness. Poor kids, but if they are that sick, get it down somehow. If it tastes that bad from the mortar after 3 washings of cherry syrup, I can't imagine what the full strength stuff tates like. Hope Roche gets on the ball and gets some more made soon.
I can speak from personal experience that Cherry Syrup works much better than Flavor Sweet SF. I haven't had the chance to try the Ora Sweet SF yet, so I can't speak to that one. We had Flavor Sweet in stock to start with, but now that that's gone, I'm happily using Cherry Syrup instead.
What about having the kid eat something quite pungently different such as cinnamon, lemon drop, or super sweet such as butterscotch drop, or black licorice or horehound as a pre-med or 'chaser', or drink ice water or ice cream?
I would advise that even though both vehicles were tested and approved by the FDA for the suspension, the Humco cherry syrup has a much lower pH ranges ~3 almost out side the stability window for Tamiflu (3 to 5) where as the Ora-sweet SF has a ~4.3 both those values are based on the 35 day stability testing done by the FDA.
Good points.
And Mr. Asshole needs a slapping. I love them. They need emergency work-ins, then show up 20 minutes late and are pissed that I'm now seeing the person who showed up on time.
To the anonymous commenter who questioned my suitability as a pharmacist and said "shame on you" for 'taking revenge' on this customer: I deleted your comment because it made me so angry. But here's my answer-- the child got his medication, correctly prepared. The father cared about NOTHING except how long it was going to take. He badgered me the entire time and when I had the medication mixed and ready, he then demands that it be flavored. (And his next question would have been, "how long is THAT going to take?") I can assure you that there is a sick kid in a tent in Syria tonight who has no hope of getting access to Tamiflu or any OTHER medicine, much less having it WATERMELON-flavored to his liking. When you've been a pharmacist for as long as I have you see a lot of things, but you never get used to the poor behavior of some people. In spite of it, this child was very well served.
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