By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
I was at a Multiple Sclerosis Society conference several years ago, when I went to a talk by an epidemiologist. He was showing how the further north you went in the world, the more likely it was that you would get MS. In other words MS is relatively common in places like Manitoba, Canada, but almost unheard of near the equator. I thought that was very interesting because I also have an interest in asthma and asthma has a similar distribution around the world. Asthma is more common the further you get from the equator. Now what else changes the further you get from the equator? The amount of sunshine does. Is that related? Maybe.
Researchers are making more links between Vitamin D and health all the time. Although not a direct cause and effect, some researchers think that the increased sunshine in the lower latitudes may be a reason there is less Multiple Sclerosis and less asthma the further south you live. More sunshine means your body produces more Vitamin D. Vitamin D effects many things in the body. One thing Vitamin D does is to reduce inflammation. Both MS and asthma involve inflammation. So maybe Vitamin D deficiency is involved in asthma and MS.
Another interesting theory that came out was Vitamin D and the flu. If you ignore the current H1N1 scare, influenza is a group of viruses that move around the world. They move between humans, birds and pigs and they mutate a bit every year. The interesting part for our Vitamin D story is when people get sick. Flu season in North America is in the winter months, when sunshine is in short supply. However flu season in Australia is about 6 months before us, in their winter months, when sunshine there is the least abundant. In countries around the equator, when the hours of sunshine are the same all year round, flu season happens in the rainy season when there is less sun. So there is research into whether Vitamin D deficiency makes you less able to fight off the flu.
What is Vitamin D? As usual, there isn’t a simple answer. There are different forms of Vitamin D. The type of Vitamin D your body makes is called Vitamin D3 (or cholecalciferol). The formation is complicated, but it goes like this. A precusor chemcial is converted to Vitamin D3 in the skin with the help of sunlight (UV Radiation). Vitamin D3 is converted in the liver to a second form called calcidiol. The calcidiol is converted to calcitriol by the kidney. Calcitriol is the most active form of Vitamin D. So you can get Vitamin D3 from taking pills, you can go outside and have your skin make it from sunshine or you can eat things like fish. Then you hope your kidneys are healthy enough to convert the Vitamin D3 to calcitriol. There is another form of Vitamin D called Vitamin D2 . It is formed by plants and it can be converted to calcitriol in your body as well. There are those that argue that Vitamin D2 doesn’t form calcitriol as well at Vitamin D3.
Why do we care about Vitamin D? Despite the interesting, but speculative research into other good things Vitamin D does, it is still mostly about the bones. Vitamin D helps your gut absorb calcium. This was originally discovered by people who studied Rickets. Rickets is most common in children and is a characterized by bone deformaties and “soft bones” which don’t have enough calcium. However if we gave these children Vitamin D, we could reverse and prevent rickets. Moving back to the present, current research shows that if adults get between 400-800 IU of Vitamin D per day their bones break less often. Research also shows these adults fall less often if they get enough Vitamin D. Some of the newer research is talking about people taking up to 2000 and more IU per day.
How much Vitamin D do we need? The easy answer is that most of us adults should get 1000 IU of Vitamin D3 per day. The dose is still being debated among groups like the Osteoporosis Society and the Canadian Cancer Society, but 1000 IU seems to be a safe middle road. Although Vitamin D is a fat soluable vitamin and can build up in your tissues, the toxic dose of Vitamin D is probably above 10,000 IU per day.
We live in a Northern Country. Most of us probably get Vitamin D deficient in the winter as the days get shorter and we put on more clothes. A Vitamin D supplement may be an inexpensive health booster most of us should look at.
As always if you have any questions or concerns about these products, ask your pharmacist.
Friday, November 27, 2009
Friday, November 20, 2009
Ear Infections in Children
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Today you are a family doctor. Congratulations on making it through 7 plus years of education and a bunch of on the job experience in about 15 seconds. Your patient is this little kid I know called Eric. He is 4 years old. Eric complains to his mom that his ear hurts. His mom takes him to see you. You examine Eric and determine that he has acute otitis media or a middle ear infection. What should you do? Should Eric get an antibiotic? Recent guidelines from the Canadian Pediatric Society say maybe not.
Acute otitis media or a middle ear infection is very common in children. It is estimated that 75% of children will have an ear infection by the time they are one year old. Why do so many children get ear infections? Well, just being young gives children a shorter and more horizontal eustachian tubes as compared to adults. The eustachian tubes, among other things, helps fluid from behind the ear drum drain out. If these eustachian tubes become blocked or squeezed shut by inflammation, fluid behind the ear drum can become trapped. Allergies and viral infections are also common in young children. These can cause the eustachian tubes to become inflamed and blocked. There is even the suggestion that children who get many ear infections have less of a certain antibody called secretory immunoglobulin A. Since this antibody makes it harder for bacteria to stick in the nose and throat, if children have less of it, they may have more bacteria hanging around ready to cause ear infections.
As you talk to Eric’s mom, you find out he had an upper respiratory tract infection for a few days before his ears started to hurt. You figure that the virus from this infection inflamed his eustachian tubes and caused his adenoids to swell. Eric’s eustachian tubes got blocked eustachian tubes and fluid got trapped behind his ear drum. The blocked tube also created a bit of a vacuum and pulled bacteria from Eric’s nose and throat back into his middle ear space. The bacteria grew in the trapped fluid and voila, Eric got an ear infection!
An interesting thing about middle ear infections is we don’t know exactly what is going on behind the ear drum. The only way to find out what is causing an ear infection is to push a big needle through Eric’s ear drum, draw out some fluid and test it. I don’t think he’d like that much. However some brave, unfortunate children have had their ear drums poked for science, so we know that most ear infections have bacteria in the fluid behind the ear drum. As you are a doctor, you know that antibiotics can kill bacteria. So every ear infection should get an antibiotic, right? That brings us back to the Canadian Pediatric Society.
So what are the experts at the Canadian Pediatric Society recommending you do with Eric? Nothing. If the child is older than 6 months, doesn’t have other under-lying complicating diseases, and doesn’t have a fever over 39 C or severe ear pain, then parents should just watch the child. The reason is that about two thirds of children will have their ear infection symptoms just go away in 48 to 72 hours without antibiotics. If the child doesn’t get better in 48 to 72 hours, then the parents should take them back to the doctor to get an antibiotic.
So you are a good family doctor and follow the guidelines. You tell Eric’s mom that although she has taken time off work, and she has a cranky four year old with a sore ear that she should just go home with no antibiotic prescription. Do you think she will be very happy? Probably not. So you make a deal with her. First you explain to her that only about 1 in 15 kids with ear infections get better faster on antibiotics than without. Then you tell Eric’s mom that antibiotics aren’t without risk. About 20% of kids on antibiotics get diarrhea. A smaller number of children on antibiotics can get things like rashes, trouble breathing or antibiotic resistance. Eric’s mom calms down. Eric has gotten a rash before on a certain antibiotic, so his mom starts to see the risk.
You tell Eric’s mom to go to the pharmacy and ask the pharmacist for the appropriate doses of acetaminophen and ibuprofen for Eric based on his weight. This should make Eric’s ear feel better for the next 48 to 72 hours. You also give Eric’s mom a prescription for an antibiotic, but you tell her not to fill it. She will leave the prescription at the pharmacy. That way if he doesn’t get better in 48 to 72 hours, Eric’s mom can get him a prescription without having to get back into see you. Good job, doc!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Today you are a family doctor. Congratulations on making it through 7 plus years of education and a bunch of on the job experience in about 15 seconds. Your patient is this little kid I know called Eric. He is 4 years old. Eric complains to his mom that his ear hurts. His mom takes him to see you. You examine Eric and determine that he has acute otitis media or a middle ear infection. What should you do? Should Eric get an antibiotic? Recent guidelines from the Canadian Pediatric Society say maybe not.
Acute otitis media or a middle ear infection is very common in children. It is estimated that 75% of children will have an ear infection by the time they are one year old. Why do so many children get ear infections? Well, just being young gives children a shorter and more horizontal eustachian tubes as compared to adults. The eustachian tubes, among other things, helps fluid from behind the ear drum drain out. If these eustachian tubes become blocked or squeezed shut by inflammation, fluid behind the ear drum can become trapped. Allergies and viral infections are also common in young children. These can cause the eustachian tubes to become inflamed and blocked. There is even the suggestion that children who get many ear infections have less of a certain antibody called secretory immunoglobulin A. Since this antibody makes it harder for bacteria to stick in the nose and throat, if children have less of it, they may have more bacteria hanging around ready to cause ear infections.
As you talk to Eric’s mom, you find out he had an upper respiratory tract infection for a few days before his ears started to hurt. You figure that the virus from this infection inflamed his eustachian tubes and caused his adenoids to swell. Eric’s eustachian tubes got blocked eustachian tubes and fluid got trapped behind his ear drum. The blocked tube also created a bit of a vacuum and pulled bacteria from Eric’s nose and throat back into his middle ear space. The bacteria grew in the trapped fluid and voila, Eric got an ear infection!
An interesting thing about middle ear infections is we don’t know exactly what is going on behind the ear drum. The only way to find out what is causing an ear infection is to push a big needle through Eric’s ear drum, draw out some fluid and test it. I don’t think he’d like that much. However some brave, unfortunate children have had their ear drums poked for science, so we know that most ear infections have bacteria in the fluid behind the ear drum. As you are a doctor, you know that antibiotics can kill bacteria. So every ear infection should get an antibiotic, right? That brings us back to the Canadian Pediatric Society.
So what are the experts at the Canadian Pediatric Society recommending you do with Eric? Nothing. If the child is older than 6 months, doesn’t have other under-lying complicating diseases, and doesn’t have a fever over 39 C or severe ear pain, then parents should just watch the child. The reason is that about two thirds of children will have their ear infection symptoms just go away in 48 to 72 hours without antibiotics. If the child doesn’t get better in 48 to 72 hours, then the parents should take them back to the doctor to get an antibiotic.
So you are a good family doctor and follow the guidelines. You tell Eric’s mom that although she has taken time off work, and she has a cranky four year old with a sore ear that she should just go home with no antibiotic prescription. Do you think she will be very happy? Probably not. So you make a deal with her. First you explain to her that only about 1 in 15 kids with ear infections get better faster on antibiotics than without. Then you tell Eric’s mom that antibiotics aren’t without risk. About 20% of kids on antibiotics get diarrhea. A smaller number of children on antibiotics can get things like rashes, trouble breathing or antibiotic resistance. Eric’s mom calms down. Eric has gotten a rash before on a certain antibiotic, so his mom starts to see the risk.
You tell Eric’s mom to go to the pharmacy and ask the pharmacist for the appropriate doses of acetaminophen and ibuprofen for Eric based on his weight. This should make Eric’s ear feel better for the next 48 to 72 hours. You also give Eric’s mom a prescription for an antibiotic, but you tell her not to fill it. She will leave the prescription at the pharmacy. That way if he doesn’t get better in 48 to 72 hours, Eric’s mom can get him a prescription without having to get back into see you. Good job, doc!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, November 13, 2009
Angina Meds
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
One good idea can go a long way. Did you know that an ingredient in TNT or dynamite can helped chest pain?
A long time ago, I thought I was going to be a physicist. That turned out not to be the case, but I did get to go to one physics conference. I forget most of what I learned at that conference. However I remember I saw two Nobel Prize winners. The Nobel Prize is an international award administered by the Nobel Foundation in Stockholm, Sweden. It was started by Alfred Nobel. Alfred Nobel was a great scientist and inventor in 1800’s. One of his greatest inventions was dynamite. His inventions made him very wealthy, but at some point he grew very concerned about all the war around him in the 1800’s and how his inventions were being used to kill people. So in his will he left money to be given out the person who accomplished "the most or the best work for fraternity among nations, for the abolition or reduction of standing armies and for the promotion of peace congresses." This turned in to the Nobel Peace Prize. Every year since 1901 the Nobel Prize has been awarded for achievements in physics, chemistry, physiology or medicine, literature and for peace.
In places like Alfred Nobel’s dynamite factories, people worked with nitroglycerin. The workers noticed they got awful headaches every Monday morning after being away from the factory for a few days. These headaches went away in a few hours. It was eventually determined that the headaches were caused by the nitroglycerin opening blood vessels in the brains of the workers. Opening up blood vessels in the brain can hurt, but if we open up blood vessels in the heart, we can actually make pain go away. This type of pain is called angina.
You may hear your doctor call chest pain angina pectoris, but many people simple call it angina. If suddenly start experiencing chest pain, get to your doctor or the hospital as soon as possible. For those people that the doctor has diagnosed as having angina, he/she may have given them a nitro-spray, or a nitro-patch. Both of these medications contain nitroglycerin, which helps open the blood vessels to the heart. Opening up blood vessels to the heart gets more blood and oxygen to the heart muscle and helps the pain go away. Even though both nitro-spray, and the nitro-patch contain nitroglycerin, they are used in different ways, and are used under different circumstances.
The nitro-spray is used at the first sign of angina, and should help the chest pain immediately. At the first sign of chest pain, sit down or recline, because the nitro-spray will probably make you dizzy. Don’t shake the canister. Hold it in an upright position, and remove the plastic cover. Open your mouth, bring the canister as close as possible, and spray the nitro under or onto your tongue. Don’t inhale the spray. If the pain persists, you can spray again in 5 minutes. If you need more than 3 doses in 15 minutes, seek medical attention immediately. Finally, if your doctor has prescribed nitro-spray for you, you should always carry it with you.
The nitro-patch works differently than the spray. With the nitro-patch, the nitroglycerin is absorbed slowly through the skin instead of through the mouth. It is designed to be used every day to prevent angina, where the spray is used to treat angina that is occurring now. To apply the patch, first wash your hands, then tear open the package. Hold the patch so that both brown lines are vertical and facing you. Bend the patch forward and back until you hear a light “SNAP”. Twist the patch to peel off its plastic backing, and avoid touching the backing. Apply the patch to a hairless area, such as the shoulders, back or hip. Unless your doctor tells you differently, you should only have the patch on for 12 hours, then it should be off for 12 hours. You should also rotate the various places you put the patch each day, to avoid irritating the skin.
So Alfred Nobel’s prizes still motivate and reward those who push forward the boundaries of science and medicine. Alfred Nobel’s own great invention, dynamite is still in use today. And nitroglycerin, one of the main ingredients in dynamite is still helping people’s hearts. One good idea can go a long way.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
One good idea can go a long way. Did you know that an ingredient in TNT or dynamite can helped chest pain?
A long time ago, I thought I was going to be a physicist. That turned out not to be the case, but I did get to go to one physics conference. I forget most of what I learned at that conference. However I remember I saw two Nobel Prize winners. The Nobel Prize is an international award administered by the Nobel Foundation in Stockholm, Sweden. It was started by Alfred Nobel. Alfred Nobel was a great scientist and inventor in 1800’s. One of his greatest inventions was dynamite. His inventions made him very wealthy, but at some point he grew very concerned about all the war around him in the 1800’s and how his inventions were being used to kill people. So in his will he left money to be given out the person who accomplished "the most or the best work for fraternity among nations, for the abolition or reduction of standing armies and for the promotion of peace congresses." This turned in to the Nobel Peace Prize. Every year since 1901 the Nobel Prize has been awarded for achievements in physics, chemistry, physiology or medicine, literature and for peace.
In places like Alfred Nobel’s dynamite factories, people worked with nitroglycerin. The workers noticed they got awful headaches every Monday morning after being away from the factory for a few days. These headaches went away in a few hours. It was eventually determined that the headaches were caused by the nitroglycerin opening blood vessels in the brains of the workers. Opening up blood vessels in the brain can hurt, but if we open up blood vessels in the heart, we can actually make pain go away. This type of pain is called angina.
You may hear your doctor call chest pain angina pectoris, but many people simple call it angina. If suddenly start experiencing chest pain, get to your doctor or the hospital as soon as possible. For those people that the doctor has diagnosed as having angina, he/she may have given them a nitro-spray, or a nitro-patch. Both of these medications contain nitroglycerin, which helps open the blood vessels to the heart. Opening up blood vessels to the heart gets more blood and oxygen to the heart muscle and helps the pain go away. Even though both nitro-spray, and the nitro-patch contain nitroglycerin, they are used in different ways, and are used under different circumstances.
The nitro-spray is used at the first sign of angina, and should help the chest pain immediately. At the first sign of chest pain, sit down or recline, because the nitro-spray will probably make you dizzy. Don’t shake the canister. Hold it in an upright position, and remove the plastic cover. Open your mouth, bring the canister as close as possible, and spray the nitro under or onto your tongue. Don’t inhale the spray. If the pain persists, you can spray again in 5 minutes. If you need more than 3 doses in 15 minutes, seek medical attention immediately. Finally, if your doctor has prescribed nitro-spray for you, you should always carry it with you.
The nitro-patch works differently than the spray. With the nitro-patch, the nitroglycerin is absorbed slowly through the skin instead of through the mouth. It is designed to be used every day to prevent angina, where the spray is used to treat angina that is occurring now. To apply the patch, first wash your hands, then tear open the package. Hold the patch so that both brown lines are vertical and facing you. Bend the patch forward and back until you hear a light “SNAP”. Twist the patch to peel off its plastic backing, and avoid touching the backing. Apply the patch to a hairless area, such as the shoulders, back or hip. Unless your doctor tells you differently, you should only have the patch on for 12 hours, then it should be off for 12 hours. You should also rotate the various places you put the patch each day, to avoid irritating the skin.
So Alfred Nobel’s prizes still motivate and reward those who push forward the boundaries of science and medicine. Alfred Nobel’s own great invention, dynamite is still in use today. And nitroglycerin, one of the main ingredients in dynamite is still helping people’s hearts. One good idea can go a long way.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
Friday, November 06, 2009
Tamiflu Liquid
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Sometimes I get asked if I like being a pharmacist. I do. Very much. I have to keep learning new things all the time. Every day on the job is different, and I never know what to expect when I show up to work. Let me walk you through a couple exciting days last week.
A few weeks before our story begins, a father had taken his children to the Children’s Hospital in Winnipeg with flu like symptoms. Fearing they might have H1N1, the doctor gave the children a prescription for tamiflu liquid. The father had to go to three different Winnipeg pharmacies before he could get the tamiflu filled. The first two pharmacies didn’t have the liquid. It is not really the pharmacies’ fault as there is a shortage of liquid tamiflu. The third pharmacy mixed the adult dose of tamiflu in some syrup for the children. The father was understandably upset and called CBC.
What is tamiflu, and why is liquid tamiflu in short supply? Tamiflu (or oseltamivir) and Relenza (or zanamivir) are called neuramidnase inhibitors. They can stop or slow viruses from reproducing. If tamiflu is given within the first 48 hours of the onset of symptoms, it can decrease the amount and severity of flu symptoms. Even during this current flu scare, most people will not get flu symptoms. Those that do get symptoms, most will get very mild symptoms. Only a small number of people will get very sick and need to be hospitalized. Tamiflu can reduce the chance the patient will end up in the hospital or die from influenza. The adult capsule of Tamiflu is 75 mg. That is too strong for little children. The company, Roche, makes a liquid form for kids, but it is not always available. Roche says it takes 20 times as long to make the liquid form as the capsule form. So, especially during a flu scare, liquid Tamiflu is hard to come by.
So now the first two pharmacies were being blamed for delaying treatment of the children. The Federal Minister of Health was on CBC saying pharmacies should just compound the liquid tamiflu when required. Our regulator in Manitoba, the Manitoba Pharmaceutical Association or MPhA, sent all Manitoba pharmacies a fax with instructions how to compound liquid tamiflu for children.
The story gets better. The specific liquid we are supposed to use to compound the liquid tamiflu with is now in short supply. I guess that’s what happens when MPhA tells every pharmacy in the province to order the same thing. In fact, the company that makes tamiflu recommended pharmacies compound liquid tamiflu with that specific liquid also. So pharmacies all over North America are trying to order that specific liquid.
So what is a pharmacist to do when handed a prescription for liquid tamiflu? Do a little homework. We went to a very good talk by Dr. Blair Seifert. He is a pharmacist who specializes in pediatrics at Children’s Hospital in Winnipeg. He had a few good ideas about how to make the liquid tamiflu. We also used our contacts at PCCA Canada and did some research in the International Journal of Pharmaceutical Compounding. We made a liquid tamiflu a formula. We have flavored it so it is not so bitter. We are ready to fill a liquid tamiflu prescription.
So on top of the usual crisises of computers not working, student doctor questions, reports due for nursing homes and of course my main job of checking prescriptions and talking to patients, the challenge of that day was liquid tamiflu. We got that one figured out and are ready for the next challenge. And I still really like being a pharmacist.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Sometimes I get asked if I like being a pharmacist. I do. Very much. I have to keep learning new things all the time. Every day on the job is different, and I never know what to expect when I show up to work. Let me walk you through a couple exciting days last week.
A few weeks before our story begins, a father had taken his children to the Children’s Hospital in Winnipeg with flu like symptoms. Fearing they might have H1N1, the doctor gave the children a prescription for tamiflu liquid. The father had to go to three different Winnipeg pharmacies before he could get the tamiflu filled. The first two pharmacies didn’t have the liquid. It is not really the pharmacies’ fault as there is a shortage of liquid tamiflu. The third pharmacy mixed the adult dose of tamiflu in some syrup for the children. The father was understandably upset and called CBC.
What is tamiflu, and why is liquid tamiflu in short supply? Tamiflu (or oseltamivir) and Relenza (or zanamivir) are called neuramidnase inhibitors. They can stop or slow viruses from reproducing. If tamiflu is given within the first 48 hours of the onset of symptoms, it can decrease the amount and severity of flu symptoms. Even during this current flu scare, most people will not get flu symptoms. Those that do get symptoms, most will get very mild symptoms. Only a small number of people will get very sick and need to be hospitalized. Tamiflu can reduce the chance the patient will end up in the hospital or die from influenza. The adult capsule of Tamiflu is 75 mg. That is too strong for little children. The company, Roche, makes a liquid form for kids, but it is not always available. Roche says it takes 20 times as long to make the liquid form as the capsule form. So, especially during a flu scare, liquid Tamiflu is hard to come by.
So now the first two pharmacies were being blamed for delaying treatment of the children. The Federal Minister of Health was on CBC saying pharmacies should just compound the liquid tamiflu when required. Our regulator in Manitoba, the Manitoba Pharmaceutical Association or MPhA, sent all Manitoba pharmacies a fax with instructions how to compound liquid tamiflu for children.
The story gets better. The specific liquid we are supposed to use to compound the liquid tamiflu with is now in short supply. I guess that’s what happens when MPhA tells every pharmacy in the province to order the same thing. In fact, the company that makes tamiflu recommended pharmacies compound liquid tamiflu with that specific liquid also. So pharmacies all over North America are trying to order that specific liquid.
So what is a pharmacist to do when handed a prescription for liquid tamiflu? Do a little homework. We went to a very good talk by Dr. Blair Seifert. He is a pharmacist who specializes in pediatrics at Children’s Hospital in Winnipeg. He had a few good ideas about how to make the liquid tamiflu. We also used our contacts at PCCA Canada and did some research in the International Journal of Pharmaceutical Compounding. We made a liquid tamiflu a formula. We have flavored it so it is not so bitter. We are ready to fill a liquid tamiflu prescription.
So on top of the usual crisises of computers not working, student doctor questions, reports due for nursing homes and of course my main job of checking prescriptions and talking to patients, the challenge of that day was liquid tamiflu. We got that one figured out and are ready for the next challenge. And I still really like being a pharmacist.
As always if you have any questions or concerns about these or other products, ask your pharmacist.
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