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Practice
Resources: Pandemic Resources (en français)
On October 23, Canadian Health Minister Leona Aglukkaq declared, "Canada has officially entered the second wave of the H1N1 flu pandemic."
CPhA is continuing to work with the Public Health Agency of Canada (PHAC) and other health care organizations to ensure that we can send you the most up-to-date information.
As front line health care professionals, pharmacists are often the first point of contact for patients experiencing flu-like symptoms. Be prepared for an increase in the number of questions from the concerned public.
Pharmacists are strongly encouraged to review their emergency preparedness plans. CPhA has developed an extensive pandemic guide for pharmacists that includes information on the role of the pharmacist, infection control, developing your plan, supply chain issues, business continuity, etc.
FIGHTFLU.ca is your primary source for H1N1 information. Use the map to find H1N1 information specific to your province or territory.
FRONT-LINE CLINICAL MANAGEMENT
New pandemic H1N1 clinical resources were recently released. This information supports front-line pharmacists when patients present with influenza-like illness (ILI) symptoms:
An additional resource is provided by Rx Files in Saskatchewan:
ANTIVIRALS
Antiviral Guidelines and Dosing
Visit the PHAC website for more information on the use of antivirals to treat H1N1 flu virus. PHAC has issued an interim guidance for use of oseltamivir in children under one year of age in the context of H1N1 pandemic.
TAMIFLU SUSPENSION
Health Canada issued an advisory regarding the limited global supply of Tamiflu powder for oral suspension. CPhA has been working with Health Canada and Hoffmann-La Roche Limited. There continues to be a very limited supply of the Tamiflu suspension formulation. Roche is actively working to bring additional quantities of the suspension formulation into Canada, for use among paediatric populations.
Home Preparation of Tamiflu Suspension
When Tamiflu oral suspension is not available, and the dose is equivalent to an entire capsule, parents/caregivers can be instructed on home preparation. The contents of Tamiflu capsules can be mixed, immediately before dosing, with sweetened liquids to prepare an oral suspension for children.
In Part III: Consumer Information of the Tamiflu product monograph, instructions are provided for Emergency Home Preparation of an Oral Suspension from Tamiflu Capsules. This information is also available in the Information to the Patient section of Tamiflu monograph in e-CPS. Please note that these instructions are applicable to administration of an entire capsule of Tamiflu:
Follow your pharmacist’s or doctor’s instructions carefully to ensure proper dosing:
- Holding one capsule over a small bowl, carefully pull the capsule open and pour the complete contents of the capsule into the bowl.
- Add a small amount of a sweetened liquid such as chocolate syrup (regular or sugar-free) that your child will consume completely.
- Stir the mixture and give the entire dose to your child.
- Rinse the bowl with a bit of sweetened liquid and administer the rinse to your child.
Pharmacy Preparation of Tamiflu Suspension
Emergency compounding of an oral suspension from Tamiflu capsules should only be done if the commercially manufactured Tamiflu for oral suspension is NOT readily available. Ora-Sweet® Sugar-Free (Paddock Laboratories) is the Health Canada-approved suspending vehicle. The Tamiflu product monograph in e-CPS includes directions for emergency compounding of an oral suspension from Tamiflu capsules (final concentration 15mg/mL). Roche has a bilingual document with detailed compounding instructions using Ora-Sweet® Sugar-Free.
However, there are shortages of this suspending vehicle. CPhA has been advised that Paddock anticipates that backorders and new orders should be filled shortly. There are three Canadian distributors of OraSweet: Galenova Inc., 4555, Beaudry, St-Hyacinthe, QC J2S 8W2; Tel: (800) 223-0666; Medisca Pharmaceutique Inc., 6090 Henri-Bourassa West, Saint-Laurent, QC H4R 3A6; Tel: (514) 333-7811 Wiler PCCA Corp., 744 Third Street, London, ON N5V 5G4; Tel: (800) 668-9453.
Alternate suspending vehicles can be considered for pharmacy-prepared emergency compounding of an oral suspension from Tamiflu capsules.
NOTE that the concentration of oseltamivir for the compounded formulation (i.e., 15 mg/ml or 10 mg/ml, depending upon formula used), is different than the commercially available Tamiflu Powder for Oral Suspension (i.e., 12 mg/ml). If Tamiflu suspension is prescribed in milliliters rather than milligrams, convert to the appropriate volume when dispensing to ensure accurate dosing. Dispense the suspension with a graduated oral syringe.
NOTE: These instructions on compounding of an oral suspension from Tamiflu capsules and dosing recommendations are based on the European Union Summary of Product Characteristics. This information is unapproved as per the Canadian Tamiflu product monograph. For approved dosage and administration in the management of seasonal influenza, please refer to the approved Canadian Tamiflu product monograph. For the management of non-seasonal H1N1 influenza, please refer to local, provincial or federal (e.g., Public Health Agency of Canada) guidelines.
H1N1 VACCINE
On October 21, the Government of Canada authorized the use of the H1N1 flu vaccine, AREPANRIX - manufactured by GlaxoSmithKline (GSK). Advance supply of 2-million doses was distributed across Canada earlier this month in anticipation of the approval. Enough vaccine has been ordered for all Canadians who need and want protection. GSK is currently producing 3-million doses per week (1.8-million doses of the non-adjuvanted vaccine will be available in early November for use in pregnant women).
Vaccination is the most effective form of prevention for H1N1. Certain groups of people are more at risk for complications of the flu, and are encouraged to get the vaccine as soon as possible. These groups include pregnant women, people with chronic diseases, and children under the age of five.
A priority group for vaccination is health care workers involved with the pandemic response or delivery of essential health services, which includes pharmacy practitioners. We encourage you and your essential pharmacy staff to get vaccinated, and to encourage your patients to have a H1N1 vaccination.
Visit the PHAC website for information on the vaccine. For further details on the safety, efficacy, dosage and recommended recipients, see: Guidance Document on the Use of Pandemic Influenza A (H1N1) 2009 Inactivated Monovalent Vaccine
INFORMATION FOR YOUR PATIENTS:
(Updated October 30, 2009)
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