A sharp jump in flu cases has created a shortage of the main antiviral drug prescribed to reduce the impact of the virus, Triangle pharmacists say.
Some pharmacies in the region already are out of Tamiflu, and others report dwindling supplies.
“Even the wholesalers can’t get it,” said Wendy Haun, pharmacy manager at Blue Ridge Pharmacy in Raleigh. “It seems like every year we have problems with the Tamiflu (oral) suspension, but this year, it’s everything, the suspension, the capsules, everything.”
Haun’s pharmacy has run out, and its wholesaler emailed her Thursday morning to say that the manufacturer, Genentech, wasn’t keeping up with demand, which had tripled in the past week.
Gurley’s Pharmacy in Durham has a modest stockpile it was able to scrounge from a small wholesaler, but pharmacy manager Vipul Patel said he wasn’t sure how long he can keep the drug on hand. All the largest wholesalers are out, he said, and even some chain pharmacies have called to ask whether Gurley’s has any to spare.
Wholesalers do seem to be able to find Tamiflu when there are serious issues, said Lynn Eschenbacher, a pharmacist and manager at WakeMed Health and Hospitals’ Raleigh campus.
Recently, Eschenbacher said, a group of WakeMed workers was exposed to a case of flu, and the hospital was able to obtain enough to treat them. But that doesn’t mean the drug is abundant, she said.
“So far, when we really need it, we can get enough, though,” she said.
Relenza, another antiviral drug, can also be used to fight flu, but the U.S. Centers for Disease Control and Prevention says it shouldn’t be used by younger children or people with underlying respiratory illnesses. That makes Relenza less useful because antivirals are prescribed mainly to patients most at risk from serious complications from flu, which include those two groups as well as the elderly and those with other underlying conditions that render them more vulnerable.
The Tamiflu shortage is probably related to the lower effectiveness of the flu vaccine this year, because that’s letting more people get sick, several pharmacists said.
Each year, the flu vaccine is formulated to protect against several strains of flu. That formula is created months in advance of each winter flu season based on experts’ guesses about which strains are likely to appear. This year, doctors are mainly seeing the expected strains, but the main one, H3N2, has “drifted,” or mutated, in ways that mean the vaccine can help prevent infection only about half the time.
Tamiflu can help reduce the risk of complications and the duration of a case of flu if administered early in an infection, according to CDC guidelines. Doctors especially recommend it for people who are unusually vulnerable to the effects of the virus, including young children, the elderly and those with underlying health issues such as heart or respiratory disease.
Dr. Brian Bowman of Apex Pediatric Center said Friday that he hadn’t heard of the shortage yet, and that normally word of one would filter back via calls from the families of patients who hadn’t been able to fill a prescription.
If the shortage becomes so acute that patients aren’t able to get the drug, Bowman said, that could be a serious problem.
“Since we really only try to use Tamiflu in patients who are at the highest risk, it would be concerning because there really aren’t a lot of other options,” he said.
Depending on the age of the child and the severity of underlying conditions such as asthma, not being able to get Tamiflu might mean that his office would have to begin monitoring a patient closely, he said. That would mean either having the family bring the child in periodically, or assigning a nurse to check with the family by phone.
Flu season intensifying
There is no question that the flu season is accelerating, Bowman said. This week was his practice’s busiest in more than a year.
The CDC recommends that people get vaccinated because the vaccine is still effective in many cases. And the state epidemiologist, Megan Davies, has said that even when the vaccine doesn’t prevent a case of H3N2 flu that it may make the symptoms less severe.
On Thursday, the state Department of Health and Human Services announced the fifth flu-related death of the season, which occurred the previous week. The person who died was between 50 and 64 years old. The previous victims include two children and a patient 65 or older.
The state’s weekly update of flu statistics Thursday also showed an upswing in the number of patients appearing in clinics, emergency rooms and doctors’ offices exhibiting flu symptoms.
It’s unclear when – or whether – those patients can expect Tamiflu to become easier to find.
“Our primary wholesaler, the biggest in the country, is totally out,” said Patel, the pharmacy manager at Gurley’s. “So is the other large one, and ours said that when they do get it, they will be allocating it.”