タミフルドライシロップが不足し、薬剤師はタミフルカプセルの中身をチェリーシロップと混ぜて子ども用の薬剤に作っている。Humco Holding Groupのチェリーシロップは薬剤と混ぜることを認可されたシロップであり、今や需要を満たすために急展開している。
Sugary Mix Is Just What the Flu Doctor Ordered
By ANDREW POLLACK
Published: October 3, 2009
Parents usually try to steer their children away from ingredients like sugar and artificial cherry flavoring. But this fall, those pedestrian food additives might help treat some children stricken with the flu.
Tina Fineberg for The New York Times
Pharmacists like Laura Kilcher can make their own version of liquid Tamiflu with cherry syrup and the powder from capsules.
With the liquid children’s version of the anti-influenza drug Tamiflu in short supply, pharmacists are making their own children’s version by mixing cherry syrup with the contents of the Tamiflu capsules.
But not just any cherry syrup. The prescribing information for Tamiflu lists cherry syrup made by the Humco Holding Group ― a mixture of sugar, purified water, artificial cherry flavoring and some other common ingredients ― as one of the approved liquids to mix with the medicine.
Humco has been scrambling to keep up with demand.
“Our volume has exploded,” said Greg Pulido, the chief executive of Humco, based in Texarkana, Tex. “About 30 days ago we got a phone call. We got another phone call. Then we started getting calls from all over the world.”
The company typically sells about 50,000 pint-size bottles of the syrup each year. But with the spread of pandemic H1N1 influenza, also known as swine flu, Humco shipped 100,000 bottles in September alone. In October it is planning to make 400,000 bottles.
The company has had to have some ingredients shipped to its factory by air in order to meet the surge of orders, Mr. Pulido said. Last week the factory worked seven days instead of the usual four. But he said that contrary to rumors, there was no shortage of the syrup, and that he was confident there would not be.
The liquid version of Tamiflu is scarce because Roche, the manufacturer of the drug, is concentrating on making the capsules used by adults and older children, which it says is a quicker way to increase world supplies. The same production capacity needed to produce a liquid treatment for one person can be used to make capsules for more than 10 people, Roche says.
But Tamiflu’s label has instructions for pharmacists to make a liquid version themselves.
This practice, known as compounding, evokes “the origins of pharmacy,” said Leanne Trela, director of retail clinical services at Walgreens, the big pharmacy chain. But with mass-manufactured pills now the norm, she said, compounding is used mainly for special needs like adapting adult medicines for children.
A spokesman for Walgreens, Jim Cohn, said the shortages of liquid Tamiflu were sporadic and mainly in the South. The company’s pharmacists are making their own when necessary.
Besides Humco’s cherry syrup, the Tamiflu label says that Ora-Sweet SF, a sugar-free syrup, can be used. Other syrups could conceivably be used as well, but the label notes that others have not been studied.
Paddock Laboratories of Minneapolis, the manufacturer of Ora-Sweet, has also experienced a surge in demand. The company, which typically sells 50,000 bottles a year, has had orders for about 200,000 in the last two months, said Paddock’s president, Michael Graves.
But he said the company could easily meet demand by shifting production away from other products. “We can go from 50,000 bottles a year to 50,000 a week,” Mr. Graves said.
Syrups used for compounding are considered foods by the Food and Drug Administration. Approval is not needed from the agency before such products can be marketed. But certain manufacturing processes must be followed, and factories are subject to inspection.
Humco was founded as the Hutchison Medicine Company in 1872 by a man who traveled through East Texas in a covered wagon hawking homemade remedies. The company makes various liquids and creams for use in drug mixtures. It also sells the over-the-counter medicines Castiva, for arthritis pain relief, and Miranel, to treat toenail fungus.
Mr. Pulido declined to identify the company’s owners, other than himself, or to disclose its revenue. The company has about 150 employees, he said.
He said Humco had not raised the wholesale price of its cherry syrup ― about $8 a bottle ― because it did not want to take advantage of the shortage of Tamiflu for children. Even so, the surge in orders will certainly help the company’s bottom line.
“Humco will benefit from the spike,” he said. But, he added, “You hate to build your business around the spike.”
That might be wise, because it is unclear how long the demand will last. To alleviate the shortages, the federal government has begun shipping 300,000 treatment courses of the pediatric Tamiflu from its stockpile to state health agencies.
Cherry syrups like Humco’s could also have a potent competitor. The label for Tamiflu says that parents, if directed by a physician, can make single doses of liquid Tamiflu at home. The sweet liquid the label uses as an example for parents is chocolate syrup.
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