North Carolina News: Item 2187 - Health Department Dispensing of Antiviral Medications

July 1, 2009 4:00 pm

Reprinted from the July 2009 North Carolina Board of Pharmacy Newsletter.

During the H1N1 influenza virus scare this spring, Board staff worked with North Carolina Public Health Preparedness and Response to communicate information to pharmacists in a timely fashion. As Public Health Preparedness and Response began distributing antiviral medications to state and local health departments, two questions arose concerning registered nurses (RNs) dispensing at those facilities:

1. May RNs dispense antivirals from health departments? Board Rule .2403 provides that properly trained RNs may dispense certain types of prescription drugs from health departments. Antivirals are not among the types listed. Board staff, however, has no objection to properly trained RNs dispensing antivirals as needed to treat H1N1 influenza. Such dispensing is clearly a benefit to the public health and safety and well within the spirit of Board Rule .2403.
2. May RNs “compound” Tamiflu^® suspension if needed? The Centers for Disease Control and Prevention has provided a document detailing Emergency Use Authorization of antivirals to treat H1N1 influenza. The document may be found at www.cdc
.gov/h1n1flu/eua/. More specifically, the document contains detailed information about Tamiflu, that may be found at www.cdc.gov/h1n1flu/eua/pdf/tamiflu-patients.pdf. The first question on the second page states “What if my child or I cannot swallow capsules? For pediatric patients who cannot swallow capsules, TAMIFLU^® Oral Suspension is preferred. If the oral suspension is not available, TAMIFLU^® capsules may be opened and mixed with sweetened liquids such as regular or sugar-free chocolate syrup.” Accordingly, there is no apparent need to “compound” Tamiflu suspension from the capsules. Dispensing professionals should simply instruct parents or other patients to open the capsule and mix the contents as described. Dispensing professionals can also provide this service for parents or other patients who need it.

Board staff also discussed these and other issues with several community pharmacists around the state who were ready and willing to volunteer their time to state and local health departments during the crisis. Thankfully, the H1N1 influenza, though now classified as a pandemic by World Health Organization, has only been of moderate severity. But the preparatory activities demonstrated, once again, how pharmacists can and should play a critical role in these emergency situations.