“What do you MEAN you’re out of stock?!”

This blog post is brought to you by the patient who had a prescription for #30 Tamiflu 75mg sent to our pharmacy by his primary care physician “just in case” he got sick. (That’s three 5-day treatment courses.) The blatant disregard for public health by both the patient and the prescriber made my blood boil. Here’s a little history on Tamiflu, for those of you who may not be familiar with it.

Tamiflu (oseltamivir) is an anti-viral drug that is FDA approved for the treatment of acute, uncomplicated influenza in patients 2 weeks of age and older who have been symptomatic for no more than 2 days, and for the prophylaxis of influenza in patients 1 year and older. What exactly does that mean? It’s approved to treat the flu if you’re at least two weeks of age, and you start taking it within two (2) days of your first symptoms, or to prevent the flu (“prophylaxis”). It’s usually given twice daily for five days (treatment) or once daily for 10 days (prophylaxis).

Now, there’s a few caveats to using Tamiflu. It hasn’t been shown to be effective after 48 hours of symptom onset. It’s not a replacement for the annual flu vaccine. I repeat:  It’s not a replacement for the annual flu vaccine. It’s also not approved for other types of viruses (like the cold virus, which coincidentally seems to strike around the same time as the flu).

For those of you who do not work in the pharmacy world, Tamiflu has historically seen shortages in past flu seasons – and this flu season is no exception. It’s been on backorder from various wholesalers, and pharmacies are exhausting their current inventory left and right. The fact that this patient wanted three boxes of Tamiflu “just in case” absolutely frustrated me. While I don’t know the circumstances, I would guess that the patient didn’t get their flu shot, and now they’re scared about getting the flu. Maybe they saw all the media coverage about how this year’s flu vaccine wasn’t a perfect match for the strain of flu that is making people sick (for the record – making a vaccine that’s a perfect match a full year ahead of time is tough. It’s trying to predict the future.) Perhaps the patient is just greedy, and wants to make sure his Zombie Apocalypse Kit has enough Tamiflu for their family.

In clinical studies, Tamiflu shortened the duration of flu an average of 1.3 days. That’s right, an extra day of wellness. One day. Is it worth the cost? One course of treatment can easily cost $100 or more, and not much better with some insurance plans. For some people, of course, it’s worth it. But does everyone who gets a runny nose, cough, and body aches absolutely need to spend the money on this? By the time you schedule a doctor’s appointment, get a prescription, bring it to the pharmacy, (the pharmacy may have to order it), and begin your treatment, you’ve already used up the day that it’s going to save you.

Now, for someone who has a weakened immune system, or a patient who has been hospitalized, of course the circumstances are different. One journal article looked at using Tamiflu outside the standard dosing regimens. It was found that Tamiflu improved survival if used within five days for patients hospitalized to the Intensive Care Unit, but showed little to no benefit in other populations.

Influenza is a serious illness, albeit one with proven prevention and treatment strategies. Please, everyone, get your flu shot! If you do come down with an illness during flu season, you should visit your doctor to make sure that what you have is indeed the flu and not just a cold. Visit your doctor, but be aware that Tamiflu may not help you if you’ve had symptoms for more than 48 hours, or if you don’t actually have the flu virus. When in doubt, feel free to ask your family pharmacist! (Just don’t bring us a prescription for 30 capsules of Tamiflu. We will judge you, and we will likely turn you away because we don’t have it.)