Taste for flavored flu treatment keeps syrup maker scurrying

Parents usually try to steer their children away from ingredients such as sugar and artificial-cherry flavoring. But this fall, those pedestrian food additives might help treat some children with the flu.

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 Tamiflu capsules.

Not just any cherry syrup. The prescribing information for Tamiflu lists cherry syrup made by 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.

"Our volume has exploded," said Greg Pulido, chief executive of Humco, based in Texarkana, Texas. "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. This month, it is planning to make 400,000 bottles.

The company has had some ingredients shipped to its factory by air to meet the surge of orders, 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 he was confident there would not be.

The liquid version of Tamiflu is scarce because Roche, the manufacturer, is concentrating on 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.

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 pharmacy chain. But with mass-manufactured pills the norm, she said, compounding is used mainly for special needs such as 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 compounding when necessary.

Besides Humco's cherry syrup, the Tamiflu label says that Ora-Sweet SF, a sugar-free syrup, can be used. Other compounding syrups could 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 past 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," 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.

Cherry syrups like Humco's could 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.