Like many other states, Minnesota has experienced temporary shortages of liquid Tamiflu for children as it deals with a wave of H1N1 influenza. The federal government is releasing 234,000 doses of the drug -- the last in its stockpile -- in the next several days.
Once this new batch of the drug is used up, it could be months before manufacturers make more liquid Tamiflu available.
As a result, the Health Department is urging pharmacists to use a process called compounding to make kid-sized doses of the drug from adult-sized capsules. We visited a pharmacy lab in Minneapolis to watch how a batch is made.
The pharmacists at Fairview's Specialty Pharmacy in Minneapolis have been asked to perform an important service to help sick kids. But the work can get a bit tedious. For instance, they have to pop each individual Tamiflu capsule out of its foil blister pack.
"Doing a few is fun. Doing thousands upon thousands of them in a few weeks is not so fun," said Deb Landrith, a technician in the pharmacy.
Landrith usually handles the office's paperwork. But these days she's traded in her pens for a small utility knife. It helps her cut through the plastic domes that protect each pill. It's simpler than pushing on the foil base.
"It's very time-consuming and difficult, and your fingers go numb. Easier to use a blade and slice them out," she said.
In recent weeks, Fairview's Specialty Pharmacy has compounded approximately 40 liters of Tamiflu for its 30 retail pharmacies and six hospitals.
Last week, Landrith spent the better part of two days cutting through the packaging on 2,000 doses of adult-strength Tamiflu. Then she had to open each capsule and collect the powder from each one. Once she collects enough powder, she hands it over to a pharmacist to be "compounded," or turned into liquid medicine for children.
"This is a recipe for two liters, but I'm making one liter in each beaker so I have to split this in half," explained Gary Carlson, who oversees Fairview's Specialty Pharmacy.
The recipe is pretty simple. All Carlson has to do is add the powder to a medical syrup called Ora-Sweet and mix it for about an hour.
There's no heat involved in the process, but Carlson looks a lot like a cook in his kitchen. He admits he's a pretty good cook at home, too.
"Yes, I am. Almost all compounders are good bakers or good cooks," said Carlson. "Drives my wife nuts, because I'm always carefully measuring everything and she's just tossing in the pinch of salt."
When the Tamiflu is done mixing, Carlson will bottle it and store it in the refrigerator. The liquid medication has to be used within 35 days or it will expire.
That hasn't been an issue so far. Fairview's retail pharmacies have been ordering up the Tamiflu almost as soon as it has been made.
But within the last week, the orders have slowed down a bit. Carlson says that could be a sign that H1N1 flu is easing up. But he says it's impossible to say for sure what it means.
Fellow pharmacist Don Terhaar says it could mean that the clinics are planning ahead.
"The feeling is that the sites are stocking, keeping it on hand now and stocking it in larger quantities so that they have enough," said Terhaar. "And they're not ordering it at the last second, like they were the first few weeks of the outbreak here."
Presumably that means that in most cases, parents of sick kids no longer have to drive all over town to find a pharmacy that carries liquid Tamiflu.
Still, there are probably some spot shortages. In fact, the Centers for Disease Control and Prevention says it knows of pharmacists who are reluctant to compound the drug because they're worried they will do it incorrectly, or they don't have time.
The CDC's Dr. Anne Schuchat said last week that it's an issue in some states.
"We know that some pharmacists don't want to do that. But a lot -- more and more -- are saying they will be part of the solution," said Schuchat. "A number of the chains, Wal-Mart and Walgreens ... Rite-Aid and CVS, are also saying that at least in many states their pharmacists will do this kind of compounding."
It's possible that pharmacists will be compounding Tamiflu for at least a couple more months. The federal government has ordered more liquid Tamiflu from the manufacturer. But that delivery is not expected to arrive until early next year.