Ruth M. Parker, etc.,al. Risk of Confusion in Dosing Tamiflu Oral Suspension in Children. NEJM
After the diagnosis of novel H1N1 influenza, a 6-year old received a prescription for Tamiflu (oseltamivir) oral suspension (12 mg per milliliter) at a dose of 3/4 teaspoon PO BID. However, the parents, one a primary care physician and the other one of the authors, had great difficulty determining the correct dose to administer to their child. The medication bottle was accompanied by a prepackaged syringe with markings of 30, 45, and 60 mg (Figure 1). The label attached by the pharmacy specified the dose in volume units ("3/4 teaspoonful") but the syringe provided only markings in mass units (milligrams). Despite the disparate directions, the parents were eventually able to determine the correct dose with the aid of 1 of 10 tables in the portion of the package insert intended for prescribers, not for parents. Specifically, they solved the following equation for the milligram equivalent of the 3/4-tsp dose: 5 ml (volume of a teaspoon)x0.75x12 mg per milliliter Tamiflu suspension=45 mg on the syringe.
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