Analysis of extemporaneous oral liquid from commercially available drugs in hospital

Abstract

The objective of this study was to identify drugs that received dose adjustments (DA) and pharmaceutical alternatives (PA) that avoid DA, and calculate the economic percentage of this replacement. A descriptive, observational and cross-sectional study was performed in a second level hospital. The pharmacy and nursing services was accompanied to identify the drugs that received DA and the compounding techniques. After identifying all the drugs that received DA, was identified in the Brazilian market the corresponding pharmaceutical alternative, with the Drugs Price List of Brazilian Health Regulatory Agency. For those drugs that was not available any PA, was performed a research of studies that describe compounding techniques in international scientific databases. Was identify 88 drugs that received DA, and these, 50 do not have any PA. Were identified compounding techniques to 40 drugs. Although any drug has your own particularity of compounding, the compounding techniques can be grouped in five categories. The standardization of 29 drugs can reduce in 28% the DA procedure and cost saving of 34,85%/month. We can conclude that every three drugs prescribed, one received DA and every three DA, one can be avoided by the selection of 29 PA, saving cost as well. The use and standardization of five techniques would attend the pharmaceutics recommendations for better dissolution, bioavailability and patient safety. Uniterms:Pharmaceutical preparations/hospitals. Patient safety. Pharmacoeconomics. Drugs/descritive study/ Off-Label Use. INTRODUCTIONDose adjustment (DA) is performed to supply a patient's therapeutic needs when non-standard dosages are needed (Brasil, 2007; FDA, 2013). The lack of liquid pharmaceutical forms for oral use on the market has become a problem for the pharmacotherapy of patients that primarily uses liquid formulations, such as pediatric patients, the elderly, patients receiving drugs via probe, patients with dysphagia, and patients with dementias, Parkinson's, or Alzheimer's disease (Haywood, Glass, 2013;Thombre, Berchielli, Rogers, 2014). Patients with these problems require extemporaneous oral preparations in order to ensure the patient's therapy. DA is common in health systems; however, there are no guarantees regarding the quality, effectiveness, and safety of drugs after DA and DA can expose the patient to adverse events (Glass, Haywood, 2006).With the aim of ensuring the pharmacotherapy of the patient, contributing to the culture of patient safety, and objectively identifying drugs that underwent DA and pharmaceutical alternatives (PAs) that could avoid DA, we compared DA to the compounding techniques described in the literature and calculated the economy of PAs. METHODS Study designThis was a pharmaco-epidemiological, descriptive, and observational cross-sectional study based on the guideline Strengthening the Reporting of Observational studies in Epidemiology (STROBE) (Von Elm et al., 2008). Study siteThis study was conducted at the State Hospital Américo Brasiliense (HEAB) in Américo Br...

Drug administration adjustments for elderly patients with dysphagia: A case report

“…Benzi and Mastroianni have been working on many procedures for optimizing drug prescriptions that meet patient needs, in turn enhancing drug effectiveness, safety and quality. 29 …”

Cost Analysis of Clinical Compounding in Saudi Arabia: Antihypertensive of Pediatric Formulations

“…this problem, extemporaneous oral dosage forms are required as it widens the therapeutic options for this specific population. [12,13] Due to the legal regulations in some countries, the final cost of prepared extemporaneous syrups is high due to unregistered components for pharmaceutical use. [13,14] In this study, we focused on the cost analysis of antihypertensive pediatric formulations in Saudi Arabia.…”

Making extemporaneous suspensions from solid oral dosage forms as the way of age-appropriate personalized pharmacotherapy

“…Dla pacjentów, którzy nie mogą przyjąć leku w postaci stałej formy (ze względu na niemożność połknięcia lub nieadekwatną dawkę), można przygotować w aptece szpitalnej lek w postaci płynnej [7,11,15]. Istnieje możliwość wykonania leku z substancji leczniczej dedykowanej do receptury lub z gotowej, występującej na rynku stałej postaci leku.…”

“…Przygotowując taką zawiesinę, należy wziąć pod uwagę jej stabilność pod względem fizykochemicznym, mikrobiologicznym, terapeutycznym oraz toksykologicznym. Trzeba uwzględnić obecność możliwych interakcji nie tylko samej substancji leczniczej, lecz również substancji pomocniczych z wykorzystywanym vehiculum oraz z materiałem użytego opakowania [15,16].…”