Comparing Two Methods of Tablet Manipulation to Adjust the Warfarin Dose in Paediatric Care

Abstract

Tablets containing prescribed doses are not always available, and this is of particular importance in paediatric care where suitable age-appropriate formulations are generally lacking. To obtain a child-adjusted dose, tablets are manipulated in several ways; e.g., they may be dispersed in water before a fraction is extracted, or they may be split before the resulting fragment is dispersed. In this study, the accuracy attained through these manipulation methods was investigated for two generic tablets containing the anticoagulant warfarin. Tablets were dispersed in water (10 mL) before a fraction (10%) was withdrawn, alternatively tablets were split in half or quarter fragments before the fragments were dispersed in water. To investigate the contribution of variability from the different steps in the manipulation processes, the amount of warfarin recovered from the various dispersions was determined, as was the accuracy of the splitting. A validated UHPLC-method was used for quantitative determination of warfarin. Splitting of the tablets could result in deviation >30% from the ideal, theoretical weight. The amount of drug substance extracted as a fraction from the dispersed tablets deviated no more than 10% from the intended amount. To obtain the most accurate child-adjusted fraction dose of warfarin, the tablets investigated in this study should be dispersed and the desired proportion extracted. Practices that involve splitting tablets are likely to increase the variation, and should be avoided.

The effectiveness of split tablet dosing versus alternate-day dosing of warfarin: a randomized control trial

“…Despite discouraging results of pill splitting studies with dosage deviation of 9–37% 11 – 13 , if the inaccuracy attributes primarily from the weight variation in split tablets (not from tablets powder or fragment loss during the splitting process), this effect would be diluted day-by-day as warfarin has protracted blood-thinning effect. This idea supports the need for tablet scoring and the pill-splitter.…”

The Effectiveness of Split Tablet Dosing Versus Alternate-Day Dosing of Warfarin: A Randomized Control Trial

“…Despite discouraging results of pill splitting studies with dosage deviation of 9 to 37% [11][12][13] , if the inaccuracy attributes primarily from the weight variation in split tablets (not from tablets powder or fragment loss during the splitting process), this effect would be diluted day-by-day as warfarin has protracted blood-thinning effect. This idea supports the need for tablet scoring and the pill-splitter.…”