Magistral drugs in hospitalized newborns and children

Abstract

Objective:Study the use of magistral oral solutions and suspensions in infants and children at a university hospital.Methods:This is a descriptive study based on the analysis of the assessed hospital's magistral drug request forms regarding the patients in the neonatal ICU, Obstetrics, Pediatrics and Pediatric Emergency from January 2012 to December 2013. The frequency of drug requests and dispensation was evaluated and the consumption of each active ingredient of the preparations was expressed as number of “infant defined daily dose” (iDDD) and of iDDD/100 bed-days.Results:A total of 657 forms were analyzed - a monthly average of 27 pediatric preparations. The neonatal ICU accounted for 69.6% of these requests. Twenty-one drug items were used, of which the most common were folinic acid (88 requests), sulfadiazine (85) and captopril (73). The consumption of the active principle in these preparations varied in number of iDDD, from 7.5 (hydralazine) to 16,520.0 (folic acid), and in number of iDDD/100 bed-days in the neonatal ICU, from 0.1 (zinc sulfate) to 146.1 (folic acid).Conclusions:The constant consumption of magistral oral solutions and suspensions by newborns and children of the assessed hospital indicates the need for such preparations as a pediatric therapeutic alternative in this hospital.

Compounded medications for cardiovascular use in neonatology: an integrative review

“…The 10 studies considered in this review mentioned the most indicated cardiovascular medicines in pediatrics and neonatology. Among them, in descending order, are Spironolactone, 13,[25][26][27][28][29][30] Captopril, 25,[29][30][31] Furosemide, 13,[25][26][27][28][29][30][31] Hydrochlorothiazide, 13,[25][26][27][28]31 Propranolol, [25][26][27][28][29] Amiodarone, 27,28 Nifedipine, 27 Carvedilol, 27 Digoxin, 3 Enalapril, 32 Epinephrine, 29 and Hydralazine. 28 The present study also compared the presence of the cardiovascular drugs mentioned in this review with the List of Essential Medicines for Children, of the World Health Organization, 22 and verified the existence of registration of the oral liquid dosage form in Brazil and in the United Kingdom, as described in Table 2.…”

“…Among them, in descending order, are Spironolactone, 13,[25][26][27][28][29][30] Captopril, 25,[29][30][31] Furosemide, 13,[25][26][27][28][29][30][31] Hydrochlorothiazide, 13,[25][26][27][28]31 Propranolol, [25][26][27][28][29] Amiodarone, 27,28 Nifedipine, 27 Carvedilol, 27 Digoxin, 3 Enalapril, 32 Epinephrine, 29 and Hydralazine. 28 The present study also compared the presence of the cardiovascular drugs mentioned in this review with the List of Essential Medicines for Children, of the World Health Organization, 22 and verified the existence of registration of the oral liquid dosage form in Brazil and in the United Kingdom, as described in Table 2. It was found that none of the mentioned cardiovascular medicines has a registration of the oral liquid dosage form in Brazil, and only four drugs (Spironolactone, Furosemide, Captopril, and Propranolol) have a registration of the oral liquid dosage form in the United Kingdom.…”

“…The studies used in this review state that the most indicated cardiovascular medications in pediatrics and neonatology are: Spironolactone, 13,[25][26][27][28][29][30] Captopril, 25,[29][30][31] Furosemide, 13,25 Hydrochlorothiazide, 13,[25][26][27][28]31 Propranolol, [25][26][27][28][29] Amiodarone, [27][28] Nifedipine, 27 Carvedilol, 27 Digoxin, 3 Enalapril, 28 Epinephrine, 29 and Hydralazine. 28 Considering that the articles have representative data of the routine of that clinical unit, the most cited drugs are more likely to be part of the list of medicines standardized for a given establishment. Therefore, these drugs are important medicines in neonatology.…”

“…Ferreira et al 31 described the cardiovascular medications prescribed to different groups of neonates through a cross-sectional study carried out in the Pediatric Intensive Care Unit (ICU) of a hospital in the city of Belo Horizonte (state of Minas Gerais, Brazil), and found prescriptions containing the drugs Captopril, Furosemide, and Hydrochlorothiazide for neonatal use. Pereira et al 28 studied the use of magistral oral solutions and suspensions in newborns and children at a university hospital, by analyzing compounding request forms for patients admitted to the neonatal, obstetrics, and pediatrics ICU. This study mentioned pediatric oral liquid preparations of Captopril, Furosemide, Spironolactone, Hydrochlorothiazide, Hydralazine, Amiodarone, Propranolol, and Enalapril, which were produced in the compounding pharmacy, under the responsibility and guidance of the pharmacist.…”

“…This process occurs in 75.63% of medications in the pediatric ICU, due to patients' difficulty or inability to swallow and the need for lower doses. [26][27][28] A relevant aspect in relation to obtaining pediatric medicines is the dose adjustment, which must be performed through complex calculations, which in turn are necessary to adapt the formulation indicated for adult use to another formulation aimed at pediatric use, usually with very small doses, as those used for neonates. Thus, Ferreira et al 31 found that the cardiovascular drugs most prescribed in underdoses were Spironolactone, Captopril, and Furosemide, while Captopril and Digoxin were among the most prescribed drugs in overdoses, with the majority of overdoses occurring among lactating women.…”