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Isles M. Patient safety issues associated with the use of compounded medicines as alternatives to approved pharmaceutical products in Europe and how best practice can improve outcomes. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 31:133-144. [PMID: 32538874 DOI: 10.3233/jrs-200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Pharmaceutical compounding allows individuals with special requirements access to medicines. Compounding can also be used to provide cheaper alternatives to commercially produced medicines which may be less strictly regulated than those commercially produced as they do not require marketing authorisation. OBJECTIVE This review describes the issues and potential risks associated with compounded medicines and equally importantly identifies best practices. METHODS To establish reports about lack of effectiveness, adverse events and medication errors occurring with compounded pharmaceuticals, a literature search was conducted of PubMed, Embase and MEDLINE databases for relevant cases in European countries which were published between 2003 and 2018. Case reports/series that described instances of successful use of compounded medicines over the same period were also identified. RESULTS Overall, 12 case reports/case series describing problems associated with compounded medicines in Europe have been identified. Sources of patient risk associated with compounded medicines include lack of quality, safety and efficacy data, preparation and labelling errors, and improper storage and handling practices. CONCLUSIONS Several case reports/series describing instances of overdose, medication errors and adverse events associated with compounded medications were reviewed. The number of affected patients was relatively small, but many were children and two adult patients experienced permanent sequelae. The number of incidents associated with compounded medicines is unknown, and so these numbers should be interpreted with caution. When licensed medicines are available, the use of compounded medicines can put patients at unnecessary risk which should be avoided. Stricter regulation is necessary to prevent similar cases from occurring in the future as the European market for compounded medications grows. Pharmacists can promote best practices in compounding through professional organisations. Future recommended actions are: 1. Stricter regulation is necessary to prevent similar cases from occurring in the future as the European market for compounded medications grows. 2. A comprehensive pan-European survey to gain a greater understanding of compounding procedures and techniques. This would provide valuable information to the benefit of hospital systems and their patients. 3. The results of the survey can then be used to improve the knowledge and quality control of compounded medicines for the good of patient safety.
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Affiliation(s)
- Mike Isles
- The European Alliance for Access to Safe Medicines, 20 Madeira Park, Tunbridge Wells, Kent, UK
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Curti C, Gallice S, Lamy E, Rathelot P, Vanelle P. [City-hospital network and quality control of officinal preparations]. ANNALES PHARMACEUTIQUES FRANÇAISES 2017; 76:242-247. [PMID: 29037451 DOI: 10.1016/j.pharma.2017.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/05/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES In a hospital environment, the quality control of the hospital preparations allows to release homogeneous batches in a secure way. These controls are totally integrated into the process of production and can also, in certain cases, be realized for high-alert magistral preparations. In community pharmacy, these controls were not required, but the Agence régionale de santé (ARS) recently incited compounding community pharmacies to realize this type of analyses. This decision motivated the creation of a collaboration between the pharmacy department of a French teaching hospital and a society including around thirty community pharmacies having a preparatory. METHODS Twenty community pharmacies distributed on all the territory have submitted one of their pediatric preparation, capsules of captopril 2mg, to the pharmacopoeia controls usually realized in the industry or hospital. RESULTS All the analyzed batches were in agreement with European Pharmacopeia specifications. CONCLUSIONS We shall present the rational of this work, the results as well as the numerous perspectives offered by this new type of collaboration joining completely the logic of a network city-hospital allowing the improvement of security of the medication circuit in France.
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Affiliation(s)
- C Curti
- Service central de la qualité et de l'information pharmaceutiques, AP-HM, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; CNRS, UMR 7273, laboratoire de pharmaco-chimie radicalaire, faculté de pharmacie, institut de chimie radicalaire ICR, Aix-Marseille université, 27, boulevard Jean-Moulin, CS 30064, 13385 Marseille cedex 05, France
| | - S Gallice
- Pharmacie des Rosiers, 106, boulevard Charles-Moretti, 13014 Marseille, France
| | - E Lamy
- Service central de la qualité et de l'information pharmaceutiques, AP-HM, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; Laboratoire de biochimie, faculté de pharmacie, Aix-Marseille université, 27, boulevard Jean-Moulin, CS30064, 13385 Marseille cedex 05, France
| | - P Rathelot
- Service central de la qualité et de l'information pharmaceutiques, AP-HM, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; CNRS, UMR 7273, laboratoire de pharmaco-chimie radicalaire, faculté de pharmacie, institut de chimie radicalaire ICR, Aix-Marseille université, 27, boulevard Jean-Moulin, CS 30064, 13385 Marseille cedex 05, France
| | - P Vanelle
- Service central de la qualité et de l'information pharmaceutiques, AP-HM, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France; CNRS, UMR 7273, laboratoire de pharmaco-chimie radicalaire, faculté de pharmacie, institut de chimie radicalaire ICR, Aix-Marseille université, 27, boulevard Jean-Moulin, CS 30064, 13385 Marseille cedex 05, France.
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Sivén M, Kovanen S, Siirola O, Hepojoki T, Isokirmo S, Laihanen N, Eränen T, Pellinen J, Juppo AM. Challenge of paediatric compounding to solid dosage forms sachets and hard capsules – Finnish perspective. J Pharm Pharmacol 2016; 69:593-602. [DOI: 10.1111/jphp.12648] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/04/2016] [Indexed: 11/29/2022]
Abstract
Abstract
Objectives
The study evaluated the quality of compounded sachets and hard gelatine capsules and their feasibility in paediatric drug administration.
Methods
Commercial tablets were compounded to sachets and capsules in hospital environment, and the uniformity of content and simulated drug dose were determined.
Key findings
Compounded formulations were successfully obtained for a range of drug substances; dipyridamole, spironolactone, warfarin and sotalol formulations were within acceptable limits for uniformity of content, in most cases. However, some loss of drug was seen. The type and amount of excipients were found to affect uniformity of content; good conformity of capsules was obtained using lactose monohydrate as filler, whereas microcrystalline cellulose was a better choice in sachets. In capsules, content uniformity was obtained for a range of drug doses. If the drug is aimed to be administered through a nasogastric tube, solubility of the drug and excipients should be considered, as they were found to affect the simulated drug dose in administration.
Conclusions
Compounded sachets and capsules fulfilled the quality requirements in most cases. In compounding, the choice of excipients should be considered as they can affect conformity of the dosage form or its usability in practice. Quality assurance of compounded formulations should be taken into consideration in hospital pharmacies.
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Affiliation(s)
- Mia Sivén
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Satu Kovanen
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Outi Siirola
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Tuomas Hepojoki
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | | | | | | | - Jukka Pellinen
- Department of Environmental Sciences, Faculty of Biological and Environmental Sciences, University of Helsinki, Helsinki, Finland
| | - Anne M Juppo
- Division of Pharmaceutical Chemistry and Technology, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
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Popescu M, Vialet R, Loundou A, Peyron F, Buès-Charbit M. Étude de la variabilité dans les reconstitutions de vancomycine intraveineuse en réanimation pédiatrique. ACTA ACUST UNITED AC 2011; 30:726-9. [DOI: 10.1016/j.annfar.2011.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 04/06/2011] [Indexed: 10/18/2022]
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Helin-Tanninen M, Naaranlahti T, Kontra K, Savolainen K. Nifedipine capsules may provide a viable alternative to oral powders for paediatric patients. J Clin Pharm Ther 2007; 32:49-55. [PMID: 17286789 DOI: 10.1111/j.1365-2710.2007.00798.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare content uniformities between different sizes of extemporaneously compounded nifedipine oral powders and capsules, in order to find out if capsules could be used instead of oral powders as paediatric medications. METHODS Actual content and content uniformity of extemporaneously compounded 1-mg nifedipine oral powders and capsules were evaluated by a high performance liquid chromatographic assay. Capsules and powders were prepared by triturating 10-mg nifedipine tablets with different amounts of lactose or microcrystalline cellulose with a mortar and pestle using a standard geometric dilution technique. Oral powders were weighed individually and capsules were filled by a hand-operated capsule-filling machine. Four different sizes of powders (500, 300, 100 and 50 mg) and three different sizes of capsules (numbers 1, 3 and 4) were prepared. Ten oral powders and 10 capsules from each batch were randomly selected and individually assayed for nifedipine amount. RESULTS AND DISCUSSION The extemporaneously prepared nifedipine oral powders and capsules were within acceptable limits for content uniformity, as defined by the European Pharmacopoeia, but the results indicate that the loss of nifedipine during the preparation process may be considerable for both preparations. The concentration on nifedipine decreased while the total mass of the oral powder decreased. These results demonstrate that nifedipine oral powders can be replaced by capsules, whose contents are emptied for use, in paediatric medications. Compounding small capsules, such as size number 3 or 4, is acceptable when considering the average drug content. The total weight of the oral powder should be at least 300 mg. CONCLUSION The preparation of nifedipine in all studied capsule sizes was safe with either lactose monohydrate or microcrystalline cellulose as excipients. Thus, emptied capsules seem to be a good choice for delivering a paediatric medication. The loss of nifedipine was considerable in oral powders with low total weight.
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Affiliation(s)
- M Helin-Tanninen
- Pharmacy Department, Kuopio University Hospital, Kuopio, Finland.
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