Extent of extemporaneous compounding and pattern of prescribing and use of extemporaneous medicines in a developing setting

Abstract

Objectives To determine the extent of extemporaneous compounding, the prescribing pattern and use of extemporaneous medicines in a developing setting like Nigeria. Methods A cross‐sectional assessment was conducted at the Pharmacy Department of the premier teaching hospital in Nigeria. A pretested data collection form and direct inspection of packaging and labelling information were used for data extraction. Key findings About 100% (678) of the extemporaneous products were liquid dosage form made with trituration using crushed tablets (76.5%, 519), opened capsules (17.6%, 119) and broken ampoules (5.9%, 40), and the majority (77.2%, 524) were dispensed to inpatients. The ten most frequent extemporaneous preparations were zinc gluconate (11.1%, 75), spironolactone (10%, 60), hydrochlorothiazide (9%, 60), captopril (9%, 60), hydroxyurea (8.1%, 55), furosemide (6%, 40), lisinopril (5.2%, 35), phenytoin (5.2%, 35), carbamazepine (4.1%, 28) and enalapril (4%, 27). Simple syrup and amaranth solution were the most frequently used excipients (97.2%, 659). Packaging was done with white plastic bottles (100%, 678). No labelling information was provided on storage condition and expiry date, and the compounding pharmacists’ lacked access to key information on the stability, bioavailability, efficacy and safety of extemporaneously prepared medicines. Conclusions The extent of compounding and use of extemporaneous products is considerable and remain an importance source of critical access to essential medicines for children with cardiovascular and neurological disorders, and electrolyte imbalance and nutritional deficiencies in both the inpatient and ambulatory settings. However, the limited access to information on the stability, efficacy and safety of extemporaneous products may potentially expose patients to harm.

Prescribing Pattern of Dermatological Compounding in Ethiopia: The Case of ALERT Hospital

“…[5][6][7][8] This time-honored practice is still ordered and remain a viable option by many practitioners. 9,10 A typical study indicated that a dermatologist prescribes 2 to 5 compounded medications daily. 11 Compounding can be defined as combining, admixing, diluting, reconstituting, or otherwise altering a drug or bulk drug substance to create a desired medication.…”

“… 5–8 This time-honored practice is still ordered and remain a viable option by many practitioners. 9 , 10 A typical study indicated that a dermatologist prescribes 2 to 5 compounded medications daily. 11…”

“…12 , 13 Most commercially available medicines are formulated as solid dosage forms and may not be in the desired strength and dosage forms to meet specific patient needs particularly for dermatological complications. 10 , 14 Buurma et al reported that dermatological dosage forms accounted a significant share (62.1%) among compounded medicines. 15 Similar studies also revealed that dermatological preparations were among the most frequently prescribed therapeutic categories for extemporaneous compounding.…”

Extemporaneous Compounding: Prevalence, Risks and Quality Assurance

“…In Ethiopia, about 5% of 353 operating hospitals in the nation had dermatologic compounding facilities in the year 2020 (Selam & Ababu, 2021). In a study conducted at a teaching hospital in Nigeria, all the extemporaneous preparations were liquid dosage form prepared from crushed tablets, capsules and parenteral dosage forms (Yusuff, 2019). A study performed at Kenyatta hospital, Kenya to evaluate extemporaneously prepared products derived from oral solid dosage form alterations, a total of 392 oral liquid formulations were compounded over the study period of January, 2012 to December, 2013.…”