Wrongly Prescribed Half Tablets in a Swiss University Hospital

Arnet, Isabelle; Moos, M. Von; Hersberger, Kurt E.

doi:10.4236/ijcm.2012.37114

Cited by 8 publications

(8 citation statements)

References 25 publications

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“…Splitting was inappropriate for 2.7% of all drugs, mainly because of the absence of a score line. A retrospective study performed at the University Hospital Basel in Switzerland showed similar results [ 11 ]. Of the 36,751 electronic prescriptions delivered in 2011 at discharge, 3,724 (10.1%) contained the mention “1/2” and concerned 4,888 single tablets.…”

Section: Introductionmentioning

confidence: 61%

Issues around the Prescription of Half Tablets in Northern Switzerland: The Irrational Case of Quetiapine

Allemann

Bornand

Hug

et al. 2015

BioMed Research International

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Background. Prescription of fragmented tablets is useful for individualisation of dose but includes several drawbacks. Although without score lines, the antipsychotic drug quetiapine was in 2011 the most often prescribed 1/2 tablet in discharge prescriptions at the University Hospital in Basel (USB, 671 beds). We aimed at analysing the prescription patterns of split tablets in general and of quetiapine in particular in Switzerland. Methods. All orders of community pharmacies for unit-of-use soft pouch blisters placed at Medifilm AG, the leader company in Switzerland for repackaging into pouch blisters, were analysed. Results. Out of 4,784,999 tablets that were repacked in 2012 in unit-of-use pouch blisters, 8.5% were fragmented, mostly in half (87.6%), and were predominantly psycholeptics (pipamperone 15.8%). Prescription of half quetiapine appears to be a Basel specificity (highest rates of fragments and half quetiapine). Conclusions. Prescription of fragmented tablet is frequent. It represents a safety issue for the patient, and a pharmaceutical care issue for the pharmacist. In ambulatory care, the patient's cognitive and physical capacities must be clarified, suitability of the splitting of the tablet must be checked, appropriate aids must be offered, like a pill-splitting device in order to improve accuracy, and safe use of the drug must be ensured.

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Section: Introductionmentioning

confidence: 61%

Issues around the Prescription of Half Tablets in Northern Switzerland: The Irrational Case of Quetiapine

Allemann

Bornand

Hug

et al. 2015

BioMed Research International

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“…In the few studies on the frequency of tablet splitting in hospitals, Arnet et al and Quinzler et al have observed higher splitting frequency (10.1% and 8.5%, respectively) than the one observed in the study reported here (4.5%). 9,22 The differences may stem from the varying characteristics of the hospitals, including the number of beds, medical specialties available, and patient profile. Regardless of the inter-hospital variation, the prevalence of tablet splitting is clearly high, which underscores the need to understand its causes and propose alternatives to mitigate its potential adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of tablet splitting in a Brazilian tertiary care hospital

Melo

Pereira

Soares

et al. 2020

Pharm Pract (Granada)

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Background: Although a highly common practice in hospital care, tablet splitting can cause dose variation and reduce drug stability, both of which impair drug therapy. Objective: To determine the overall prevalence of tablet splitting in hospital care as evidence supporting the rational prescription of split tablets in hospitals. Methods: Data collected from inpatients’ prescriptions were analyzed using descriptive statistics and used to calculate the overall prevalence of tablet splitting and the percentage of split tablets that had at least one lower-strength tablet available on the market. The associations between the overall prevalence and gender, age, and hospital unit of patients were also assessed. The results of laboratory tests, performed with a commercial splitter, allowed the calculation of the mass loss, mass variation, and friability of the split tablets. Results: The overall prevalence of tablet splitting was 4.5%, and 78.5% of tablets prescribed to be split had at least one lower-strength tablet on the market. The prevalence of tablet splitting was significantly associated with the patient’s age and hospital unit. Laboratory tests revealed mean values of mass loss and variation of 8.7% (SD 1.8) and 11.7% (SD 2.3), respectively, both of which were significantly affected by the presence of coating and scoreline. Data from laboratory tests indicated that the quality of 12 of the 14 tablets deviated in at least one parameter examined. Conclusions: The high percentage of unnecessary tablet splitting suggests that more regular, rational updates of the hospital’s list of standard medicines are needed. Also, inappropriate splitting behavior suggests the need to develop tablets with functional scores.

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“…This percentage is far higher than in other studies because our study involved children aged one to 7 years whereas other studies have involved a mixed group of patients. [ 18 19 20 ] Despite it being well-known that coated, unscored, and special formulations such as sustained-release and controlled-release, should not be split,[ 21 22 ] patients are prescribed such formulations and advised to split them as they are the only formulations available for prescribing in our hospital. VPA was the most commonly prescribed drug as well as in split forms followed by PHY.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effect of Divided Doses of Adult Solid and Liquid Oral Formulations of Antiepileptic Drugs in the Management of Pediatric Epilepsy

Nidanapu

Tamijarassy

Mahadevan

et al. 2017

Journal of Pharmacology and Pharmacotherapeutics

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Objective:To compare the differences in the efficacy and safety of the commonly prescribed AEDs in the management of epilepsy in children when using divided doses of adult solid oral formulations (DDSF) with the liquid oral formulations (LFs).Materials and Methods:Patients who had one or more seizures per month and prescribed with DDSF were recruited. Initially the patients were continued on DDSF for 4 months following which they were switched over to LF for the subsequent 4 months. Seizure frequencies and adverse drug effects (ADRs) were recorded every month for 8 months and plasma AED levels were estimated at the end of 4th and 8th months.Results:A total of 200 patients completed the study protocol. The median seizure frequencies per month with DDSF and LF were: partial seizures (20.5, 9.0; P < 0.001), generalized tonic-clonic seizures (6.5, 2.0; P < 0.001), myoclonic seizures (58.5, 29.0; P < 0.001). Mean plasma drug levels ± SD (μg/ml) with DDSF and LF were: sodium valproate (48.2 ± 13.7, 69.1 ± 16.3; P < 0.001), phenytoin sodium (5.0 ± 2.4, 12.8 ± 3.8; P < 0.001), carbamazepine (4.5 ± 2.0, 11.5 ± 4.8; P < 0.001) and phenobarbitone (14.1 ± 5.2, 25.4 ± 12.3, P < 0.001). The incidence of treatment emergent ADRs was poor scholastic performance (25.5%), behavioral problems and dizziness/sedation (21.0%), somnolence/sleep disorders (19.5%).Conclusion:Patients treated with LF had better seizure control and optimal therapeutic drug levels and less adverse effects when compared to DDSF.

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Wrongly Prescribed Half Tablets in a Swiss University Hospital

Cited by 8 publications

References 25 publications

Issues around the Prescription of Half Tablets in Northern Switzerland: The Irrational Case of Quetiapine

Issues around the Prescription of Half Tablets in Northern Switzerland: The Irrational Case of Quetiapine

Prevalence of tablet splitting in a Brazilian tertiary care hospital

Comparative Effect of Divided Doses of Adult Solid and Liquid Oral Formulations of Antiepileptic Drugs in the Management of Pediatric Epilepsy

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