A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice



Richey, RH, Hughes, C, Craig, JV, Shah, UU, Ford, JL, Barker, CE, Peak, M ORCID: 0000-0003-1909-3211, Nunn, AJ and Turner, MA ORCID: 0000-0002-5299-8656
(2017) A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice. International Journal of Pharmaceutics, 518 (1-2). pp. 155-166.

[img] Text
MODRIC after referees comments.doc - Author Accepted Manuscript

Download (217kB)

Abstract

This study sought to determine whether there is an evidence base for drug manipulation to obtain the required dose, a common feature of paediatric clinical practice. A systematic review of the data sources, PubMed, EMBASE, CINAHL, IPA and the Cochrane database of systematic reviews, was used. Studies that considered the dose accuracy of manipulated medicines of any dosage form, evidence of safety or harm, bioavailability, patient experience, tolerability, contamination and comparison of methods of manipulation were included. Case studies and letters were excluded. Fifty studies were eligible for inclusion, 49 of which involved tablets being cut, split, crushed or dispersed. The remaining one study involved the manipulation of suppositories of one drug. No eligible studies concerning manipulation of oral capsules or liquids, rectal enemas, nebuliser solutions, injections or transdermal patches were identified. Twenty four of the tablet studies considered dose accuracy using weight and/or drug content. In studies that considered weight using adapted pharmacopoeial specifications, the percentage of halved tablets meeting these specifications ranged from 30% to 100%. Eighteen studies investigated bioavailability, pharmacokinetics or clinical outcomes following manipulations which included nine delayed or modified release formulations. In each of these nine studies the entirety of the dosage form was administered. Only one of the 18 studies was identified where drugs were manipulated to obtain a proportion of the dosage form, and that proportion administered. The five studies that considered patient perception found that having to manipulate the tablets did not have a negative impact on adherence. Of the 49 studies only two studies reported investigating children. This review yielded limited evidence to support manipulation of medicines for children. The results cannot be extrapolated between dosage forms, methods of manipulation or between different brands of the same drug.

Item Type: Article
Additional Information: publisher: Elsevier articletitle: A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice journaltitle: International Journal of Pharmaceutics articlelink: http://dx.doi.org/10.1016/j.ijpharm.2016.12.032 content_type: article copyright: © 2016 Elsevier B.V. All rights reserved.
Uncontrolled Keywords: Drug manipulation, Hospital, Paediatric practice, Systematic review
Depositing User: Symplectic Admin
Date Deposited: 24 May 2017 14:50
Last Modified: 18 Feb 2023 06:16
DOI: 10.1016/j.ijpharm.2016.12.032
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3007640