Comparing Two Methods of Tablet Manipulation to Adjust the Warfarin Dose in Paediatric Care

Area of Science:

• Pharmaceutical Science
• Clinical Pharmacy
• Drug Formulation

Background:

• Accurate pediatric dosing is challenging due to a lack of age-appropriate formulations.
• Tablets are often manipulated to achieve specific pediatric doses, but accuracy varies.
• Warfarin, an anticoagulant, requires precise dosing, especially in children.

Purpose of the Study:

• To evaluate the accuracy of different tablet manipulation methods for pediatric warfarin dosing.
• To compare the precision of dispersing tablets versus splitting tablets for dose adjustment.
• To identify the most reliable method for obtaining accurate child-adjusted warfarin doses.

Main Methods:

• Two generic warfarin tablet formulations were tested.
• Tablets were dispersed in 10 mL water, and 10% was extracted.
• Tablets were split into halves or quarters before dispersion and extraction.
• Ultra-High Performance Liquid Chromatography (UHPLC) was used for quantitative warfarin determination.

Main Results:

• Splitting tablets resulted in deviations greater than 30% from the theoretical weight.
• Extracting a fraction from dispersed tablets showed deviations of no more than 10% from the intended dose.
• Dispersion and fractional extraction offered greater accuracy compared to tablet splitting.

Conclusions:

• Dispersion of warfarin tablets followed by fractional extraction is the most accurate method for achieving child-adjusted doses.
• Tablet splitting introduces significant variability and should be avoided in pediatric warfarin preparation.
• Standardizing formulation practices is crucial for ensuring safe and effective pediatric anticoagulant therapy.