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Adjusting the dose in paediatric care: dispersing four different aspirin tablets and taking a proportion
Jørgen Brustugun1, Nikolai Notaker2, Lasse Holtan Paetz2
1Oslo Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway jorgen.brustugun@sykehusapotekene.no.
Insights
Tablet formulation and manipulation method significantly impact aspirin dose accuracy in pediatric care. Dispersible aspirin tablets, when manipulated correctly, offer better dose precision for children.
Area of Science:
- Pharmaceutical Sciences
- Pediatric Pharmacology
- Drug Formulation
Background:
- Tablets are frequently manipulated in hospital settings to achieve accurate pediatric doses.
- Aspirin, an antiplatelet agent, is often administered to children in tablet form.
- Limited evidence exists on the optimal tablet formulations and manipulation techniques for pediatric dosing.
Purpose of the Study:
- To evaluate the impact of different tablet formulations and manipulation methods on dose accuracy and precision.
- To determine the suitability of various aspirin tablet types for pediatric dose extraction.
- To provide evidence-based recommendations for manipulating aspirin tablets for children.
Main Methods:
- Four aspirin tablet formulations (chewable, conventional, two dispersible) were dispersed in water.
- Simulated clinical manipulation techniques included passive dispersion, stirring, and syringe-based mixing.
- Dose recovery was quantified using ultra-high-performance liquid chromatography (UHPLC).
Main Results:
- Dose recovery varied widely (3% to 99%) depending on tablet formulation and manipulation intensity.
- Only dispersible aspirin tablet formulations consistently yielded doses within 20% of the intended amount.
- Non-dispersible tablets resulted in inaccurate dosing regardless of the manipulation method used.
Conclusions:
- Tablet formulation is critical; dispersible aspirin tablets are preferable for pediatric dosing.
- Specific manipulation techniques (passive dispersion or stirring/pumping) are crucial for accurate dosing with dispersible tablets.
- Non-dispersible aspirin tablets are unsuitable for manipulation to achieve accurate pediatric doses.
Objectives:
When caring for children in a hospital setting, tablets are often manipulated at the ward to obtain the right dose. One example is manipulation of tablets containing the slightly water-soluble substance aspirin, used in paediatric care as an antiplatelet agent. The evidence base, however, for choosing certain tablet formulations and manipulation methods over others for extraction of proportions is lacking. The aim of this study was to investigate the effect of tablet formulation and manipulation technique on the dose accuracy and precision attained when dispersing different commercially available aspirin tablets and extracting a small proportion suitable for children.
Methods:
The manipulation methods investigated simulated those observed in the paediatric clinic. Four tablet formulations-one chewable, one conventional and two dispersible-were dispersed in 10 mL water in a medicine measure. On (1) passive dispersion, (2) mixing by stirring with the syringe, or (3) stirring and pumping the dispersion in and out of the syringe, respectively, proportions (1 mL or 2 mL) were extracted and the doses recovered were determined using a validated UHPLC (ultra high-pressure liquid chromatography) method.
Results:
Fractions from the four different dispersed aspirin tablet formulations varied from 99% to 3% of that intended with the lowest degree of mixing, and from 96% to 34% of that intended with the highest degree of mixing. Only the dispersible tablets gave average doses within 20% of the intended dose.
Conclusions:
Fraction extraction from dispersed aspirin tablets only gave doses within 20% of intended for the dispersible tablets, and then only for some of the manipulation methods: 'passive dispersion' for the 75 mg dispersible tablet and 'stirring and pumping' for the 300 mg dispersible tablet. The tablets not intended for dispersion gave unsatisfactory results, outside 20%, regardless of manipulation method. The findings underline the importance of considering both tablet formulation and dose extraction technique when manipulations are required.
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