PATIENT ACCESS TO COMPOUNDED DRUGS IN PEDIATRICS AFTER DISCHARGE FROM A TERTIARY CENTER

Abstract BACKGROUND: Many commonly used drugs are not commercially available in forms suitable for children. Therefore, pharmacies create new compounds by adding excipients to existing adult formulations, often by crushing tablets and creating suspensions. Timely safe delivery of compounded drugs is challenging but very little is known about the problems faced by young patients and their parents with new compounded drug prescriptions. OBJECTIVES: To describe the barriers and issues faced by young patients and their parents when obtaining and using compounded drugs. DESIGN/METHODS: This prospective observational descriptive study included patients 0 through 21 years of age who were discharged from a mother-child tertiary hospital with a prescription containing at least one compounded drug between February 2016 and July 2016. Families were called 7 to 10 business days after discharge to complete a telephone follow-up questionnaire. Retail pharmacies were then contacted to obtain additional information in order to compare the dispensed compounded drug with the prescription and published formulations. The main outcomes and measures included potential issues experienced by patients and/or their parents, the number of pharmacies consulted and reasons for changing pharmacies, delays in obtaining compounded drugs and reasons for the delays, the number of missed doses and potential issues identified with the dispensed compounded drug when compared with the discharge prescription and published formulations. RESULTS: Seventy-one patients with a median age of 6.9 months were surveyed regarding 99 compounded drugs corresponding to 34 different oral compounded drugs. According to the parents, doses of the compounded drugs were provided at hospital discharge for 90 compounded drugs (median 7 days of treatment; IQR 4) and hospital pharmacists contacted the retail pharmacists before discharge for 69 compounded drugs. Out of 314 potential issues identified, 252 involved actual or potential consequences and were therefore considered as issues. Nine involved major and 243 minor actual or potential consequences. One hundred and thirteen (113) of the 252 issues were reported by parents and 139 by the research team. Although any dosage form of compounded drug was eligible for this study, all the recruited compounded drugs were either oral suspensions or oral solutions. CONCLUSION: This study identifies a significant number of compounded-related issues. It suggests that current p