Enhancing extemporaneous preparations in Thai Hospitals: exploring variation, common formulations, and challenges and needs related to extemporaneous preparations

Main Article Content

Teeraporn Supapaan https://orcid.org/0000-0002-6887-8181
Chinnawat Jamlongpeng
Natthapon Yangyuen
Komkrit Srisawai
Lersak Prachuabaree
Wannaporn Wattanawong
Jirana Anansushatgul
Thanatcha Songmuang https://orcid.org/0009-0000-8181-0926
Saksit Sripa https://orcid.org/0000-0002-1528-8006
Chonladda Pitchayajittipong https://orcid.org/0000-0001-6003-7145

Keywords

Extemporaneous compounding, variation, formulations, standardization, challenges, opportunities, Thai hospitals

Abstract

Objective: This study aimed to assess the diversity of extemporaneous preparations, identify the prevalent formulations, and highlight the challenges and opportunities for standardization and improvement of extemporaneous preparation practices. Methods: A survey was conducted among 88 Thai hospitals representing the public and private sectors. The questionnaire gathered information on general hospital characteristics, detailed aspects of extemporaneous compounding, and the specific extemporaneous formulations used. Results: The survey revealed significant variations in extemporaneous preparations among Thai hospitals, with oral liquids, semisolids, and eye preparations commonly employed. The primary oral liquid formulations used were suspensions, syrups, and solutions. Specific medications frequently used in extemporaneous preparations were also identified. The challenges encompassed space, personnel, skills, raw materials, equipment, standardized formula information, preparation process information, funding, and other factors. Conclusion: A survey among Thai hospitals revealed significant variations in extemporaneous preparations in 88 participating hospitals. Common formulations used in extemporaneous compounding include oral liquid preparations, such as suspensions, syrups, solutions, semisolid preparations, and eye preparations. Stakeholder involvement, implementation of standardized operating procedures, resource allocation, comprehensive training programs, and collaboration among hospitals, pharmaceutical companies, and regulatory agencies are recommended to enhance extemporaneous compounding practices.

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References

1. US Food and Drug Administration (FDA). (2018). Compounding and the FDA: Questions and Answers. https://www.fda.gov/ drugs/human-drug-compounding/compounding-and-fda-questions-and-answersAccessed 10 April, 2022.
2. Carvalho M, Almeida IF. The Role of Pharmaceutical Compounding in Promoting Medication Adherence. Pharmaceuticals (Basel). 2022;15(9):1091. http://doi.org/1010.3390/ph15091091
3. Watson CJ, Whitledge JD, Siani AM, et al.Pharmaceutical Compounding: a History, Regulatory Overview, and Systematic Review of Compounding Errors. J Med Toxicol. 2021;17(2):197-217. https://doi.org/10.1007/s13181-020-00814-3
4. Rood JM, Engels MJ, Ciarkowski SL, et al.Variability in compounding of oral liquids for pediatric patients: A patient safety concern. J Am Pharm Assoc. 2014;54(4):383-389. https://doi.org/10.1331/japha.2014.13074
5. Taylor S, Hays C, Glass B. Compounding medications in a rural setting: an interprofessional perspective. J Multidiscip Healthc. 2018;11:197-204. https://doi.org/10.2147/jmdh.s156161
6. Sherr Z, Karara AH. Evaluation of the most frequently prescribed extemporaneously compounded medications in a rural setting: a case study from the Delmarva Peninsula. Int J Pharm Compd. 2014;18(6):462-468.
7. Cook GK, Ling JW, Lee R. Extemporaneous Compounding in Queensland Hospitals. J Pharm Pract Res. 2007;37(3):204-209.
https://doi.org/10.1002/j.2055-2335.2007.tb00745.x
8. Lyon J. Drug shortage compounding: the only safe medication source in a time of crisis. Int J Pharm Compd. 2012;16(6):456- 460.
9. Baranowski P, Karolewicz B, Gajda M, et al. Ophthalmic drug dosage forms: characterisation and research methods. Sci World J. 2014;2014:861904. https://doi.org/10.1155/2014/861904
10. Assefa D, Paulos G, Kebebe D, et al. Investigating the knowledge, perception, and practice of healthcare practitioners toward rational use of compounded medications and its contribution to antimicrobial resistance: a cross-sectional study. BMC Health Serv Res. 2022;22(1):243. https://doi.org/10.1186/s12913-022-07649-4
11. Abousheishaa AA, Sulaiman AH, Huri HZ, et al. Global Scope of Hospital Pharmacy Practice: A Scoping Review. Healthcare (Basel). 2020;8(2). https://doi.org/10.3390/healthcare8020143
12. van der Schors T, Amann S, Makridaki D, et al. Pharmacy preparations and compounding. Eur J Hosp Pharm. 2021;28(4):190- 192. https://doi.org/10.1136/ejhpharm-2020-002559
13. Loomis M, Kosinski T, Wucherer S. Development and Implementation of a Standardized Sterile Compounding Training Program. Hosp Pharm. 2019;54(4):259-265. https://doi.org/10.1177/0018578718788841
14. The Association of Hospital Pharmacist (Thailand). The Professional Pharmacy Standards for Thai Hospitals 2018-2022. http:// www.pknhospital.com/2019/data/drug/drugsystem/drug1.pdf. Accessed 6 May, 2023
15. Romano A Fois, Barry T Mewes, Iqbal Ramzan, et al. Compounded medicines and ‘off label’ prescribing. Aust J Gen Pract. 2012;38:16-20.
16. The Association of Hospital Pharmacy (Thailand). The hospital pharmacist standard performance 2013. https://thaihp.org/ index.php?lang=th&option=contentpage&sub=29. Accessed 16 May, 2020.
17. Fois RA, Mewes BT, McLachlan AJ, et al. Compounded medicines and ‘off label’ prescribing - a case for more guidance. Aust Fam Physician. 2009;38(1-2):16-20.
18. Jaidee S. The pharmaceutical production system in district hospital. Bangkok: Faculty of Chula; 1984.
19. Pitchayajittipong C, Sriboon S, Kulmee S, et al. An Overview of Pharmaceutical Production in Thai Hospitals. Hosp Pharm. 2019;56(4):265-275. https://doi.org/10.1177/0018578719890090
20. Yuliani SH, Putri DCA, Virginia DM, et al. Prevalence, Risk, and Challenges of Extemporaneous Preparation for Pediatric Patients in Developing Nations: A Review. Pharmaceutics. 2023;15(3):840. https://doi.org/10.3390/pharmaceutics15030840
21. Kristina SA, Wiedyaningsih C, Widyakusuma NN, et al. Extemporaneous compounding practice by pharmacists: a systematic review. Int J Pharm Pharm Sci. 2017;9(2):42-46. https://doi.org/10.22159/ijpps.2017v9i2.15681
22. Tiengkate P, Lallemant M, Charoenkwan P, et al. Gaps in Accessibility of Pediatric Formulations: A Cross-Sectional Observational Study of a Teaching Hospital in Northern Thailand. Children (Basel). 2022;9(3). https://doi.org/10.3390/children9030301
23. Pharmaceutical Services Division Ministry of Health Malaysia. (2015). Extemporaneous Formulation. https://www.invotek. com.tr/images2/MOH_Malaysia_Extemporaneous_Formulation.pdf. Accessed 22 May, 2023
24. Silva MR, Dysars LP, Santos EPd, et al. Preparation of extemporaneous oral liquid in the hospital pharmacy. Braz J Pharm Sci. 2020;56. https://doi.org/10.1590/s2175-97902019000418358
25. Engels MJ, Ciarkowski SL, Rood J, et al. Standardization of compounded oral liquids for pediatric patients in Michigan. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. 2016;73(13):981-990. https://doi.org/10.2146/150471
26. Cokro F, Arrang ST, Chiara MA, et al. Prevalence of pharmacist knowledge on beyond-use date (BUD) of various non-sterile compounding drugs in Indonesia. Pharm Pract (Granada). 2022;20(1):2630. https://doi.org/10.18549/pharmpract.2022.1.2630
27. Joungmunkong Z, Na-Ranong S, Rakrod S, et al. Accelerated stability testing of extemporaneous suspensions and reconstituted powder for suspensions of acetazolamide and furosemide. Isan J Pharm Sci. 2013;9(1):32-39.
28. Nahata MC, Morosco RS, Hipple TF. Stability of spironolactone in an extemporaneously prepared suspension at two temperatures. Ann Pharmacother. 1993;27(10):1198-1199. https://doi.org/10.1177/106002809302701009
29. Sellers S, Utian WH. Pharmacy compounding primer for physicians: prescriber beware. Drugs. 2012;72(16):2043-2050. https:// doi.org/10.2165/11640850-000000000-00000
30. Glass BD, Haywood A. Stability considerations in liquid dosage forms extemporaneously prepared from commercially available products. J Pharm Pharm Sci. 2006;9(3):398-426.
31. Gianturco SL, Mattingly AN. Distinguishing between compounding facilities and the development of the 503B bulk drug substance list. J Am Pharm Assoc. 2021;61(1):e8-e11. https://doi.org/10.1016/j.japh.2020.06.024

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