Oral Liquid Medications Research Articles

An Analysis of pH and Sugar Content of Commonly Prescribed Pediatric Liquid Medications: The Current Indian Scenario.

Oral liquid medications are frequently prescribed to children because they are easier to swallow than other dosage forms. These pediatric liquid medications (PLMs) have sugars added to them for better compliance or as preservatives. Children with chronic illnesses may frequently consume these medications. The presence of sugars and their frequent exposure presents a high risk of dental caries in these children. Additionally, the critical pH can be reached if acids below a pH of 5.5 contact the tooth, causing enamel demineralization. Hence, there was a need to study the sugar content and pH of these medications. Pediatricians and pharmacists in Vadodara city, Gujarat, India, were given a short questionnaire to assess the most prescribed and sold PLMs for analgesics, antibiotics, antiepileptics, multivitamins, and antitussives in the Indian pharmaceutical market. The sugar content and pH of the 15 most prescribed PLMs were assessed with ultraviolet/visible (UV/VIS) spectrophotometry and digital pH meter, respectively. Descriptive statistics were used to analyze the data. Only 1 of the 15 most sold/prescribed medicines did not contain sugar. Among the remaining PLMs, the sugar concentration ranged from 6.1% to 78.7%. The pH of the PLM ranged from 3.6 to 7.3. Sugar was present in 93.3% of the 15 analyzed PLMs and the pH was lower than the critical pH in 80% of them. Medications with high sugar content and low pH can cause caries development. Sugar-free PLMs are preferred alternatives.

M25 - The Computerized Oral Prescription Administration System (COPA™): An Innovative Hand-Held Oral Liquid Medication Dispensing Device With Remote Monitoring and Dual Biometrics With the Potential to Streamline Clinical Trials

M25 - The Computerized Oral Prescription Administration System (COPA™): An Innovative Hand-Held Oral Liquid Medication Dispensing Device With Remote Monitoring and Dual Biometrics With the Potential to Streamline Clinical Trials

Understanding medication recycling practices in Canadian hospitals.

Medication recycling within hospitals has proven financial and possible environmental benefits according to local evaluations done in British Columbia. Despite this, the extent of medication recycling in Canadian hospitals remains unclear in the literature. To determine if Canadian hospitals recycle medications, provide an estimate of how much medication is recycled by dosage form, and identify medication recycling barriers through the distribution of a cross-sectional survey. A nine-question survey was distributed to 171 hospital pharmacy departments across Canada that consented to complete the survey. The survey identified whether sites recycled unused medications, an estimate of how much is recycled based on dosage form, and barriers to recycling. Of 62 respondents, the majority indicated they do have medication recycling procedures; however, the frequency of recycling is suboptimal (30-50% of medications are not recycled), and not all medication types are always recycled. Individually packaged oral tablets were most often recycled, and oral liquid medications were least often recycled. Many multi-dose medications were not tamper-proofed. Most respondents selected "sanitization/infection control" and "resource constraint" as reasons for not recycling all medications. Among respondents, the proportion and type of unused medicines that are recycled varied. For sites that did not respond, this might suggest that medication recycling is not a priority. This could represent a missed opportunity to standardize practices and increase medication recycling in hospitals, both of which could represent a meaningful step towards responsible use of medications and reduction of negative impacts on human health and the environment.

Carbon 14 and Carbon 13 Syntheses of Velagliflozin.

Velagliflozin is the active ingredient of the first oral liquid medication approved by the Food and Drug Administration for the treatment of diabetes in cats. This compound belongs to the known class of sodium-glucose cotransporter 2 inhibitors approved to treat diabetes in human. Here, we report the detailed synthesis of velagliflozin labeled with carbon 14 and carbon 13.

Evaluation of KIDs List Compliance at a Children’s Hospital Within a Large Academic Medical Center

OBJECTIVES In 2020, a list of Key Potentially Inappropriate Drugs in Pediatrics, known as the “KIDs List,” was published. The objective of this analysis was to evaluate institutional compliance with the ­recommendations in this publication and identify areas for improvement. METHODS Medications in the KIDs List were compared to the institutional formulary at a large academic medical center caring for pediatric and adult patients. Medications listed in the formulary were then ­evaluated for order comments and restrictions related to their use in pediatric patients. Oral liquid products and a group of commonly used intravenous (IV) medications were reviewed for potentially inappropriate excipients through available manufacturer information. The pediatric clinical specialists were then solicited to review and make recommendations for medications that had not been addressed. RESULTS Of the 67 medications or classes listed in the KIDs List, 47 (70.1%) of the medications are listed in our formulary and available for use. Of these 47 medications, 4 (8.5%) included warnings related to their use in pediatric patients. Of the 270 oral liquid medications reviewed, 206 (76.3%) contained at least 1 ­potentially inappropriate excipient. Of the 20 commonly used IV medications, 3 (15%) contained at least 1 potentially inappropriate excipient. CONCLUSIONS This review found that many medications listed in the KIDs List are included in our ­institution’s formulary and that few have warnings for pediatric patients built into the institutional electronic health record. Further review of medications in the formulary will be conducted to determine the next steps to implementing KIDs List recommendations.

Dental biofilm acidogenicity induced by pediatric oral medications: a double-blind randomized clinical trial.

The aim of this study was to evaluate in vivo dental biofilm acidogenicity induced by nine long-term pediatric oral liquid medications (OLMs). A double-blind crossover randomized clinical trial was conducted with 12 individuals aged 18 to 22 years who had good oral hygiene (OSI < 1.1) and a DMFT index of less than 12. Each participant was exposed to nine OLMs and a 10% sucrose solution (positive control) as part of the crossover design. The pH of the dental biofilm was measured with a Beetrode® microelectrode at 0, 5, 10, 15, 20, 25, and 30 min. Statistical analysis was performed to determine the minimum pH and the area under the curve (AUC). One-way ANOVA was utilized, and the significance level was set at 0.05. Pediatric OLMs caused a sucrose-like decrease in biofilm pH, regardless of therapeutic class (p > 0.05). The mean ± standard deviation of the AUC ranged from 16.26 ± 11.59 (cetirizine) to 39.22 ± 20.81 (azithromycin), with no statistically significant difference compared to sucrose (25.22 ± 6.97) (p > 0.05). The findings suggest that pediatric OLMs contribute to dental biofilm acidogenicity, with a more pronounced effect induced by medications used for respiratory diseases and also by antibiotics.

A Single Center Exploratory Survey of Patients and Nurses on post-Surgical Oral Opioid Delivery Through Patient-Controlled Analgesia.

The most common route of opioid delivery is nurse-administered pills. However, there are numerous challenges such as nursing burden, opioid diversion, medication delay, and patient dissatisfaction. In this study, we conducted two surveys, first to assess patients' and nurses' opinions on the current administration of opioids in pill form, followed by their attitudes towards an innovative concept of oral medication delivery based on a medical device currently undergoing research and development within the University, patient-controlled dispenser and deactivator (PCDD) that allows patients to self-administer liquid oral opioids on demand based on physician prescription. Questionnaires were developed, verified and deployed to assess nurse and post-surgical patient opinions on the current administration of opioids in pill form, as well as the proposed new concept of patient -controlled administration of oral liquid medication via an illustration of PCDD, from September 2022 through July 2023 at a major academic tertiary care center. Quantitative and qualitative data were collected from postoperative patients and nurses from surgical specialties including General Surgery, Surgical Oncology, Trauma Surgery, Orthopedics, and Neurosurgery. Forty-three patients and 53 nurses were interviewed. Seventy percent of patients frequently called nurses for pain medication post-surgery 1-4 times daily, and 32% of patients were told each day by nurses that they could not receive medication because they were not due yet. Medication delay caused 24% of patients to worry about nursing availability for medication delivery. Likewise, nurses reported that half of patients receive delayed medication (22 minutes median delay time) and half of nursing time was spent administering pain medication. Nurses expressed moderate satisfaction with their current delivery of medication (median satisfaction score 6.5 out of 10). When being introduced to the concept of PCDD via a product illustration, 15% of patients said that they prefer liquid medication and 51% said they prefer PCDD or were interested in trying it. Nurse-administered pills are a common but suboptimal method for postoperative pain management. Based on patient and nurse feedback, patient controlled self-administered liquid oral opioid delivery is conceptually innovative, practically viable and potentially a preferred alternative for timely and less nurse-exhaustive pain management.

Implementation Status and Challenges Associated With Implementation of the Targeted Medication Safety Best Practices in a Tertiary Hospital.

Background The Institute for Safe Medication Practices (ISMP) is a well-known non-profit organization dedicated to preventing medication errors. Every two years they publish best practices that can reduce the occurrence of medication errors. This study aims to evaluate the implementation status of these best practices and to understand barriers associated with non-implementation at a tertiary hospital in Saudi Arabia. Methodology This was a two-phase qualitative study. First, a survey consisting of the ISMP best practices was sent to employees (mainly heads of departments) to fill out the implementation rate for each best practice. Then an interview or a focus group was conducted to further validate their answers and understand why some best practices were not implemented. Results Our study found that the highest implemented best practices were having strategies to improve safety with high-alert medications (best practice #19, 85.7%), having antidotes and reversal agents readily available (best practice #9, 75%), independent verification of sterile preparation (best practice #11, 75%), and limiting the number of removable medications from the automated dispensing unit by override (best practice #16, 75%). The least implemented best practices were ensuring that oral liquid medications are dispensed in a syringe (best practice #4, 12.5%), maximizing use of barcode verification (best practice #18, 12.5%), purchasing oral liquid dosing devices that display metric scale (best practice #5, 25%), eliminating glacial acetic acid from all areas of the hospital (best practice #6, 28.6%), and eliminating all 1,000 mL of sterile water from all areas outside of the pharmacy (best practice #10, 28.6%). Challenges associated with implementation were related to knowledge, motivation, and opportunity in the environment, with the latter being the highest barrier associated with non-implementation. Conclusions Healthcare providers need to have knowledge about the best practices and the rationale behind them, the motivation to perform them, and the necessary resources to implement the best practices in their hospital.

Changes in Provider Perceptions and Practices Regarding Dosing Units for Oral Liquid Medications

ObjectiveA 2015 survey of primary care providers (PCPs) found that while many believed that milliliter (mL)-only dosing was safest for oral liquid medications, few would use mL alone in dosing instructions. Since 2015, many recommendations have promoted “mL-only” dosing. In 2019, a follow-up survey was conducted to assess if PCP perceptions and practices have changed. MethodsPediatricians, family medicine physicians, nurse practitioners, and internists participating in the 2015 and 2019 DocStyles cross-sectional, web-based surveys were asked about their perceptions and practices regarding dosing units for oral liquid medications. ResultsIn 2019, among 1392 respondents, the proportion of PCPs who reported they believed using mL-only is the safest dosing instruction ranged from 55.1% of internists to 80.8% of pediatricians. While fewer PCPs believed patients/caregivers prefer dosing instructions in mL-only (23.9% of nurse practitioners to 48.4% of pediatricians), more held this belief in 2019 compared to 2015; pediatricians had the greatest absolute increase (+14.4%) and family medicine physicians had the smallest increase (+1.3%). While 61.6% of pediatricians reported they would use mL-only dosing, only 36.0% of internists, 36.6% of nurse practitioners, and 42.5% of family medicine physicians reported they would do so. After controlling for age, gender, region, and specialty, 2019 PCP survey participants were more likely to report that they would use mL-only dosing compared to 2015 participants (adjusted odds ratio 1.51, 95% confidence interval 1.29–1.77). ConclusionsBroader educational efforts may be necessary to reach nonpediatricians, to encourage prescribing and communication with patients/caregivers using mL-only dosing.

Estimation of the Efficacy of Remineralizing Agents on the Microhardness of Deciduous Teeth Demineralized Using Pediatric Formulations.

This study aimed to evaluate the demineralizing effect of commonly used pediatric syrup formulations on primary teeth and the efficacy of two readily available remineralizing agents in treating this effect. Ninety primary teeth were used for sample preparation and divided into three groups: antibiotic syrup (group A), cough syrup (group B), and control (group C) groups. These groups were further categorized into intragroups according to the treatment with remineralizing agents: groups A1, B1, and C1 received GC Tooth Mousse (casein phosphopeptide-amorphous calcium phosphate, CPP-ACP paste) and groups A2, B2, and C2 received Clinpro Tooth Crème. The samples were subjected to a series of demineralization cycles for 14 days, and remineralization cycles until 30 days were performed using two remineralizing agents, that is, GC Tooth Mousse (CPP-ACP paste) and Clinpro Tooth Crème and were evaluated using Vicker's microhardness test. Antibiotic syrup (group A) and cough syrup (group B) showed a significant decrease in surface microhardness compared with control (group C). All intragroups showed an increase in surface microhardness after treatment with remineralizing agents, which was significantly higher in intragroups A1, B1, and C1 treated with GC Tooth Mousse (CPP-ACP paste). Oral liquid medications showed definite demineralization potential. CPP-ACP paste was found to be better than Clinpro Tooth Crème for demineralized teeth. The use of over-the-counter drugs has increased among the average Indian population, especially for the treatment of fever, cold, and cough. Unwise use of medications by the present population without proper medical guidance will lead to irreparable changes in future generations.

Assessment of the Availability and Accuracy of Dosing Devices Packaged with Oral Liquid Medications in the Ho Municipality of Ghana.

Introduction Administering the right dose of medications is essential in avoiding potentially life-threatening adverse drug reactions. Industry guidelines for manufacturers of oral, over-the-counter, and liquid medications recommend including dose-delivery devices with packaging to limit dosing inaccuracy. This study describes the prevalence and accuracy of dosing devices packaged with oral liquid medications in the Ho municipality of Ghana. Methods Dosing device accuracy was determined after deviation of the measured volume from the expected volume was evaluated using the United States Pharmacopoeia criteria. Results A total of 78.6% of the oral liquid medications were packaged with a dosing device. The most common dosing devices were cups (83.6%), followed by spoons (14.3%), droppers (1.4%), and syringes (0.7%). The volumes measured with cups (5.14 ± 0.52 mL, p = 0.006) and spoons (5.3 ± 0.67 mL, p < 0.001) were significantly different from the desired 5 mL volume; this was dissimilar to the volume measured using syringes (5.01 ± 0.02 mL, p > 0.999). Further, the measured volumes for 38.6% and 72.2% of the cups and spoons, respectively, deviated by more than 15% of 5 mL. Conclusion Dosing cups and spoons are associated with significant inaccuracy. Yet, manufacturers continually favour them over syringes in packaging for oral liquid medications. This is unacceptable and of considerable concern due to the risk of variations in therapeutic outcomes. Therefore, strict regulatory directives on the inclusion of accurate dosing devices in the packaging of oral liquid medicines are needed to reduce the possibility of medication errors.

The knowledge and practices of caregivers regarding the administration of oral liquid medication to children at a healthcare clinic in Bloemfontein, South Africa

Background. Children are dependent on their caregivers to accurately administer medication to them.Objectives. To determine the knowledge and practices of primary caregivers regarding their methods of oral liquid medication administration, preferred measuring utensils, accuracy of preferred measuring utensils and different medication classifications that they collected. The study was conducted at Pelonomi Polyclinic Pharmacy, Bloemfontein, South Africa.Methods. A quantitative, cross-sectional descriptive study (with analytical aspects) was conducted, which used consecutive, convenient sampling. The pharmacy staff assisted in recruiting participants, after which a screening form was used to determine their eligibility. Participants were provided with an information document and consent form. The liquid medication was classified according to a drug classification list, and one medication was selected for the focus of the structured interview. The questionnaire was completed using REDCap. Thereafter, researchers used the information on the medication label to determine the accuracy of the caregiver’s answers.Results. The majority of the 89 participants (56.2%) answered all 3 administration-related questions correctly, with 84.3% answering the questions regarding quantity and frequency correctly. The medication measure (43.8%) was the preferred measuring utensil for any liquid medication at home, and the syringe (53.9%) for the selected liquid medication used in the interview, both accurate measuring utensils. Most children (56.2%) were prescribed ‘other medication’ (e.g. vitamins and mineral supplements), followed by analgesics (47.2%) and antibiotics (42.7%).Conclusion. Primary caregivers at Pelonomi Polyclinic Pharmacy know how to administer oral liquid medication to children accurately. Most caregivers indicated that they use accurate measuring utensils

Evaluation of Remineralizing Effects of CPP-ACP and Nanohydroxyapatite on Erosive Lesions of Enamel in Deciduous Teeth After Exposure to Acetaminophen Syrup: An in vitro Study

Background: Oral pediatric liquid medications are commonly used in children who suffer from chronic diseases. Due to acid components in their formulations, these medications may possess a high erosive potential to dental tissues. Erosion is one of the major causes of degradation and demineralization of the enamel. If demineralization causes are not inhibited, it progresses and completely degrades the enamel. So, the dentin is exposed, and, finally, the pulp will be engaged in the process. Aim: This study aimed to evaluate the remineralizing properties of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and nanohydroxyapatite on erosive lesions caused by acetaminophen syrup intake in vitro. Methods: The microhardness of 34 healthy human primary molars was determined prior to and following a seven-day, three-times-a-day, one-minute exposure to acetaminophen syrup. The teeth were then randomly divided into four groups and were immersed in artificial saliva, fluoride gel, nano-hydroxyapatite, and CPP-ACP for 10 minutes. Then, their final microhardness was measured, and repeated-measures ANOVA analyzed the data. Results: Enamel microhardness in two groups decreased after exposure to acetaminophen syrup and increased after applying remineralization agents, CPP-ACP, and nano-hydroxyapatite. The two groups did not show significant differences in terms of microhardness increase (p-value=0.141). Conclusions: According to the findings of this study, CPP-ACP and nano-hydroxyapatite can improve the microhardness of enamel, which has been reduced as a result of exposure to medicinal syrups.

Development of Pediatric Dosage Preparation for CVD 103-HgR Live Oral Cholera Vaccine.

PXVX0200 is an oral cholera vaccine that is approved for use by the U.S. Food and Drug Administration and European Medicines Agency under the tradename Vaxchora. The vaccine is supplied as two packets, one containing buffer component and the other the active component, that are mixed with water and ingested. The aim of this study was to develop vaccine preparation methods that are appropriate for administering PXVX0200 to children. Developing oral liquid medication for children has unique challenges, including administration volume and palatability. These challenges were addressed by preparing PXVX0200 in different volumes and testing the potency of the vaccine in the presence of sweeteners, flavorings, and food and drinks. Vaccine potency, defined as colony-forming units/dose, was used to determine the compatibility of PXVX0200 with different vaccine preparation methods. We found that the reconstitution volume can be reduced from 100 to 50 mL to accommodate children aged 2 to 6 years and to 10 mL for children aged 6 months to 2 years, as long as the buffer concentration is the same as for the approved (100 mL) dose. Sucrose or stevia sweeteners may also be added without affecting the vaccine potency. Reconstitution in juices or foods was challenging because of effervescence caused by bicarbonate in the buffer component. An alternate preparation method was developed for reconstitution in baby formula. Vaccine preparation methods to make PXVX0200 appropriate for pediatric administration will facilitate administration of the vaccine to improve compliance and protect children from cholera infection while traveling.

Swallowing safety of oral liquid medications: assessment using the International Dysphagia Diet Standardisation Initiative framework

AbstractBackgroundThis study characterises commercially available oral liquid medications in terms of thickness and textural suitability for safe swallowing by patients with dysphagia for inclusion in the fourth edition of Don't Rush to Crush (DRTC), published by the Society of Hospital Pharmacists of Australia.AimThis study had two aims. The first was to use the International Dysphagia Diet Standardisation Initiative (IDDSI) testing methods to evaluate and document the thickness and textural properties of commercially available liquid medications in Australia to be included in the fourth edition of DRTC. The second aim was to determine the volume of oral liquids that could be mixed into medication lubricants while maintaining the lubricant's IDDSI classification.MethodsA total of 121 different oral liquid medications were assessed for flow through a syringe and consistency on a fork according to the IDDSI framework to classify them as Level 0 (Thin), Level 1 (Slightly Thick), Level 2 (Mildly Thick), Level 3 (Moderately Thick), or Level 4 (Extremely Thick).ResultsThe 121 liquid medications were classified as Level 0 (n = 47, 39%), Level 1 (n = 20, 16%) or Level 2 (n = 54, 45%). Although 18 (15%) of the liquids appeared to be thicker than Level 2 according to the IDDSI flow test, the fork drip test clearly identified them as thinner than Level 3. We considered thickening low‐volume doses using an IDDSI Level 4 medication lubricant; for 97% (n = 112) of 115 oral liquid medications it was possible to incorporate 2.5 mL within two pumps (10 g) of Gloup Forte (vanilla flavour) and retain the IDDSI Level 4 classification.ConclusionCommercially available oral liquids are classified as IDDSI Level 0, 1, or 2. While they present no problem to healthy people, most patients with dysphagia are unlikely to safely swallow these fluids. Evaluation of the swallowing function of dysphagic patients prior to use of oral medications is essential.

Liquid Medication Dosing Error amongst Parents Caregivers at Outpatient Clinic

Abstract: Objectives: To evaluate the effectiveness of Patient Information Leaflet (PIL) based educational intervention to improve liquid medication measuring ability of parents/ caregivers. Simultaneously, to assess parents’ measuring ability by dosing instrument type, and identify the association of various factors with dosing errors. Materials and Methods: A multi-centric, randomized controlled interventional study conducted at 2 pediatric clinics in Gandhinagar, Gujarat. Primary caregivers who would be giving medication to the patient (1 year to 12 years) were randomized in an alternative manner into control (without education) and intervention group (education with PILs), and asked to measure a dose of 5 mL using 3 measuring devices: dosing cup, oral dropper and calibrated spoon. Measured doses were categorized as an accurate dose (<10% deviation), acceptable dose (10%-20% deviation) and inaccurate dose (>20% deviation). Results: Total 164 parents/caregivers were enrolled and randomized; 82 in each group. Overall, 65.8% and 79.2% measured doses were accurate in the control and intervention group, respectively (p=0.0018). The range of measured doses (mL) of control group was higher than that of intervention group. About the instruments, the maximum number of participants measured an inaccurate dose with the calibrated spoon (10.9%), and the range of doses of oral dropper and calibrated spoon were higher than that of the dosing cup. Additionally, the likelihood of making dosing errors was not associated with the instruments used, gender, age and education level of the participants. Conclusion: The education provided to the participants helped to improve their measuring ability. Participants’ measuring ability was better while using the dosing cup as compared with the use of oral dropper and calibrated spoon. Keywords: Pediatric, Oral liquid medication, Parent’s dosing error, Medication error, Patient education.

Accuracy of Oral Liquid Measuring Devices Used Among Caregivers at Hospital Dungun

Oral liquid medications are common type of dosage form prescribed to children. Caregiver responsible to choose appropriate measuring device to measure intended dose and minimize dosing error. Objectives of this study were 1) To identify types of measuring devices used at home; 2) To determine dose error deviation across all the measuring devices. This cross-sectional study involved caregivers visiting outpatient pharmacy with oral liquid prescription that fulfilled inclusion and exclusion criteria. The caregivers were instructed to measure 4.8ml and 15.0ml liquid by using suitable devices provided, which were 4 types of syringes and 2 types of dosing cups. The measured liquid was read by investigator and any dose error deviation was calculated and reported as percentages. Data was analyzed descriptively using SPSS version 21. Out of 120 caregivers involved, 60% were female (n=72), aged between 31-40 years old (49.1%, n=59), and employed (62.5%, n=75). 82 caregivers (68.3%) received secondary education level. Most caregivers use standardized measuring devices at home, particularly syringes and dosing cups. For smaller dose, less dose error was detected if using syringe (13.3%) as compared to dosing cup (39.3%); while for larger dose, both syringe and dosing cups are acceptable (11.7% and 7.4% respectively). Syringe shows less dose error as compared to dosing cup for smaller dose. Pharmacist should participate in decision making of choosing right measuring device to improve accuracy of medication administration.

Evaluation of the Erosive and Cariogenic Potential of Over-the-Counter Pediatric Liquid Analgesics and Antipyretics.

To evaluate the cariogenic and erosive potentials of over-the-counter pediatric oral liquid antipyretics and analgesics, we tested nine over-the-counter pediatric oral liquid medications classified as antipyretic or analgesic medicines available in Korea. For each substance, we measured the pH with a pH meter and the sugar content with a sugar content meter. We determined the titratable acidity (TA) levels based on the volumes of NaOH solution that had to be added to reach a pH of 7.0. We also evaluated the dental erosion potentials with an International Organization for Standardization method based on observing changes in the pH of a CaPO4 solution upon introducing a small volume of the solution to be tested. The oral liquid medications had pH values of 3.40–5.68. In the TA assessments, several oral liquid medications required greater volumes of NaOH solution to reach a pH of 7.0. The dental erosion potentials varied but correlated strongly with the NaOH volumes needed to reach a neutral pH (r = 0.84; p < 0.0001). Many oral liquid antipyretics and analgesics have features that can promote dental erosion. A correct understanding of pediatric antipyretics and analgesics is required in dentistry for children’s oral health.

NCPDP recommendations for standardizing dosing in metric units (mL) on prescription container labels of oral liquid medications, version 2.0.

PurposeBest practices and guidance are provided for standardizing dosing instructions on prescription container labels of oral liquid medications by eliminating use of U.S. customary (household) units and adopting metric units universally, with the goal of decreasing the potential for error and improving safety and outcomes when patients and caregivers take and administer these medications.SummaryDespite decades of best practice use of metric units in organized healthcare settings and advocacy by various professional societies, medication safety experts, and standards setting organizations, use of household units (e.g., teaspoon) on prescription container labeling instructions for oral liquid medications persists in community pharmacy settings. Five years after publication of the National Council for Prescription Drug Programs’ (NCPDP’s) original white paper advocating metric-only dosing, very few community pharmacy companies appear to require oral liquid dosing instructions be presented in metric-only units (mL). Error-prone dosing designations contribute to medication errors and patient harm. Use of both multiple volumetric units (e.g., teaspoonsful, tablespoonsful) and multiple abbreviations for the same volumetric units (e.g., mL, cc, mls; tsp, TSP, t) increases the likelihood of dosing errors. Opportunities for error exist with each administration of an oral liquid medication and, unless coordinated with dispensing of appropriate oral dosing devices and optimal counseling, can result in use of household utensils (e.g., uncalibrated teaspoons) or discordantly marked devices that can further exacerbate the risk of error. Since publication of NCPDP’s original white paper, new standards have been adopted governing official liquid volume representation, calibrated dosing devices, and e-prescribing software which support the elimination of non-metric units to reduce use of dosing practices that are error-prone. In each case, U.S. customary (household) units have been eliminated in official standards and certification requirements. Therefore, use of non-metric units for oral dosing of liquid medications no longer is an acceptable practice.ConclusionKey factors contributing to dosing errors with oral liquid medications include use of multiple volumetric units and abbreviations; failure to institute policies and procedures that eliminate the use of non-metric (e.g., household) units and universally adopt metric-only dosing instructions in all settings; failure to coordinate dosing instructions with dosing device markings, appropriate type (oral syringe versus cup), and optimal volumes (e.g., 1-, 5-, or 10-mL devices); failure to adequately counsel patients about appropriate measurement and administration of oral liquid medication doses; and use or error-prone practices such as missing leading zeros and elimination of trailing zeros in prescriptions and container labels. Adoption of this white paper’s recommendations will align dosing designations for oral liquid medications in all settings with current standards and attain universal metric-only practice.

Establishing dose bands for commonly prescribed oral medications for children in the UK: Results of a Delphi study.

To establish weight-based dose bands for commonly used oral medicines, given in liquid forms, for children in the UK that could be used for prescribing and administering accurate and safe drug doses. A list of commonly prescribed, oral liquid medications was established from the medication dispensing database of four UK hospitals and a primary care database. The evidence base of currently used dose regimens for each drug was identified from paediatric reference books, summary of product characteristics and the literature. Then, weight-based dose bands were developed and a modified Delphi process was used to achieve healthcare professional consensus about the suggested dose bands for each drug. Forty-six experts in paediatric medicines participated in the Delphi process (mean years of experience 17.3±9.4 [standard deviation]) and assessed 45 oral liquid drugs in total. Four categories of weight-based dose bands were established: drugs with two dose bands (17.8%, 8/45), drugs with three dose bands (64.4%, 29/45), drugs with four dose bands (15.6%, 7/45) and drugs with five dose bands (2.2%, 1/45). The 46 participants reached consensus on all the suggested dose bands for 53.3% (24/45) of the drugs. Consensus was reached in the first round of the Delphi process for 91.7% (22/24) of the drugs and after two rounds for two drugs. No agreement was achieved on any of the suggested dose bands for 26.7% (12/45) of the drugs. This study provides healthcare professionals with a set of recommended weight-based dose bands for commonly prescribed oral liquid drugs for children. These bands could establish the basis for change in clinical practice to reduce dosing errors and improve healthcare for children.