Tablet Size Research Articles

Tablet/Capsule Size Variation Among the Most Commonly Prescribed Medications for Children in the USA: Retrospective Review and Firsthand Pharmacy Audit.

Children are frequently asked to take tablets and capsules of different sizes and shapes to manage acute and chronic medical conditions. Medication size is an important factor that contributes to compliance, yet few studies detail size variation or pediatric pharmacy inventory. This study assesses the available sizes and size variations of common inpatient and outpatient pediatric medications and provides an inventory of the tablet and capsule sizes available in a children's inpatient hospital pharmacy. We derived the most frequently prescribed oral medications from US national databases, including the IMS, Vector One(®): National (VONA) and Pediatric Health Information System (PHIS). We analyzed a composite list using the National Library of Medicine Pillbox website, which provides size measurements. Medications from a children's inpatient pharmacy were audited and hand measured for comparison. We created a list of the top 15 most prescribed inpatient and outpatient pediatric tablet/capsule medications and observed a wide variation in size: acetaminophen 500 mg ranged from 5 to 22 mm in length, median 15 mm. Common pediatric antibiotics were larger and ranged from 8 to 25 mm in length, median 17 mm. Hand-measured samples from the inpatient pharmacy were often the larger pill sizes, despite smaller alternatives being available. We observed a marked variation in the sizes of common pediatric tablet/capsule medications, and pharmacies that serve children may not stock the most child-friendly medications. Tablet/capsule size does not appear to be considered when decisions about tablet and capsule medication selections are made. These results should increase awareness of these sizes and affect how physicians prescribe, how pharmacies order inventory, and how insurers and pharmaceutical companies pay for and produce pediatric medications.

‘Tablet burden’ in patients with metastatic breast cancer

The implications for patients with cancer, of the ‘tablet burden’ resulting from increasing use of oral anticancer drugs and medication for co-morbidities have not previously been well explored. AimWe sought to (i) quantify tablet burden in women with metastatic breast cancer (MBC), (ii) establish which groups of drug contribute most to this burden and (iii) gain insight into patients' attitudes towards oral anti-cancer treatment. MethodsOne hundred patients with MBC anonymously completed a questionnaire describing their medication histories and attitudes towards their tablets. ResultsThe patients (mean age 60, range 31–95) were all female and taking a median of six tablets (range 0–31) daily; 37 patients were taking >10 tablets. Oral anticancer treatment constituted the category of treatment taken by the highest proportion of patients, followed by symptomatic cancer treatments, proton pump inhibitors and cardiovascular medication. Numerically, however, symptomatic drugs accounted for 44% of all tablets and specific anti-cancer treatment for 15%; medication not directly related to the cancer accounted for the remaining 40% of tablets. A quarter of patients reported inconvenience in taking their tablets, the main reason being tablet size and one third reported forgetting their tablets at least once a week. Nearly two thirds of patients expressing a preference favoured oral anticancer treatment, the commonest reason being greater convenience. ConclusionTablet burden is considerable for many patients with MBC and can be problematic. A significant proportion of tablets represent treatment for co-morbidities, the significance of which may be questionable in women with MBC.

새로운 메트포르민 산부가염을 이용한 서방성 제형 평가

본 논문에서는 제 2형 당뇨병의 1차 선택약으로 사용되는 메트포르민 염산염이 통상적으로 1일 1000mg~2000mg의 고용량으로 투여되고 동시에 매우 높은 수성용해도를 가지므로 1일 1회 복용을 위한 약물방출제어시스템에 다량의 서방성 부형제를 필요로 하여 제형의 크기가 커져 복용이 어려운 문제점이 있다. 따라서 이를 개선하고자 상대적으로 수성용해도가 낮은 새로운 메트포르민 산부가염을 합성하여 서방성 정제에 적용하여 메트포르민의 방출을 확인하고자 하였다. 이를 위해 메트포르민 염산염을 원료로 하여 NaOH하에서 메트포르민 base를 만들고 여기에 산부가염을 반응시켜 6개의 새로운 메트포르민 산부가염들을 합성하였다. 또한 이들의 수성용해도를 측정하여 메트포르민 염산염에 비해 현저히 낮은 수성용해도를 가지는 메트포르민 스테아린산염을 확인하였고 메트포르민 서방성 제형에 적용하여 실제 약물의 방출제어에도 용출시험 결과, 12시간에서 약 2배의 약물방출제어 효과를 확인하였다. 결론적으로 새로운 메트포르민 산부가염을 통해 서방성 부형제의 양을 줄여 제형의 크기를 줄임으로써 보다 높은 환자의 복약순응도를 기대할 수 있을 것이다. In this study, metformin hydrochloride for first choice of type 2 diabetes patient is administered relatively high dose, 1000 to 2000 mg orally once a day, and had very high water solubility, so it make difficult to swallow tablet to requires high amount of sustained release agent. To overcome these challenges, we used novel metformin salts had relatively low water solubility to minimize sustaining excipient for small size of dosage form. six novel metformin salts were synthesized by making metformin free form under reaction with NaOH and adding acid salts. we confirmed metformin stearate had the lowest water solubility and showed half drug release in dissolution study at 12hour. In conclusion, novel metformin salts had low water solubility can be used to reduce the size of sustained metformin tablet for improving patient compliance.

Ease of opening of blistered solid dosage forms in a senior citizens target group

Blisters differing in design and handling are established as packaging material for solid dosage forms. The ease of opening of blisters influences application and patient’s compliance. In this study the influence of visibility and movability of solid dosage forms in blister packaging on both, easy opening and patient’s satisfaction, were investigated by target group testing according to ONR CEN/TS 15945.For each testing 20 participants in the age of 65–80 years were recruited randomly. They opened the blisters on realistic terms without any auxiliary devices. Video documentation of the hands' movements was recorded to analyze the opening procedure.To show the influence of visibility of the dosage form in the blister, capsules size 1 were packed in transparent and opaque blisters. A moderate influence of the visibility on both, the ease of opening and patient satisfaction, was observed. A second study dealt with the movability of solid dosage forms in blisters. Therefore, three different sizes of tablets with similar shapes were packed in identical cavities. Limited movability was found as major criterion on effectiveness and effectivity of opening as well as on satisfaction with the opening procedure.

Development and pharmaceutical approach for sustained-released metformin succinate tablets

Metformin is currently marketed in the U.S. and worldwide as a hydrochloride salt and sustained-release (SR) tablets are preferred for increasing patient compliance. However, this SR tablet is large because of its high water solubility and the high dose required for efficacy, and some patients find it difficult to swallow. To overcome these challenges, the salt formation was changed, thereby changing its solubility. Ten new pharmaceutical salts were synthesized and metformin succinate was chosen among these because of its lower solubility and lower molecular weight. DSC thermograms and FT-IR spectra demonstrated that metformin HCl and succinate were different materials. However, other tablet properties related to effectiveness, such as density, compressibility, particle size distribution, stability in various artificial human fluids, and permeability were not statistically different. Metformin succinate SR tablets with an excipient portion reduced from 43% to 14% were prepared and compared with metformin HCl SR tablets in vitro and in vivo. The drug release study in buffer solutions at pH 6.8 and the pharmacokinetic parameters, Cmax, Tmax, and AUC0−∞ showed no significant differences between the two types of tablets. In conclusion, metformin succinate, which has low water solubility, can be used to reduce the size of SR metformin tablets for improving patient compliance.

OP‐7 THERAPEUTIC EFFECTS OF DOMPERIDONE ON ABDOMINAL PAIN‐PREDOMINANT FUNCTIONAL GASTROINTESTINAL DISORDERS

Introduction:The therapeutic effect of domperidone on abdominal pain‐predominant functional gastrointestinal diseases (AP‐FGIDs) was assessed on children in 5–12 year age group at the Gastroenterology Research Laboratory of Faculty of Medicine, University of Kelaniya, Sri Lanka.Methods:Children fulfilling Rome III criteria for AP‐FGIDs were recruited from the out‐patient clinic of the University Paediatric Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka, after obtaining parental consent. They were randomized in to 8 weeks of placebo or Domperidone (Motillium 10 mg, 3 times per day, before meals) groups, using computer generated random numbers. Placebo was a specially prepared dummy tablet without any active ingredients, had the same colour, size, shape and taste of domperidone tablet and were packaged similarly. Primary outcomes defined were cure (abdominal pain less than 25 mm on the visual analogue scale and no impact on daily activities) and improvement (pain relief and sense of improvement recorded on global assessment scale). Secondary outcomes were significant improvement in symptoms, gastric motility, quality of life (QoL) and family impact. Both patients and investigators who assessed primary and secondary outcomes before and after intervention were blind to inventions administered. Symptom severity was recorded on a validated 100 mm visual analogue scale. Translated and validated PedQL Generic Score Scale version 4.0 and Family Impact Module were used. Gastric motility was assessed using a validated ultrasound method.Results:One hundred children were enrolled and 89 completed the trial [Placebo 42 (22 girls), Domperidone 47(33 girls)]. While comparing primary outcomes, domperidone group had significant improvement [37 (78.7%) vs. 25 (59.5%) in placebo group, p = 0.04], while no such difference was observed in cure. When assessing secondary outcomes, domperidone group reported significant reduction in abdominal pain severity (70.84% vs. 48.18% p = 0.03) and improvement in motility index (29.3% vs. 8.6% p = 0.04) after intervention. No such difference was seen in improvement of QoL and family impact (p > 0.05).Conclusions:Domperidone has a favorable therapeutic effect on improvement AP‐FGIDs in children aged 5–12 years. It causes significant reduction in abdominal pain and improvement in motility of the gastric antrum. However, it has no significant effect on improvement of QoL and family impact.

Tablet Inspection and Sorting Machine

Tablets are produced in a vast quantity everyday, and which require a proper quality inspection to avoid accidental production issues. The tablet quality checking is mostly done manually which makes it an error-prone process. However, automated solutions for inspection provide much faster and accurate sorting and checking for all tablet shapes, sizes and defects. Such systems require a reliable tablet image analysis mechanism. This paper describes a low cost automated solution for tablet inspection and sorting.

Enhanced oral bioavailability of felodipine by novel solid self-microemulsifying tablets

The novel self-microemulsifying (SME) tablets were developed to enhance the oral bioavailability of a poor water-soluble drug felodipine (FDP). Firstly, FDP was dissolved in the optimized liquid self-microemusifying drug delivery systems (SMEDDS) containing Miglyol® 812, Cremophor® RH 40, Tween 80 and Transcutol® P, and the mixture was solidified with porous silicon dioxide and crospovidone as adsorbents. Then after combining the solidified powders with other excipients, the solid SME tablets were prepared by wet granulation–compression method. The prepared tablets possessed satisfactory characterization; the droplet size of the SME tablets following self-emulsification in water was nearly equivalent to the liquid SMEDDS (68.4 ± 14.0 and 64.4 ± 12.0 nm); differential scanning calorimetry (DSC) and powder X-ray diffractometry (PXRD) analysis demonstrated that FDP in SME tablets had undergone a polymorphism transition from a crystal form to an amorphous state, which was further confirmed by transmission electron microscopy (TEM). A similar dissolution performance of SME tablets and liquid SMEDDS was also obtained under the sink condition (85% within 10 min), both significantly higher than commercial tablets. The oral bioavailability was evaluated for the SME tablets, liquid SMEDDS and commercial conventional tablets in the fasted beagle dogs. The AUC of FDP from the SME tablets was about 2-fold greater than that of conventional tablets, but no significant difference was found when compared with the liquid SMEDDS. Accordingly, these preliminary results suggest that this formulation approach offers a useful large-scale producing method to prepare the solid SME tablets from the liquid SMEDDS for oral bioavailability equivalent enhancement of poorly soluble FDP.

What is the mechanism of action of praziquantel and how might resistance strike?

Schistosomiasis, also known as bilharzia, is a neglected tropical disease affecting over 249 million people of which approximately 45% are school-aged children. Although there are significant numbers of people with the disease in Asia and South America, over 90% of those infected reside in Africa. The Global Burden of Disease Study 2010 estimated 11,700 deaths and 2,986,000 years lost to disability due to schistosomiasis in that year [1,2]. In 2012, the World Health Organization produced a ‘roadmap’ whose ultimate goal was the “...elimination of NTDs or reductions in their impacts to levels at which they are no longer considered public-health problems” [3]. Schistosomiasis was listed as a disease for potential elimination in the Eastern Mediterranean, Caribbean, Indonesia and Mekong River basin by 2015 and Brazil by 2020. Understandably, a more conservative note was sounded for Sub-Saharan Africa where worry over availability of medication was cited as the reason for failing to schedule elimination by 2020. The best-case scenario that could be made was with widespread availability of medication and strong political support schistosomiasis could be “...eliminated as a ‘public health problem’ in multiple countries in Africa by 2020.” The causative agents of schistosomiasis are digenetic trematode worms belonging the genus Schistosoma with Schistosoma mansoni, S. japonicum and S. haematobium being responsible for the majority of cases. Unfortunately, there is no vaccine available for the treatment of human schistosomiasis nor is the development of one on the horizon. Praziquantel (PZQ) is the only widely available drug for treatment of the disease and is thus at the heart of all control programs. It has been available for over 30 years yet the mechanism by which it kills schistosomes remains unknown and worries persist over the potential for mass administration campaigns to eventually diminish its usefulness. Here, we provide an introduction to schistosomiasis and discuss our current understanding of the mechanism of action of PZQ and the potential for widespread drug resistance.

Monitoring of the manufacturing process for ambroxol hydrochloride tablet using NIR-chemometric methods: compression effect on content uniformity model and relevant process parameters testing

This study aimed at using near-infrared (NIR) spectroscopy to monitor compaction pressure for simultaneously determining the tensile strength and content uniformity, as well as moisture and mean particle size of ambroxol hydrochloride tablets. The content uniformity, compression force and tensile strength of the laboratory samples were obtained by pressing a mixture of active principle and excipient components into tablets. To reduce the spectral baseline shift of the laboratory samples, the compaction pressure applied to the mixture was assessed by a variable pressure test. Production samples were added to the test and subjected to principal component analysis. The expanded partial least-squares (PLS) calibration model used to quantify the active content was more accurate than the model constructed from laboratory samples using the production tablets included in the calibration set. The model showed good predictability, with correlation coefficient (R) 0.9977. The validation and reliability of the content model were evaluated to determine trueness and reliability for the measurement of individual production tablets and the laboratory tablets with drug content ranging from 24 to 36 mg. The PLS calibration models for compression force and tensile strength were constructed using the same spectral set assuming both were highly related. These models yielded high R values (0.9955 and 0.9910). The R values of the moisture and mean particle size were 0.9994 and 0.9919, respectively. This study demonstrated that NIR spectroscopy combined with chemometric techniques can be successfully used to quantitatively monitor the tablet manufacturing process in the pharmaceutical industry.

Posicionamiento de dolutegravir en el tratamiento de la infección por el VIH

Initial treatment with dolutegravir offers higher efficacy than treatment with efavirenz, darunavir/ritonavir and even with raltegravir in patients with a high viral load. Like ritonavir-boosted protease inhibitors, dolutegravir will probably have a high genetic barrier to resistance and prior genetic testing will not be required in integrase inhibitor-naïve patients. The drug is well tolerated and associated with few treatment discontinuations. It can be administered once daily and the tablet size is small. A fixed-dose combination tablet containing dolutegravir, abacavir and lamivudine will soon be available. Dolutegravir has few interactions with commonly-used drugs. It does not require pharmacological boosting and has no food or time of day restrictions. Because of these characteristics, dolutegravir has a unique profile and is the ideal drug for most HIV-infected patients.

Rapid Deployment and Evaluation of Mobile Serious Games: A Cognitive Assessment Case Study

Abstract Serious games are proposed as a more efficient and enjoyable way to carry out cognitive assessment. We compare prediction of cognitive ability with a purpose-built serious game and with a similar game built using a game engine. In an experiment conducted with 28 participants, performance on the two games is assessed relative to three cognitive abilities, using two different tablet sizes and two different input methods. The results for the game-engine variant were similar to the purpose-built game, where both games significantly predicted performance on the three cognitive abilities, and were sensitive to the effects of age. Performance on both games was not significantly affected by tablet size or input method. These results support earlier findings that serious games can provide valid cognitive assessment, and they show that game engines can be used to develop serious games for cognitive assessment, cost effectively and without loss of predictive validity.

Size Effects on the Usability of Tablets in Pointing and Typing Tasks

In 2014, with increasing use of multi-purpose, tablets remain the leading entry points of mobile connectivity for global consumers. It is expected to see more competitive overlap among display sizes for tablet PCs, notebook PCs, and smartphones. In fact, no matter what type of task is applied, the size effect impacts productivity, portability and user's experience of device usage on any form factors of mobile devices. However, research seldom studied the size effects regarding the trade-offs between performance and portability of tablets. To further investigate the size effects of the display and touchscreens on their performances, this study compared the operation time and error rate for the touch-input methods of 3 different sizes of tablets in 3 applied tasks. Our lab's study on the usage of tablets showed that browsing the Internet, shopping online, watching videos, viewing and editing email (words processing and/or photos sharing) were the most common applications mostly using online real-time communication software, Internet browsers and other related software. This result was used as the base to design the applied tasks of the present study. Accordingly, the software and task types were divided into multi-direction pointing and tapping, multi-direction dragging and dropping, and on-screen typing. Overall, it seems that the closer the sizes of displays and on-screen keyboards to those sizes of a generic laptops, the shorter the operation times. As these objective measures confirmed by the subjective assessments, the 10.1” tablets was most preferred; while the differences in the satisfactions were not significant among the three tablets. The results rationalized the phenomena in the tablet PC market that the 8.1” and 10.1” diagonal screens were popular especially for applied tapping tasks (e.g., Internet browsing) and on-screen typing tasks (e.g., word processing for email messages), respectively.

Tablet splitting: is it worthwhile? Analysis of drug content and weight uniformity for half tablets of 16 commonly used medications in the outpatient setting.

Tablet splitting is a well-established medical practice in clinical settings for multiple reasons, including cost savings and ease of swallowing. However, it does not necessarily result in weight-uniform half tablets. To (a) investigate the effect of tablet characteristics on weight and content uniformity of half tablets, resulting from splitting 16 commonly used medications in the outpatient setting and (b) provide recommendations for safe tablet-splitting prescribing practices. Ten random tablets from each of the selected medications were weighed and split by 5 volunteers (2 men and 3 women aged 25-44 years) using a knife. The selected medications were mirtazapine 30 mg, bromazepam 3 mg, oxcarbazepin 150 mg, sertraline 50 mg, carvedilol 25 mg, bisoprolol fumarate 10 mg, losartan 50 mg, digoxin 0.25 mg, amiodarone HCl 200 mg, metformin HCl 1,000 mg, glimepiride 4 mg, montelukast 10 mg, ibuprofen 600 mg, celecoxib 200 mg, meloxicam 15 mg, and sildenafil citrate 50 mg. The resulting half tablets were evaluated for weight and drug content uniformity in accordance with proxy United States Pharmacopeia (USP) specification (95%-105% for digoxin and 90%-110% for the other 15 drugs). Weight and drug content uniformity were assessed by comparing weight or drug content of the half tablets with one-half of the mean weight or drug content for all whole tablets in the sample. The percentages by which the weight and drug content of each whole tablet or half tablet differed from sample mean values were calculated. Other relevant physical characteristics of the 16 products were measured. A total of 52 of 320 half tablets (16.2%) and 48 of 320 half tablets (15.0%) fell outside of the proxy USP specification for weight and drug content, respectively. Bromazepam, carvedilol, bisoprolol, losartan, digoxin, and meloxicam half tablets failed the weight and content uniformity test; however, the half tablets for the rest of the medications passed the test. Mean percent weight loss after splitting was less than 1.5% for all drugs. Bromazepam, carvedilol, and digoxin showed the highest powdering loss during the tablet-splitting process. Tablet splitting could be safer and easier when drug- and patient-specific criteria have been met. Tablet size, shape, and hardness may also play a role in the decision to split a tablet or not. Tablets containing drugs with a wide therapeutic index and long half-life might be more suitable candidates for division. Dose variation exceeded a proxy USP specification for more than one-third of sampled half tablets of bromazepam, carvedilol, bisoprolol, and digoxin. Drug content variation in half tablets appeared to be attributed to weight variation due to fragment or powder loss during the splitting process.

Thermoplastic polyurethanes for the manufacturing of highly dosed oral sustained release matrices via hot melt extrusion and injection molding

This study evaluated thermoplastic polyurethanes (TPUR) as matrix excipients for the production of oral solid dosage forms via hot melt extrusion (HME) in combination with injection molding (IM). We demonstrated that TPURs enable the production of solid dispersions – crystalline API in a crystalline carrier – at an extrusion temperature below the drug melting temperature (Tm) with a drug content up to 65% (wt.%). The release of metoprolol tartrate was controlled over 24h, whereas a complete release of diprophylline was only possible in combination with a drug release modifier: polyethylene glycol 4000 (PEG 4000) or Tween 80. No burst release nor a change in tablet size and geometry was detected for any of the formulations after dissolution testing. The total matrix porosity increased gradually upon drug release. Oral administration of TPUR did not affect the GI ecosystem (pH, bacterial count, short chain fatty acids), monitored via the Simulator of the Human Intestinal Microbial Ecosystem (SHIME). The high drug load (65wt.%) in combination with (in vitro and in vivo) controlled release capacity of the formulations, is noteworthy in the field of formulations produced via HME/IM.

Design and development of a combined calcium-iron-folic acid prenatal supplement to support implementation of the new World Health Organization recommendations for calcium supplementation during pregnancy.

Hypertensive diseases of pregnancy are important causes of maternal and perinatal mortality. Based on meta-analyses of efficacy trials of prenatal calcium supplementation to reduce the risk of hypertensive diseases of pregnancy, the World Health Organization recommends 1.5 to 2.0 g of elemental calcium per day for pregnant women with low dietary calcium intakes (as well as 60 mg of iron and 400 microg of folic acid). However, implementation of this recommendation is challenged by the size and number of calcium tablets required and the need to avoid concurrent ingestion of calcium and iron due to intraintestinal interactions. We developed a novel micronutrient powder containing microencapsulated pH-sensitive calcium in addition to iron and folic acid, designed to facilitate early intestinal iron release and delayed calcium release. Two pharmaceutical companies were contracted to develop a prototype, one of which was chosen for clinical testing. Calcium carbonate granules were coated with a trilayer pH-sensitive enteric coating using a fluid-bed spray coater. Iron and folic acid granules were encapsulated with a time-release coating. Iron and calcium dissolution profiles were assessed during exposure to acidic (pH 1.2) and/or basic (pH 5.8) media using a modified USP apparatus 1 (basket) method. At pH 1.2, calcium and iron release was < or = 10% and > 90% after 120 minutes, respectively. At pH 5.8, > 80% of total calcium was released after 90 minutes. Based on in vitro criteria, the supplement may be a promising approach for delivering calcium, iron, and folic acid as a single daily dose to pregnant women in settings of low dietary intake of calcium.

Delayed Presentation of DPD Deficiency in Colorectal Cancer.

Delayed Presentation of DPD Deficiency in Colorectal Cancer.

Sa1124 A Report on the Prevalence and Reactivation Rate of Hepatitis B Virus in Patients With Inflammatory Bowel Disease in Japan

factors that determine patient satisfaction are slightly known. The purpose of this study is to understand perceptions and attitudes of patients with mild-to-moderate UC and specialists in inflammatory bowel disease on relevant aspects determining patient satisfaction in the management of their UC. Methods: A two-round Delphi method was performed with a panel of physicians and patients. The first round questionnaire was developed from literature search and findings arising from a qualitative study (discussion group) with patients suffering mild-to-moderate UC. The patients final questionnaire was composed of 258 items grouped into 6 sections: diagnosis, follow-up, and treatment (including mesalazines, corticosteroids and immunomodulators). This questionnaire was sent to 20 patients. Another questionnaire, was sent to 22 physicians, which included the 258 items of the patients questionnaire and 32 additional items exclusively for physicians. Relevance of items on patient satisfaction was scored on a scale of 1 (least important) to 9 (very important). Agreement among panellists was measured according to RAND/UCLA’s IPRAS methodology. Concordance between physicians and patients was defined as parity in relevance level (very high, high, medium and low). Items rated with very high relevance by patients, or by physicians on specific physicians items, comprise the recommendations included in this study. Results: Most issues analyzed, although not all, are considered by physicians and patients with similar levels of relevance. Patients gave greater relevance to the follow-up of moderate flares at hospital rather than at primary care or specialized outpatient centre, and to be informed about aspects such as diet, impact of UC on their health and lifestyle, drug contraindications and interactions. For physicians and patients, efficacy, safety, and improved quality of life obtained with the treatments are highly relevant. Physicians consider that improvement of patient satisfaction could be achieved by reducing dose frequency, amount and size of tablets, while the most relevant aspects for patients are avoid rectal administration and increasing usage of oral medication. Conclusions: Findings of this study contribute to a better understanding of relevant aspects that influence satisfaction of patients with mild-to-moderate UC, and could support developing strategies and interventions to improve the patients satisfaction.

The practice and clinical implications of tablet splitting in international health

ObjectiveTablet splitting is frequently performed to facilitate correct dosing, but the practice and implications in low-income settings have rarely been discussed.MethodsWe selected eight drugs, with narrow therapeutic indices or critical dosages, frequently divided in the Lao PDR (Laos). These were split, by common techniques used in Laos, by four nurses and four laypersons. The mean percentage deviation from the theoretical expected weight and weight loss of divided tablets/capsules were recorded.ResultsFive of eight study drugs failed, on splitting, to meet European Pharmacopoeia recommendations for tablet weight deviation from the expected weight of tablet/capsule halves with 10% deviating by more than 25%. There was a significant difference in splitting accuracy between nurses and laypersons (P = 0.027). Coated and unscored tablets were less accurately split than uncoated (P = 0.03 and 0.0019 for each half) and scored (0.0001 for both halves) tablets.ConclusionThese findings have potential clinical implications on treatment outcome and the development of antimicrobial resistance. Investment by drug companies in a wider range of dosage units, particularly for narrow therapeutic index and critical dosage medicines, is strongly recommended.

G403(P) Tablet preferences in children and young people

AimsThe aim was to determine the optimum size, shape and colour intensity of tablets for children and young people using both images and physical models.Materials and methodsThis study used photo-realistic...