Arch Dis Child. Published Online First: 15 March 2007. doi:10.1136/adc.2006.109389
Original articles |
Variations in captopril formulations used to treat children with heart failure: a United Kingdom survey
1 Centre for Pharmacy Practice Research, United Kingdom
2 Congenital and Paediatric Heart Service Glenfield Hospital, Leicester, United Kingdom
3 Department of Cardiovascular Sciences, University of Leicester, United Kingdom
* To whom correspondence should be addressed. E-mail: hp28{at}leicester.ac.uk.
Accepted 29 November 2006
Abstract
Objective: Different liquid formulations of a drug prepared for use in children cannot be assumed to have therapeutic equivalence. The objective of this study was to ascertain the inter-hospital constancy of unlicensed liquid captopril formulations used to treat children with heart failure in the UK.
Design: A questionnaire-based telephone survey.
Setting: 13 tertiary paediatric cardiac centres in the United Kingdom and 13 large hospitals referring patients to these centres.
Participants: Pharmacists responsible for providing the pharmaceutical input to children with congenital heart disease or a pharmacist designated to cover paediatric services. Also technical staff employed by "specials" manufacturers.
Results: 4 hospitals dispensed captopril tablets for crushing and dissolving in water prior to administration; the remaining 22 used 9 different liquid formulations of captopril. Only 3 cardiac centres and their referring hospitals were found to be using the same liquid captopril formulations; 10 centres and their referring hospitals were using completely different captopril formulations.
Conclusions: This survey shows that paediatric cardiac centres and their referring hospitals use a variety of unlicensed liquid captopril formulations inter-changeably. This degree of inconsistency raises issues about optimal captopril dosing and potential toxicity to a level where its use may influence paediatric cardiac -surgical and -interventional outcomes.
Keywords: captopril, children, heart failure, unlicensed
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