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Variations in captopril formulations used to treat children with heart failure: a United Kingdom survey
  1. Hussain Mulla (hussain.mulla{at}uhl-tr.nhs.uk)
  1. Centre for Pharmacy Practice Research, United Kingdom
    1. Magdi Tofeig (magdi.tofeig{at}uhl-tr.nhs.uk)
    1. Congenital and Paediatric Heart Service Glenfield Hospital, Leicester, United Kingdom
      1. Frances Bu'Lock (frances.bulock{at}uhl-tr.nhs.uk)
      1. Congenital and Paediatric Heart Service Glenfield Hospital, Leicester, United Kingdom
        1. Nilesh Samani (njs{at}leicester.ac.uk)
        1. Department of Cardiovascular Sciences, University of Leicester, United Kingdom
          1. Hitesh Pandya (hp28{at}leicester.ac.uk)
          1. Congenital and Paediatric Heart Service Glenfield Hospital, Leicester, United Kingdom

            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.

            • captopril
            • children
            • heart failure
            • unlicensed

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