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KMID : 0869620070240030203
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Journal of Korean Society of Hospital Pharmacists
2007 Volume.24 No. 3 p.203 ~ p.218
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Studies on the Efficacy of Oral Medications That Should Not be Crushed
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Oh Jun-Hee
Lee Yong-Seok
Min Myung-Sook
Lee Young-Mee
Sohn Kie-Ho
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Abstract
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In the present day many pharmaceutical products are developed and used in practical settings which were specially designed to make patients more convenient to use with ensuring adequate efficacy and safety. Considering special pharmaceutical formulations and characteristics in relation to their purposes of development, it should be noticed that crushing these dosage forms may compromise the efficacy and cause serious side effects. However, crushing tablets are prevalent by reasons of the lack of understanding their special properties as well as the regard only to the convenience of administration. The objectives of this study is to examine medications that should not be crushed in Samsung Medical Center(except opioids and cytotoxic agents) and to analyze their prescriptions written for crushing them between November 2005 and April 2006, with the intention of optimizing their uses related to pharmaceutical dosage forms and some other specific characteristics. The number of medications that should not be crushed were 106 tablets and of crushing-prescriptions were 1,241(2.5%) cases out of 49,789 cases which meant total prescriptions of medications that should never be crushed in a monthly average. As a result of classifying crushing-prescriptions of tablets that should not be crushed by reasons for not crushing them, extendedrelease accounted for 38.4% followed by enteric-coated(14.8%), dissolubility by moisture in the air(12.8%), remarkably bitter taste(11.5%), variable dose(8.8%) and soluble/dispersible dosage forms(5.4%). As the one of improvements for appropriate use of these medications, 11 tablets which came to 72 cases in a monthly average(formed 6.3% among 1,127 cases of total crushing prescriptions that could be improved) were evaluated that crushing process was unnecessary because of their special pharmaceutical formulations. 244 cases of 15 tablets(21.7%) included medications that could be crushed only just before the administration cause of their properties. 29 tablets of 435 cases(38.6%) were available in other dosage forms, 20 tablets of 377 cases(33.4%) could be considered changing to alternative medications that had same medicinal effects. Consequently 1,127 crushing-prescriptions of 75 tablets(90.8%) could be modified although 114 cases of 31 tablets(9.2%) showed crushing medications might be inevitable. Implementation of database about medications that should not be crushed and intensification of patient counseling by pharmacists can lead to reduce the inappropriate use of these medications significantly. Also, arrangements of standards about a preparation as well as developments of various dosage forms and doses proper to each patient are required for the use of medications that should be crushed inevitably.
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KEYWORD
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crushing tablets, oral medications that should not be crushed
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