Medicine stability in multi-compartment compliance aids

J. Gilmartin C W Maplethorpe Postdoctoral Fellow for Pharmaceutical Education and Research
University College London School of Pharmacy
London, UK

Multi-compartment compliance aids (MCAs) are used to organise medicines according to the day of the week and time of the day in which they must be taken or administered. In United Kingdom and Australian community pharmacies and hospital pharmacies, medicines are dispensed, removed from their original packaging and repackaged into MCAs. These MCAs assist community-dwelling patients with medicine adherence and care home staff with medicine administration.

There is relatively limited published research, as well as literature supplied from pharmaceutical manufacturers, exploring the stability of medicines repackaged into MCAs [1]. MCAs are not universally air tight, light resistant or moisture impermeable and therefore there is the potential for medicine instability to occur. Active ingredient degradation, formulation changes, degradation product accumulation and changes in physical appearance have the potential to negatively impact patients.

Stability concerns have been raised in studies of prochlorperazine [2], sodium valproate [3] and atenolol [4] repackaged into MCAs, in contrast to studies involving paracetamol [5] and clozapine [6]. The type of MCA examined and testing conditions used must be considered when interpreting these studies for their applicability to pharmacy practice.

More information concerning medicine stability when repackaged into MCAs is needed to support pharmacists as they prepare MCAs. Pharmaceutical manufacturers can be encouraged to undertake medicine stability testing in MCAs. This data can be provided to pharmaceutical bodies, leading to updated pharmacy guidelines and increased awareness among pharmacists. A comprehensive understanding of the medicine stability risks associated with MCA preparation can be used to determine if they outweigh the benefits of MCA use.

[1Gilmartin JF-M, Raimi-Abraham BT, Jani Y, Smith F, Orlu-Gul M. Taking the guesswork out of supplying multicompartment compliance aids : do pharmacists require further guidance on medication stability ? Int J Pharm Pract. 2015 (epub ahead of print).

[2Glass B, Mangan M, Haywood A. Prochlorperazine tablets repackaged into dose administration aids : can the patient be assured of quality ? J Clin Pharm Ther. 2009 ;34(2):161-9.

[3Llewelyn VK, Mangan MF, Glass BD. Stability of sodium valproate tablets repackaged into dose administration aids. J Pharm Pharmacol. 2010 ;62:838-43.

[4Chan K, Swinden J, Donyai P. Pilot study of the short-term physico-chemical stability of atenolol tablets stored in a multi-compartment compliance aid. Eur J Hosp Pharm Sci Pract. 2007 ;13(3):60-6.

[5Haywood A, Mangan M, Glass B. Stability implications of repackaging paracetamol tablets into dose administration aids. J Pharm Pract Res. 2006 ;36:25-8.

[6Perks S, Robertson S, Haywood A, Glass B. Clozapine repackaged into dose administration aids : a common practice in Australian hospitals. Int J Pharm Pract. 2011 ;20(1):4-8.

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