Key result
UK hospitals use 9 different liquid captopril formulations for pediatric heart failure, showing marked variation.
Why the study?
Different liquid formulations of captopril prepared for children with heart failure cannot be assumed to have therapeutic equivalence, and interhospital consistency was unknown.
Cross-Sectional (n=26)
Yes
There is significant inconsistency in the unlicensed liquid captopril formulations used across UK pediatric cardiac centers and referring hospitals, raising concerns about dosing accuracy and potential toxicity.
Clinicians should verify local captopril liquid formulations for pediatric HF; leaves open need for standardization and bioequivalence data.
BACKGROUND AND 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 interhospital 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 UK and 13 large hospitals referring patients to these centres. PARTICIPANTS: The study included pharmacists responsible for providing the pharmaceutical input to children with congenital heart disease or a pharmacist designated to cover paediatric services. Technical staff employed by "specials" manufacturers also participated. RESULTS: Four hospitals dispensed captopril tablets for crushing and dissolving in water before administration; the remaining 22 used nine different liquid formulations of captopril. Only three 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 interchangeably. This degree of inconsistency raises issues about optimal captopril dosing and potential toxicity, such that its use may influence paediatric cardiac surgical and interventional outcomes.
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Mulla et al. (2007) conducted a cross-sectional in Heart failure in children (n=26). Unlicensed liquid captopril formulations was evaluated on Interhospital constancy of unlicensed liquid captopril formulations. A survey of 26 UK hospitals found that 22 used 9 different liquid captopril formulations for children with heart failure, with only 3 centers and referring hospitals using the same formulation.
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