ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2017) 51 OC8.1 | DOI: 10.1530/endoabs.51.OC8.1

Hydrocortisone tablets: human factors in manipulation and their impact on dosing accuracy

Emma A Webb1,2, Cameron Watson2,3, Stephanie Kerr4, Justin H Davies4, Heather Stirling5 & Hannah Batchelor3

1Deparntment of Endocrinology & Diabetes, Birmingham Children’s Hospital, Birmingham, UK; 2Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK; 3School of Pharmacy, Institue of Clinical Sciences, University of Birmingham, Birmingham, UK; 4Department of Endocrinology & Diabetes, Southampton General Hospital, Southampton, UK; 5Paediatric Department, University Hospitals Coventry and Warwickshire, Coventry, UK.

Introduction: Exposure to deficient/excess glucocorticoids can lead to long-term health problems in patients with adrenal insufficiency. An age-appropriate low dose hydrocortisone formulation is not available therefore manipulation a 10 mg tablet is required with potential for inaccurate dosing.

Aims: To assess the variability in manipulation procedures recommended by healthcare professionals and undertaken by parents/carers. To quantify the dose-variability in the manipulated product based on the method of preparation.

Methods: Parents (HC(UC1) of children with adrenal insufficiency from across the UK completed a survey assessing the methods used to manipulate hydrocortisone 10 mg tablets. Naïve participants undertook manipulation of a 10 mg tablet (Auden-Mackenzie vs Amdipharm brand) to make a 2.5 mg dose either by quartering the tablet or by crushing, dispersing in 10 ml and withdrawing 2.5 ml. Drug content was analysed.

Results: One hundred and twenty five parents completed the questionnaire. 25.6% of parents did not or do not remember receiving training on preparing hydrocortisone doses. There is significant variability in the advice given to parents on dose manipulation and in the methods parents use to prepare the correct dose (Table 1). 34% are prescribed a dose indivisible by 2.5 mg of whom 33% break the tablet to acquire the dose. Only 6% of health professionals prescribe a specific brand of hydrocortisone tablet. 70% of children take Auden-Mackenzie tablets of whom 44% make a dispersion without crushing the tablet. 22% of parents are currently either cutting tablets for doses indivisible by 2.5 mg or attempting to disperse Auden-Mackenzie tablets. Variability in dosing was observed based on both brand and method of manipulation.

Table 1 Methods of hydrocortisone administration recommended by paediatric endocrine doctors and nurses
Patient age range 0–12 monthsPatient age range 1–6 years
Method of hydrocortisone administration% recommend this methodDifference between doctor and nurse% recommend this methodDifference between doctor and nurse
GroupNurse (n=20)Doctor (n=32)P valueNurse (n=20)Doctor (n=32)P value
Whole tablet (10 mg)8021.90.000013065.60.01
Cut tablet6540.60.0945750.02
Whole tablet in water (10 mg in 10 mls)6559.40.77059.40.4
Cut tablet in water (5 mg in 5 mls)5031.30.25028.10.1
Crushed tablet7043.80.0765500.3
Buccal hydrocortisone3515.60.13028.10.9

Conclusion: This is the first study that compares the methods used by parents/carers to the advice provided by healthcare practitioners.

The presence of score-lines on Auden-Mackenzie tablets did not improve the accuracy of quartering tablets compared to a non-scored brand (Amdipharm). In a significant proportion of patients the manipulation of tablets is likely to result in inaccurate dosing and to impact on patient morbidity.

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