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.
|Patient age range 012 months||Patient age range 16 years|
|Method of hydrocortisone administration||% recommend this method||Difference between doctor and nurse||% recommend this method||Difference between doctor and nurse|
|Group||Nurse (n=20)||Doctor (n=32)||P value||Nurse (n=20)||Doctor (n=32)||P value|
|Whole tablet (10 mg)||80||21.9||0.00001||30||65.6||0.01|
|Whole tablet in water (10 mg in 10 mls)||65||59.4||0.7||70||59.4||0.4|
|Cut tablet in water (5 mg in 5 mls)||50||31.3||0.2||50||28.1||0.1|
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.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes