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February 26, 2014
Michigan Standardizes Concentrations for Children’s
Liquid Prescriptions

Ann Arbor, MI—With a new statewide initiative, Michigan has become the first state to standardize concentrations for compounded pediatric liquid prescriptions.

The new standards, published here, came after a survey of Michigan pharmacies indicated the lack of standardization of compounded pediatric oral liquids for more than 110 different medications.

“One of the greatest dangers associated with this variation is that children may switch pharmacies but continue to take the same volume as always—without parents or even doctors realizing that the drug’s concentration has changed and that a new dose volume should be prescribed,” explained project lead James Stevenson, PharmD, of the University of Michigan College of Pharmacy.

In fact, the survey of more than 200 participating pharmacies found that more than half of the compounded drugs had at least three different concentrations—varying according to which pharmacy was involved in preparation—with some concentration levels up to 30 times higher than others.

“The drastic differences in concentrations patients could receive depending on which pharmacy compounded their prescriptions were deeply concerning, and these uniform standards are essential for patient safety,” Stevenson noted. “We are urging all prescribers and pharmacies to follow our recommended standards to avoid potentially harmful medication errors.”

The drugs on the standardized list range literally from A to Z: Acetazolamide to Zonisamide. The website also includes a toolbox that features letters that can be sent to prescribers, as well as parents/caregivers explaining any concentration changes. It also offers use criteria for alternate concentrations.

“Transitions in sites of care, including movement between the home and the hospital as well as between pharmacies, are associated with patient safety risks and this may be especially true in the pediatric population because of the number of liquid medicines that must be compounded,” added coinvestigator Chris Dickinson, MD, pediatric associate chief medical officer at the University of Michigan Health System.




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