Tablet/Capsule Size Variation Among the Most Commonly Prescribed Medications for Children in the USA: Retrospective Review and Firsthand Pharmacy Audit
- 249 Downloads
Children are frequently asked to take tablets and capsules of different sizes and shapes to manage acute and chronic medical conditions. Medication size is an important factor that contributes to compliance, yet few studies detail size variation or pediatric pharmacy inventory.
This study assesses the available sizes and size variations of common inpatient and outpatient pediatric medications and provides an inventory of the tablet and capsule sizes available in a children’s inpatient hospital pharmacy.
We derived the most frequently prescribed oral medications from US national databases, including the IMS, Vector One®: National (VONA) and Pediatric Health Information System (PHIS). We analyzed a composite list using the National Library of Medicine Pillbox website, which provides size measurements. Medications from a children’s inpatient pharmacy were audited and hand measured for comparison.
We created a list of the top 15 most prescribed inpatient and outpatient pediatric tablet/capsule medications and observed a wide variation in size: acetaminophen 500 mg ranged from 5 to 22 mm in length, median 15 mm. Common pediatric antibiotics were larger and ranged from 8 to 25 mm in length, median 17 mm. Hand-measured samples from the inpatient pharmacy were often the larger pill sizes, despite smaller alternatives being available.
We observed a marked variation in the sizes of common pediatric tablet/capsule medications, and pharmacies that serve children may not stock the most child-friendly medications. Tablet/capsule size does not appear to be considered when decisions about tablet and capsule medication selections are made. These results should increase awareness of these sizes and affect how physicians prescribe, how pharmacies order inventory, and how insurers and pharmaceutical companies pay for and produce pediatric medications.
KeywordsOral Medication Peripherally Insert Central Catheter Cefdinir Chewable Tablet Capsule Size
The authors would like to acknowledge Amee Patel and Meghan Fox from the Pediatric Oral Medication Screener (POMS) team for their efforts in advancing this research. We would also like to thank Christopher Falato from the NC Children’s inpatient pharmacy for productive discussions on this topic.
Compliance with Ethical Standards
L Jacobsen, K Riley, B Lee, KK Bradford, and R Jhaveri have no conflicts of interest to report. No sources of funding were used to support the study.
- 14.Singh M. National Public Radio. Trouble swallowing pills? Try the ‘pop bottle’ or the ‘lean forward’. Health News From NPR. 11 November 2014. Available at http://www.npr.org/blogs/health/2014/11/11/363024822/trouble-swallowing-pills-try-the-pop-bottle-or-the-lean-forward. Accessed 6 Feb 2015.
- 19.Centers for Disease Control and Prevention (CDC). Multistate outbreak of fungal infection associated with injection of methylprednisolone acetate solution from a single compounding pharmacy: United States, 2012. MMWR Morb Mortal Wkly Rep. 2012;61(41):839–42.Google Scholar
- 24.World Health Organization (WHO), Finney E. Children’s medicines: a situational analysis. Campaign “Make medicines child size”. Progress Reports, Reports by the Secretariat 2011.Google Scholar
- 25.FDA. Guidance for industry, size, shape, and other physical attributes of generic tablets and capsules, draft guidance (Silver Spring, Md.); December 2013.Google Scholar
- 26.European Medicines Agency. “Guideline on pharmaceutical development of medicines for paediatric use”. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2013/07/WC500147002.pdf. Accessed 16 Sep 2015.