How to divide a tablet into 1/3 or even smaller? Many parents will encounter similar problems when giving medicine to their children.
In fact, problems such as inaccurate distribution and insecurity caused by "dose guessing and drug dispensing" have always been the pain points of pediatric medication. Experts pointed out that children are not "reduced version of adults", and copying adult drug use methods may become a potential safety hazard.
"Children's discretion" is too broad
"Appraise" drugs according to feeling
Recently, Xu Ning is worried about the children taking medicine. My daughter, who is over 3 years old, coughs a little. Thinking that there is honey refining Chuanbei loquat cream at home, adults eat it well, so they plan to give it to their children. "It says in the manual that an adult should take one tablespoon (15ml) every time three times a day, and the number of children should be halved. But the definition of" children "is too broad, right? There is such a big difference between the ages of 3 and 10. Is it half?"
Ding Ran, the mother of the 6-year-old child, was also baffled by the instructions. "Many instructions do not clearly indicate the usage and dosage of children at all. At most, there is only one sentence," Children may reduce ", but it is difficult to determine how much to reduce."
In fact, even with clear usage and dosage, many parents are still stuck in the matter of drug distribution. Not long ago, Cheng Wei took her 10 month old son to the hospital because of her child's poor appetite. After the doctor checked, she prescribed compound pepsin powder to help digestion. "According to the usage and dosage in the instructions, 0.75 g is used once for people under the age of one year, and the specification of a bag is 3 g, which means that only a quarter of the amount can be poured out each time. However, there is no such accurate balance at home that can weigh, and the packaging bag is opaque, which can only be estimated by feeling each time, and the results are either more or less."
In order to be as accurate as possible, Cheng Wei simply pours out all the bags and divides them into roughly four parts. But after eating one, how to keep the remaining three becomes a problem. "It's always unsanitary and easy to get damp after doing this. I'm afraid the efficacy will be affected."
In this regard, Liu Tong's approach seems quite heroic - each time he eats only the part he has divided, and the rest is gone. "It's better to waste a little than lose the efficacy." For capsule drugs, she also opened the capsule, approximately separated the needed part and put it back into the capsule for use, and the rest was thrown away directly.
For tablet drugs, the difficulty of subpackaging is that the tablets are too small to fix the position by hand. Some pills have bulges in the middle, and the material is not suitable for cutting. If you cut it, it will be uneven in size and even break into more small pieces. "If so, I will have to crush it more and then estimate that it will be allocated to children."
hidden danger
Can you be particular
It is difficult to guarantee good storage and use
Parents who felt "top priority" for drug distribution turned to the Internet to seek solutions, and a variety of drug distribution "magic tools" came into being. The reporter searched on the network platform with the keyword of "drug distributor", and a large number of drug separation tools with different shapes and colors appeared, basically targeting the most difficult to cut tablet drugs.
Take a closer look at these dispensing tools. Some of them are in the shape of a flat box, with multiple compartments inside. Some are in the shape of a vertical medicine bottle, and the upper and lower multi-layer structures can be twisted apart from each other. In addition to the differences between whether drugs can be stored and whether mini water cups are provided to facilitate drug taking, the core components of these drug distributors are the clips built in the bottom and the blades built in the cover. When dispensing, use a clamp to fix the tablet, press the box cover, and the blade will cut the tablet into two halves in a manner similar to a "chopper".
The principle is very simple, and the publicity map is perfectly displayed. However, according to the buyer's comments, the dispenser still has many limitations. For example, the medicine can only be divided into two halves. If it is further cut, it is difficult to fix it because of its uneven shape. In addition, too large and too small pills are difficult to cut, and sugar coated pills are easy to break.
"The lid with the blade is loose, and the blade cannot cut the medicine in half" "The workmanship is not good, and the cut pill directly turns into slag" "The lid of the cut pill is particularly loose, and the lid of the larger cut pill is crooked, and the pill is not divided into two halves, and directly crushed"... Taking a four in one medicine dispenser that has been purchased by nearly 10000 people as an example, there are many comments about "difficult to use" The sound of.
Even if the drug distributor successfully divides the tablet into two parts, if you want to continue cutting, it is likely that the "magic tool" is powerless. A study from the Chinese Pharmaceutical Congress and the 13th Chinese Pharmacist Zhou's Essay Collection showed that seven different size tablets were split in half and four in half by four splitting methods, namely, hand, scissors, blades and medicine cutters; The splitting of the tablets was evaluated with reference to the evaluation standard for half tablet split dose in the European Pharmacopoeia. The results showed that five of the seven tablets passed the split half test with the cutter, while the tablets split a quarter of the tablets failed the test with four splitting methods.
"Some parents try to distribute drugs at home by themselves, which may cause many drug safety hazards." Zhao Zhigang, chief pharmacist of the pharmacy department of Beijing Tiantan Hospital affiliated to Capital Medical University and chief pharmacist of Beijing Hospital Management Center, pointed out that professional pharmacists need to judge which drugs can be divided and which drugs cannot be divided. Once some drugs are separated, they will destroy the original structure and affect the efficacy of the drug itself. For example, if sustained-release tablets are taken separately, the sustained-release mechanism may be damaged, and the drug will be released suddenly, leading to poisoning.
"Even for drugs that can be divided, it is difficult for parents to ensure that they are divided accurately, stored well, and used correctly." Zhao Zhigang said that children of different ages have great differences, and the dosage of drugs cannot be halved simply depending on parents' feelings. In addition, different drug units are different, some are milliliters, and some are milligrams. If parents confuse them, they will lead to overdose, and the consequences will be very serious. Previously, a study found that the incidence of adverse drug reactions in children in China was nearly twice that of adults, and the incidence of adverse drug reactions in newborns was more than four times that of adults.
proposal
Rich dosage forms and choices
Professional drug distribution and increased services
According to the data of the 2016 Survey Report on Drug Safety for Children issued by the Southern Institute of Pharmaceutical Economics of the State Food and Drug Administration, among the 176652 domestic drug approvals, only 3517 are drugs specifically for children (drugs for children refer to those drugs that are specifically used for children in the generic name, excluding those drugs used for children but not specified in the generic name), The proportion is only 2%. In terms of variety, there are only more than 60 kinds of special drugs for children among more than 3500 conventional drugs.
Zhao Zhigang believes that there is an imbalance in the supply of drugs for children in China at present. Among them, the number of over-the-counter drugs for treating common diseases has increased significantly, and some areas even have surplus. However, prescription drugs for treating tumors, nervous system diseases and rare diseases are seriously insufficient, mainly due to the lack of varieties, dosage forms and specifications suitable for children, and the vast majority of drug instructions lack the indications, usage and dosage of children. "Due to the lack of clinical trials for children and the lack of relevant research data, doctors often have to explain the situation with the family members of children in advance, and then convert the dose needed by children according to weight or age and other indicators on the basis of adult dose combined with medication experience."
However, drug distribution has certain technical requirements. Zhao Zhigang believed that corresponding specifications should be issued, and specific operating standards should be formulated, which should be completed by professional pharmacists. Under the condition of ensuring that the sanitary conditions meet the standard, the scales and other precision instruments should be used for weighing, and properly stored to define the storage period.
In this regard, the Affiliated Children's Hospital of Zhejiang University School of Medicine has made a more active exploration. The pharmacy department has set up a special drug subcontracting post, where two full-time pharmacists grind pills every day and put them into small subpackaging bags with specifications ranging from one-third to sixteenth. Then mark the subcontracting date with marker pens of different colors, and finally stack them into a stack and put them into a sealed box for children hospitalized in the hospital. Of course, the cost of consumables and personnel for sub packaging work can only be supported by departments and hospitals for the time being.
"Drug dispensing itself requires human and material resources. In many developed countries, drug dispensing services will be compensated through separate charges. Generally, children's drug dispensing fees are higher than adults, because dispensing needs precise dosage distribution, which is more complex." In Zhao Zhigang's opinion, to solve the problem of drug shortage for children, we should start from many aspects. "Children's drug research and development cannot be accomplished overnight. The more realistic approach is to produce more dosage forms that are convenient for packaging and use, such as liquid dosage forms, granules, etc., on the basis of existing drugs, while providing specifications suitable for children's use (such as micro tablets), and implementing the pharmaceutical service compensation mechanism (children's drug dispensing fees) as soon as possible To entrust professional affairs to professional pharmacists, so as to ensure children's medication safety. (Reporter Wei Jingzong Yuanyuan)
