The Pharmaceutical Journal
Vol 269 No 7214 p319-323
7 September 2002

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  Emergency hormonal contraception (EHC)
  Olanzapine
  Drug interactions
  Consent
  Tablet crushing
  Modernisation
  The Society

Letters to the Editor

Tablet crushing

Consider specials manufacturers

From Mr J. S. Fawdry, MRPharmS

The recent Broad Spectrum piece by David Wright (PJ, 27 July, p132) and the letter from Julie Phillips et al at Solihull Hospital (PJ, 17 August, p216) concerning tablet crushing, deal with important issues around the use of medicines. I would like to highlight some other issues around the practical realities for the community pharmacist as well as the role of the specials manufacturer in this context.

To start with, the theory is that all therapy should be evidence-based with unequivocal clinical trial data to support it and should involve licensed products, used correctly.

The practical reality is rather different. First, there is a huge demand for products that are not evidence-based as defined by conventional criteria, for example, a mixture of creams containing coal tar.

Secondly, David Wright's work illustrates that even if a tablet leaves the pharmaceutical supply chain intact, current practice means that licensed medicines are handled in a way that is neither safe nor legal and often renders them unlicensed.

So, because of the practical needs of a minority of patients, medicines are not treated with the respect we in the pharmaceutical profession think they deserve.

So, is this our profession's problem? The work done at Solihull Hospital would suggest that it is. One of the objectives of the safer National Health Service is to reduce extemporaneous dispensing. By moving this to the carer's control, the practical reality of such an approach may actually be to make medicine taking less safe for an already vulnerable minority.

Sometimes the best choice in an imperfect world is not the ideal. An integrated approach like that at Solihull Hospital may be an excellent model for secondary practice, but what are the practical alternatives for the community pharmacist? Saying "so what?" is not a valid approach.

Having practical information on tablet solubility available is clearly a vital, if not widely available, tool.

Using specials, although not the theoretical ideal, may well be the most effective way of providing the patient and carer with the most appropriate therapy. For example, for those with swallowing problems, an extemporaneous suspension may be the best practical way of delivering the medicine.

One of the resources also available to the pharmacist and not mentioned so far in this debate is that of the commercial specials manufacturers. They have a wealth of manufacturing formulation and customer support experience. And by extemporaneously manufacturing products using quality assurance systems under Medicines Control Agency control, they go a long way towards meeting the safer NHS objectives, without ignoring the practical needs of a significant minority of patients in taking their medicines.

Jonathan Fawdry
Director and General Manager
Eldon Laboratories,
Newcastle-upon-Tyne

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