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· Methadone mixture
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Letters to the Editor
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Methadone mixture
Society — please reconsider your guidance!
From Mr A. Moule, MRPharmS
I must agree with Martin
Bennett (PJ, 4 March, p263) regarding the Royal
Pharmaceutical Society’s over-detailed guidance on the manufacture
of methadone mixture.
I use approximately 500L per month and have been adding 5g of methadone
powder to 5L of diluent as supplied by Thornton & Ross. We make up
about 20L of methadone mixture per day, working two days in advance to
ensure that dissolution is
complete (three “shakings” over two days). If I were to obtain
the mixture already prepared I would have over 250L of methadone mixture
in stock to cover a two-week period.
I use Socorex pumps, which are only stable on a 5L container and would
otherwise have to decant 10 500ml bottles into a 5L container (and transfer
batch numbers, etc) and then screw the pump on, which would, surely,
lead to loss of volume.
I was assured some time ago, by a manufacturer, that my method would
lead to over 99.75 per cent accuracy.
Around 70 of my 200 methadone patients have been prescribed large quantities
on “green” prescriptions and I have always measured these
into separate bottles, even though I could supply the mixture in one
bottle and supply a “suitable” measuring aid, leading, I
am sure, to far less accuracy due to patients measuring their own doses.
We need realism. It is not that long since we were making ointments extemporaneously.
How long before we cannot be trusted to add water to amoxicillin powder?
I have the nightmare vision of a Controlled Drugs register which requires
a running balance after each transaction, ie, 250,000ml – 30ml
= 249,970ml – 30ml = 249,940ml, etc, etc. I have had too many long
journeys in the car with my children singing, “a million green
bottles standing on the wall” for that.
I ask the Royal Pharmaceutical Society’s Practice Committee: please
reconsider!
Andrew Moule
Middlesbrough,
Cleveland
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The
Pharmaceutical Journal