The Pharmaceutical Journal
Vol 280 No 7491 p251-254
1 March 2008

This article
Reprint   Photocopy

PDF 80K, Acrobat Reader

Is extemporaneous dispensing really in the best interest of patients?

In this article Ryan Donnelly, Martin McNally and Johanne Barry examine extemporaneous dispensing in British community pharmacies and call for a UK-wide study to assess the quality of the products prepared and see whether the activity may be actually detrimental to patient safety

SUMMARY

Extemporaneous dispensing is the process of compounding ingredients to prepare a medicine for an individual patient. In extemporaneous dispensing, a pharmacist prepares an unlicensed medicine for supply in accordance with a prescription.

This activity may need to be carried out where no licensed product is available or where the formulation of the licensed product is not suitable. In many instances, extemporaneous dispensing has involved the preparation of a paediatric medicine in the form of an oral liquid from an adult medicine.

The formulation of bespoke medicinal products to meet the needs of individual patients has been a central feature of community pharmacists’ role since the earliest days of the profession. However, advances in the pharmaceutical industry over the past five decades, in terms of drug design and synthesis and the production of increasingly sophisticated dosage forms, have meant that the need for, and utility of, extemporaneously dispensed medicines has steadily declined.

The recent involvement of community pharmacists in prescribing and medicines management and repeat dispensing initiatives, allied to ever more time spent on health promotional activities means that the profession is currently more patient-focused than product-oriented. Despite this, a significant number of extemporaneous products are still dispensed in the UK every year.

For example, in 2001, 0.05 per cent of all prescriptions written in England were for unlicensed medicines, including those prepared extemporaneously. Given that around 587 million prescriptions were dispensed in England that year, this still represents a significant number of products, indicating a continued need for this service in the community.

The ability to dispense medicines extemporaneously has long been regarded as a skill unique to the pharmacy profession. Pharmacists combined knowledge of the physicochemical nature of drug substances (solubility, acidic or basic character) and excipients with an understanding of drug absorption, pharmacology and pharmacokinetics.

This, linked with an appreciation of patient need, in terms of delivery route (oral, rectal or topical), meant the pharmacist was the only professional capable of delivering a unique medicine for a specific patient.

Full text article PDF (80K)