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, 2015, 602021

Issues Around the Prescription of Half Tablets in Northern Switzerland: The Irrational Case of Quetiapine

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Issues Around the Prescription of Half Tablets in Northern Switzerland: The Irrational Case of Quetiapine

Samuel S Allemann et al. Biomed Res Int.

Abstract

Background: Prescription of fragmented tablets is useful for individualisation of dose but includes several drawbacks. Although without score lines, the antipsychotic drug quetiapine was in 2011 the most often prescribed 1/2 tablet in discharge prescriptions at the University Hospital in Basel (USB, 671 beds). We aimed at analysing the prescription patterns of split tablets in general and of quetiapine in particular in Switzerland.

Methods: All orders of community pharmacies for unit-of-use soft pouch blisters placed at Medifilm AG, the leader company in Switzerland for repackaging into pouch blisters, were analysed.

Results: Out of 4,784,999 tablets that were repacked in 2012 in unit-of-use pouch blisters, 8.5% were fragmented, mostly in half (87.6%), and were predominantly psycholeptics (pipamperone 15.8%). Prescription of half quetiapine appears to be a Basel specificity (highest rates of fragments and half quetiapine).

Conclusions: Prescription of fragmented tablet is frequent. It represents a safety issue for the patient, and a pharmaceutical care issue for the pharmacist. In ambulatory care, the patient's cognitive and physical capacities must be clarified, suitability of the splitting of the tablet must be checked, appropriate aids must be offered, like a pill-splitting device in order to improve accuracy, and safe use of the drug must be ensured.

Figures

Figure 1
Figure 1
Distribution of the ten most often split tablets sorted by ATC therapeutic main group (N = 406,956).
Figure 2
Figure 2
Geographical distribution of split tablets in general (heat map; the warmer the colour (i.e., red), the higher the frequency, independently of the surface) and of half quetiapine tablets (purple bars; the higher the column, the higher the proportion) for each of the 51 retirement homes (N = 406,956). Grey areas indicate cantonal borders. The two distant homes located in cantons SG and GR (<0.1% split tablets; no quetiapine) are not depicted.

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