Pediatric Pharmacy Poses Challenges for R.Ph.S

By LoBuono, Charlotte | Drug Topics, November 4, 2002 | Go to article overview

Pediatric Pharmacy Poses Challenges for R.Ph.S


LoBuono, Charlotte, Drug Topics


Arecent data analysis by Medco Health Solutions, the pharmacy benefit subsidiary of Merck and Co., revealed that spending on prescription drugs for children and teenagers is growing faster than for any other age group.

Pharmacists face certain challenges when providing care to children, said Margaret Campbell, Pharm.D., clinical specialist, Connecticut Children's Medical Center, Hartford. Speaking at a seminar cosponsored by the New York Society of Health-System Pharmacists and the Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Campbell said that these challenges include limits in education, research, and drug labeling.

Campbell said that little time in pharmacy school curricula is dedicated to pediatrics. She outlined several barriers to pediatric research, including the fact that the pediatric population is relatively small compared with other populations. She also pointed out that the safety and efficacy of many drugs have not been established in children.

Additional challenges faced when providing pharmaceutical care to children, Campbell continued, indude a lack of useful dosage forms such as suspensions and an increased risk of error when drug formulations are manipulated to make them useful for pediatric patients.

Concerns about using intravenous drug therapy in children include access to veins, drug compatibility, and the use of additives and preservatives, said Campbell. It is more difficult to access veins in children, she noted, because their veins are smaller. This limited access can raise issues of drug compatibility, she continued, because although drug compatibilities in children are the same as those in adults, more drugs must go into fewer IV lines.

The use of additives and preservatives such as benzyl alcohol and propylene glycol in pediatric patients is a cause for concern, Campbell told the audience. Benzyl alcohol is associated with a risk of metabolic acidosis and gasping syndrome, while propylene glycol has been linked with a risk of cardiovascular instability and seizures, she said. Acknowledging that it is not always possible, she advised using preservative-free drug formulations in infants younger than two months.

In terms of oral dosage forms, Campbell said that liquids may require compounding, and that tablets may be given to children older than four years. …

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