Multi one or not. The compliance aids

Multi compartment
compliance aids (MCA’s) are being increasingly used in both primary and
secondary care settings to assist patients with medicine compliance, in both a
safe and effective manner. The devices not only help patients to remember to
take their medication, but also acts as a visual prompt for carers that
patients have taken their required doses1. Additionally, these MCA’s
are an indispensable tool in polypharmacy2, with the potential to reduce
wastage3. MCA’s
are particularly useful for the elderly population and the visually impaired who
may have difficulty managing complex drug regimens and are looking to promote
independence with their medicines4. The packaging allows days of the
week to be incorporated, allowing patients to follow a specific drug regime,
organised by dosing intervals. Hence, minimising errors associated with
administrating incorrect doses at incorrect times. The pharmacist may arrange
the aids, placing different medications in the same compartment; allowing them
to keep track of the medication the patient is receiving every day, ensuring it
is taken at the desired time.

MCA’s pose a concern regarding product stability as medicines are removed from
their manufacturers original packaging, and has even prompted pharmacists to
establish a database on product stability5. Repackaging
may even be warranted as unlicensed use of the product and may invalidate the stated
expiry date2. The
original packaging has been designed with the appropriate pharmacopoeial and
quality standards in mind1, and dosage forms are required to meet
British Pharmacopoeial requirements including content uniformity. Other factors
which are considered during design are the effects of humidity, temperature and
oxygen. MCA’s cannot guarantee the same degree of protection, and
the pharmacist must use their clinical judgment to prepare one or not. The
compliance aids are not air tight and provide less moisture protection than
original packaging. This may lead to chemical and physical deterioration, reducing
efficacy and compromising patient safety. 
Often systems are re-used without cleaning posing the risk of chemical
and microbiological contamination. Also, specific medication formulations
cannot be repackaged (e.g. those which require refrigeration, dispersible
tablets, significantly hygroscopic preparations and solid dose cytotoxic
preparations including methotrexate). The Royal Pharmaceutical Society also includes medicines with
variable dosing and a narrow therapeutic index such as warfarin6. 

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