Multi compartmentcompliance aids (MCA’s) are being increasingly used in both primary andsecondary care settings to assist patients with medicine compliance, in both asafe and effective manner.
The devices not only help patients to remember totake their medication, but also acts as a visual prompt for carers thatpatients have taken their required doses1. Additionally, these MCA’sare an indispensable tool in polypharmacy2, with the potential to reducewastage3. MCA’sare particularly useful for the elderly population and the visually impaired whomay have difficulty managing complex drug regimens and are looking to promoteindependence with their medicines4. The packaging allows days of theweek to be incorporated, allowing patients to follow a specific drug regime,organised by dosing intervals.
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Hence, minimising errors associated withadministrating incorrect doses at incorrect times. The pharmacist may arrangethe aids, placing different medications in the same compartment; allowing themto keep track of the medication the patient is receiving every day, ensuring itis taken at the desired time. However,MCA’s pose a concern regarding product stability as medicines are removed fromtheir manufacturers original packaging, and has even prompted pharmacists toestablish a database on product stability5. Repackagingmay even be warranted as unlicensed use of the product and may invalidate the statedexpiry date2. Theoriginal packaging has been designed with the appropriate pharmacopoeial andquality standards in mind1, and dosage forms are required to meetBritish Pharmacopoeial requirements including content uniformity. Other factorswhich are considered during design are the effects of humidity, temperature andoxygen. MCA’s cannot guarantee the same degree of protection, andthe pharmacist must use their clinical judgment to prepare one or not.
Thecompliance aids are not air tight and provide less moisture protection thanoriginal packaging. This may lead to chemical and physical deterioration, reducingefficacy and compromising patient safety. Often systems are re-used without cleaning posing the risk of chemicaland microbiological contamination. Also, specific medication formulationscannot be repackaged (e.g. those which require refrigeration, dispersibletablets, significantly hygroscopic preparations and solid dose cytotoxicpreparations including methotrexate).
The Royal Pharmaceutical Society also includes medicines withvariable dosing and a narrow therapeutic index such as warfarin6.