Extent of extemporaneous compounding and pattern of prescribing and use of extemporaneous medicines in a developing setting

Objectives To determine the extent of extemporaneous compounding, the prescribing pattern and use of extemporaneous medicines in a developing setting like Nigeria. Methods A cross-sectional assessment was conducted at the Pharmacy Department of the premier teaching hospital in Nigeria. A pretested data collection form and direct inspection of packaging and labelling information were used for data extraction. Key findings About 100% (678) of the extemporaneous products were liquid dosage form made with trituration using crushed tablets (76.5%, 519), opened capsules (17.6%, 119) and broken ampoules (5.9%, 40), and the majority (77.2%, 524) were dispensed to inpatients. The ten most frequent extemporaneous preparations were zinc gluconate (11.1%, 75), spironolactone (10%, 60), hydrochlorothiazide (9%, 60), captopril (9%, 60), hydroxyurea (8.1%, 55), furosemide (6%, 40), lisinopril (5.2%, 35), phenytoin (5.2%, 35), carbamazepine (4.1%, 28) and enalapril (4%, 27). Simple syrup and amaranth solution were the most frequently used excipients (97.2%, 659). Packaging was done with white plastic bottles (100%, 678). No labelling information was provided on storage condition and expiry date, and the compounding pharmacists' lacked access to key information on the stability, bioavailability, efficacy and safety of extemporaneously prepared medicines. Conclusions The extent of compounding and use of extemporaneous products is considerable and remain an importance source of critical access to essential medicines for children with cardiovascular and neurological disorders, and electrolyte imbalance and nutritional deficiencies in both the inpatient and ambulatory settings. However, the limited access to information on the stability, efficacy and safety of extemporaneous products may potentially expose patients to harm.