PubMed · 14316028
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H DITTRICH. 1964. [SPASMOLYTICS].. https://pubmed.ncbi.nlm.nih.gov/14316028/
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Many medicines prescribed for children are unlicensed. Solid dosage forms present problems as children have difficulty swallowing whole tablets or capsules. When medicines are not licensed for children, it is unlikely that there will be a suitable, licensed liquid formulation and so extemporaneous liquid preparations (prepared at the dispensary or by GMP 'special' manufacturers) are often used. This study looked at a list of medicines commonly prescribed for children with cardiovascular conditions in an English specialist paediatric hospital and classified them according to licensed status and available formulations. As expected, most medicines used for children with cardiovascular problems were unlicensed and where this was the case, usually only 'special' liquids or extemporaneous preparations were available. Problems linked with formulations highlighted in this therapeutic category were: problems in dosing accuracy and unknown bioavailability of extemporaneous products, the use of potentially toxic excipients, and lack of access to modified release preparations for children. These problems are likely to extend to other paediatric therapeutic areas. There is currently a large, unmet need to improve formulations of commonly used paediatric medicines, both through licensing and standardising the production of extemporaneous and 'special' formulations. It is expected that the awaited European regulation will help to meet some of those needs.
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OBJECTIVE: To analyse whether there exists a socio-economic gradient in utilisation of cardiovascular drugs at the district level in the Czech Republic. METHODS: The aggregated data on drug utilisation during the period 1997-2000, expressed in defined daily doses per 1000 inhabitants per day, were obtained from the General Health Insurance Company. Socio-economic characteristics of the districts in year 2000 (percentage of university-educated inhabitants, percentage of single-member households, number of ambulatory physicians per 10,000 inhabitants, unemployment rate and mean monthly income) were used as single unadjusted predictor variables. Partial correlation controlling for age in districts was used to analyse the relationship of cardiovascular disease (CVD) drug utilisation and several socio-economic variables. RESULTS: There were considerable differences in the utilisation of CVD drugs within the districts studied. Significantly higher utilisation of dihydropyridine Ca-channel blockers and statins was found in the districts with a higher percentage of university-educated inhabitants and more ambulatory physicians. CVD drug utilisation (nitrates, fibrates, selective beta-blockers, verapamil and diltiazem and statins) correlated significantly with the percentage of single-member households. The five socio-economic variables explained more than 60% of the variability in use of dihydropyridine Ca-channel blockers, verapamil and diltiazem, ACE inhibitors and statins. CONCLUSION: There exists a significant gradient in the utilisation of mainly newer CVD drug groups within districts of the Czech Republic that can be, at least partly, explained by social characteristics of the districts.