OPTIMIZING ASPIRIN DESENSITIZATION WITH A PHARMACY-PREPARED ORAL SUSPENSION
European Statement
Production and Compounding
Author(s)
LYG Lidia Ybañez García, VPG Virginia Puebla García, ERS Estefanía Rosón Sanchez, NSO Natalia Sánchez Ocaña, JCV Javier Corazón Villanueva, MTO María de la Torre Ortiz, TBG Teresa Benitez Gimenez.
Why was it done?
Dual antiplatelet therapy with clopidogrel and ASA is standard for acute coronary syndrome and post-stent patients. ASA hypersensitivity occurs in approximately 1.5–2.6% of coronary patients, requiring rapid desensitization. The previous capsule-based protocol involved up to 10 strengths in batches of 100 capsules, many of which were discarded.
A literature search identified only capsule-based protocols or preparations made from dispersible tablets at the ward. To minimize the risk of errors from bedside manipulation, we developed a pharmacy-prepared oral suspension from the active ingredient, allowing centralized, standardized, and safer compounding.
What was done?
A new ASA desensitization protocol was implemented using an extemporaneous pharmacy-prepared oral suspension. It replaced multiple-strength capsules, which were laborious to produce and generated considerable waste. The suspension allowed faster preparation, simplified administration of incremental doses (standardized in the protocol), and offered a more patient-centered approach. It also eliminated the need for ward-based dilutions from dispersible tablets, enhancing safety through centralized pharmacy preparation.
How was it done?
A bibliographic review (RUESA, PubMed, SEFH, Compounding Today, Trissel’s) and analysis of existing protocols were conducted. No suitable aqueous formulations were available, and oily preparations were discarded due to poor palatability. The suspension was prepared according to national pharmacy compounding and quality guidelines.
Composition: ASA 100 mg, glycerin 3 g, carboxymethylcellulose gel 1.5% (35 mL), and purified water q.s. to 100 mL (1 mg/mL). Stable for 24 hours, packaged in individualized oral syringes
What has been achieved?
Since 2017, thirteen patients (median age 83, eight males) have undergone desensitization using the oral suspension. All tolerated the process, allowing initiation of ASA therapy. Compared with the previous protocol, the new approach is faster to prepare and administer, reduces waste, simplifies the process, and maintains patient safety and treatment effectiveness. Centralized preparation eliminated bedside dilutions and enabled safe, standardized incremental dosing.
What next?
This initiative highlights the role of hospital pharmacists in developing practical solutions to optimize patient care. The approach is easily transferable to other hospitals facing similar challenges with ASA desensitization
HIGH DOSES OF TREPROSTINIL ENTAIL LOWER HOSPITALIZATION COSTS IN PATIENTS WITH PULMONARY ARTERIAL HYPERTENSION IN NINE EUROPEAN COUNTRIES
European Statement
Introductory Statements and Governance
Author(s)
Irene Lizano, Ferran Montpart, Elisenda Pomares, Guillem Saborit-Canals, Míriam Fernández
Why was it done?
Treprostinil is a prostacyclin analogue indicated for the treatment of PAH. A recent retrospective study analyzed drug safety events observed in the clinical trials of oral and subcutaneous (SC) treprostinil. This analysis showed that higher treprostinil doses were associated with lower PAH-related hospitalization rates, compared to lower doses.
What was done?
To estimate annual pulmonary arterial hypertension (PAH)-related hospitalization costs in patients treated with different treprostinil doses in nine European countries (Belgium, France, Germany, Italy, Poland, Portugal, Spain, The Netherlands and the United Kingdom).
How was it done?
A cost estimation model was developed to calculate hospitalization costs in patients with PAH who were treated with treprostinil at different doses. Annual hospitalization rates were gathered from a retrospective analysis of an oral and SC treprostinil global safety database. Patients were categorized into three groups based on total daily dose: low, medium and high. Low dose was defined as <4.0 and <1.9 mg/day (9.0 and >7.6 mg/day (>30 ng/kg/min). PAH-related hospitalization costs were included and, when not available, heart failure-related costs were considered as it is the main cause of hospitalization in PAH patients. Mean annual hospitalization costs per dose were calculated using annual PAH-related hospitalization rates (0.9 for low dose, 0.4 for medium dose, and 0.3 for high dose) and unit costs per hospitalization in each country. All costs were obtained from national databases or published literature and were expressed in 2021 euros.
What has been achieved?
Mean annual PAH-related hospitalization costs ranged from €1,649 to €8,382 for low dose, from €733 to €3,726 for medium dose, and from €550 to €2,794 for high dose. Thus, hospitalization costs for high-dose patients were 3 times lower than for low-dose patients (mean difference €2,610) and 1.3 times lower than those for medium-dose patients (€435).
What next?
High doses of treprostinil result in lower hospitalization costs than low and medium doses in patients with PAH. Therefore, an appropriate drug titration might lead to potential cost savings in various European settings.
Adequacy and effectiveness of thromboembolic prophylaxis in multiple myeloma patients treated with inmunomodulatory drugs.
European Statement
Clinical Pharmacy Services
Author(s)
Alba María Fernández Varela, Laura López Sandomingo, Nieves Valcarce Pardeiro, Isaura Rodríguez Penín
What has been achieved?
.