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Standardization of Prescribing and
Using Oral Liquid Dosage Forms
(OLDFs)
Moslem Movahed
Department of Medical Management
of Province of Qom
Social Security Organization, Iran,
Islamic Republic of
Standardization of Prescribing and Using Oral Liquid Dosage Forms (OLDFs)
Moslem Movahed
Department of Medical Management of Province of Qom, social security
organization, Iran, Islamic Republic of
Background: Various factors affect the correct dosing and measuring of OLDFs, excluding drops, thereby leading
to adverse effects or preventing the desired results to be obtained in treatment.
Aims and Settings : This study aims to evaluate the current situation in dosing OLDFs in Qom, Iran and includes
all oral liquid products manufactured in Iran; 20 physicians (16 GPs and 4 pediatricians), 2000 OLDF
prescriptions, 20 community pharmacists, and 60 literate mothers
Results: (1) Only 60% of the oral liquid products (including antibiotics, even those presented as powder for
suspension) are offered with a measure; 8 kinds of medicine (33 products) come with varying measures, of
which some are a spoon with a capacity of 5 mL and others are in a cylindrical shape, with 4 capacities ranging
from 5 to 20 mL. (2) Many physicians and pharmacists are not aware of the current diversity in measures
whereas nearly all the physicians and pharmacists conventionally and practically presume a 5 mL measure.
(3) In the group of mothers, 50% fill 10 mL measures completely and 10% fill 20 mL measures up to 15 mL when
they are advised to use 1 measure of the drug; 5 mL measures pose no problems. (4) Although 5 sizes of
domestic spoons are used by patients, prescribers ignore this diversity by reducing it to 3 sizes only.
(5) Although pediatricians have a good knowledge of domestic spoon capacities, many GPs and most of the
pharmacists overestimate them, leading to underdosage for adults, especially in cough preparations with low
drug content. (6) Less than 10% of adults‘ prescriptions come with precisely specified dosages in mL whereas
90% have unclear volume. For children, 27% of the dosages are clear and 73% remain unclear.
Conclusion: A number of dosing problems in manufacturing, prescribing, and using OLDFs cause overdosing or
underdosing which can lead to adverse effects or treatment failure. In children; for example, if the intended
prescription is 5 mL 3 times a day (but written as "3 measures a day") and the consumer is given a 20 mL
measure. In addition, treatment fails in many cases due to underdosing of cough preparations and
acetaminophen elixirs. To improve the current situation and prevent problems, it is suggested that (1) OLDFs be
offered with a syringe (the best choice), or uniform and/or unisize (preferably 5 mL) measures, or even no
measure at all; (2) physicians be advised to prescribe the OLDFs in exact volumes (mL or cc) and avoid
prescribing in terms of ―measure‖ or domestic spoons (this should be included in physicians‘ and pharmacists‘
education); (3) cough preparations be produced in higher concentration and volume for adults; and
(4) parents be advised to use appropriate syringes (without a needle) instead of spoons or other measures.
Background:
In order to take the exact desired dose of the oral
liquid drugs (OLDs) the consumer needs to know the
exact volume (i.e. cc or mL) specified by the
physician and to have a calibrated device.
Writing the dose of OLDs in terms of “measure” by
physicians and assuming the measure to contain 5
ml, while in fact there is a diversity of measures
(both in size and shape) offered with OLDs, could
lead to overdosing and even intoxication.
Physicians’ writing the dose of OLDs in terms of
“spoon,” when they assume a spoon to contain a
volume which is usually more than the actual volume
of domestic spoons, along with the diversity of
spoons, could mostly lead to treatment failure.
Settings:
All oral liquid products (including
antibiotics offered as powder for
suspension), excluding drops,
manufactured in Iran
And
20 physicians (16 GPs and 4 pediatricians)
2000 OLDs prescriptions
20 community pharmacists
60 literate mothers
In the Province of Qom, Iran
Objectives:
This descriptive study aims to evaluate the
current situation of factors relevant to dosing
OLDs including:
Different kinds of measures coming with the
drugs
Physicians and pharmacists’ behavior in
writing the desired dose
Different kinds of domestic spoons used to
take liquid drugs
Consumers’ behavior in measuring and taking
Results (1) :
Only 60% of the oral liquid products
(including antibiotics, even those presented
as powder for suspension) are offered with
a measure; 8 kinds of medicine (33 products)
come with varying measures, of which
some are a spoon with a capacity of 5 mL
and others are in a cylindrical shape, with
4 different capacities ranging from 5 to 20
mL.
Results (2) :
Many physicians and pharmacists are not
aware of the current diversity in measures
whereas nearly all the physicians and
pharmacists conventionally and practically
presume a 5 mL measure.
In the group of mothers, 50% fill 10 mL
measures completely and 10% fill 20 mL
measures up to 15 mL when they are
advised to use one measure of the drug;
5 mL measures pose no problems.
Results (3) :
Although patients make use of 5 sizes of
domestic spoons, physicians and
pharmacists ignore this diversity by reducing
it to 3 sizes only.
While pediatricians have a good knowledge
of domestic spoon capacities, many GPs and
most of the pharmacists overestimate them,
leading to under-dosage for adults,
especially in cough preparations with low
drug content.
Results (4) :
Less than 10% of adults‘ prescriptions
come with precisely specified dosages in
mL whereas 90% have unclear volume. For
children, 27% of the dosages are clear and
73% remain unclear.
Conclusion (1):
Oral liquid drugs are offered with measures of
sizes varying from 5 to 20 ml. Physicians and
pharmacists usually write the doses in terms
of “measure” when they assume the
measure to accommodate 5 ml. This
frequently causes overdosing the drug,
which can lead to adverse effects. For
example, if the intended dosage is 5 ml 3
times a day (but written as "3 measures a
day") and the consumer is given a measure
with a capacity up to 10 or 20 mL, the patient
might take 2-4 times the desired dose.
Conclusion (2):
Prescribing the oral liquid drugs in terms of
“spoon,” when the domestic spoons are
available in 5 sizes without any calibration
and when physicians and pharmacists
usually ignore their diversity and
overestimate their capacities, can cause
treatment failure in many cases of cough
preparations and acetaminophen elixirs.
Suggested Interventions (1):
OLDs had better be offered with a syringe
(the best choice), or uniform and/or unisize
(preferably 5 mL) measures, or even no
measure at all.
Physicians should be advised to prescribe
the OLDs in exact volumes (mL or cc) and
avoid prescribing in terms of measures or
spoons. This point should be included in
physicians‘ and pharmacists‘ education.
Suggested Interventions (2):
Parents should be advised to use
appropriate syringes (without a needle)
instead of spoons or other measures
Cough preparations should be produced in
higher concentration and volume for adults