Infants at Risk for Opioid Dosing Errors

Pharmacists must be vigilant against dosing errors when filling painkiller prescriptions for very young children.

Dispensing a prescription for opioid painkillers always demands careful attention, but pharmacists should be especially vigilant when the prescription is for an infant or toddler, according to a new study.

In their review of 50,462 outpatient prescriptions for narcotic-containing drugs prescribed to children aged 0 to 36 months, a group of South Carolina researchers found that 4.1% of all children received a higher dose of the painkillers than was appropriate for their weight, age, and gender.

Risk of overdose was highest among the youngest children, said lead author William T. Basco, Jr, MD, MS, FAAP, associate professor and director of general pediatrics at the Medical University of South Carolina. Nearly 1 in 10 of children aged 0 to 2 months received more than twice the recommended dose, he reported.

Overall, 40% of children younger than 2 months received an overdose, compared with just 3% of children older than 1 year. The average overdose amount was 42% higher than the recommended dose.

Even a slight error in prescribing or dispensing the sedating drugs to infants can be extremely dangerous, the researchers noted. Previous studies have shown that pouring accurate liquid doses of medication is already a challenge for parents, and innacurate prescribing only increases the potential for harm.

"Since we know that parents have difficulty measuring doses of liquid medication accurately," Dr. Basco concluded, "it is critical to strive for accurate narcotic prescribing by providers and dispensing by pharmacies. His results were presented April 30, 2011, at the Pediatric Academic Societies annual meeting in Denver, Colorado.

In addition to checking prescriptions to ensure that the correct dose is prescribed, pharmacists can prevent dosing errors involving narcotics by teaching parents to properly measure and administer liquid medications and providing approved measuring devices when dispensing the drugs.

For other articles in this issue, see:

• OTC Status Increased Use of "Morning After" Pill
• Preventing Drug Interactions Starts With Prescribers