Background The Medicine Information Centre in the Capital Region of Denmark aims to promote the safe, effective and efficient use of medicines in order to improve quality of answers to inquiries from clinicians on drug related problems. A close knit group of highly experienced pharmacists and clinical pharmacologist work together on a daily basis.
Purpose To demonstrate the benefits of two healthcare professional groups contributing their specific knowledge and skills, exemplified by medical treatment related inquiries of a 4 month old infant with rickets.
Material and methods MedicinInfo received a question regarding dilution of ergocalficerol (vitamin D) injection 100 000 IE/mL for a 4 month old paediatric patient with normal kidney and liver function for the treatment of rickets. Oral administration was not an option in this case. In total, the patient is prescribed 3000 IE intramuscular ergocalciferol by the paediatrician. However, this was not possible unless the drug was diluted. Initially the pharmacist considered every opportunity for dilution of the drug, as well as possible alternative treatments. Then the clinical pharmacologist was consulted to assess which drug and route of administration would be the most appropriate.
Results Contribution from the pharmacist:
ergocalciferol injection 100 000 IE/mL: administration intramuscular. Metabolised in the liver and kidney to calcitriol. Can only be diluted with medium chain triglyceride oil.
alfacalcidol injection 2 µg/mL: administration intravenous. Metabolised in the liver to calcitriol. A disadvantage is that it contains propylene glycol which may cause side effects if elimination is reduced.
calcitriol injection 1 µg/mL. Administration intravenous.
Contribution from the clinical pharmacologist:
intramuscular ergocalciferol is not recommended for a 4-month-old infant due to poor blood circulation in the muscle, as the drug is probably not absorbed and therefore has no effect. Furthermore, the risk of developing muscle necrosis is high. Joint assessment: Decostriol or Etalpha would be preferable in this particular case, despite the fact that one must be careful not to overdose.
Conclusion The case illustrates that interdisciplinary collaboration between pharmacist and clinical pharmacologist increases the quality of answers to drug related inquiries from healthcare professionals, as both professions’ professional competencies is utilised.
No conflict of interest
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