Propylene glycol intake from medications used on paediatric intensive care

C. Patel, R. Isaac, C. Langley

Research output: Contribution to journalMeeting abstract

Abstract

Background: There are increasing reports of propylene glycol (PG) toxicity, which is used in many medications as a solvent for water-insoluble drugs. Polypharmacy may increase PG exposure in vulnerable PICU patients who may accumulate PG due to compromised liver and renal function. The study aim was to quantify PG intake in PICU patients and attitudes of clinicians towards PG.
Methods: A snapshot of 50 patients’ medication intake was collected. Other data collected included age, weight, diagnosis, lactate levels and renal function. Manufacturers were contacted for PG content and then converted to mg/kg. Excipients in formulations that compete with the PG metabolism pathway were recorded. The Intensivists opinions on PG intake was sought via e-survey.
Results: The 50 patients were prescribed 62 drugs and 83 formulations, 43/83 (52 %) were parenteral formulations. Sixteen formulations contained PG, 2/16 were parenteral, 6/16 unlicensed preparations. Thirty-eight patients received drugs with PG. PG intake ranged from 0.002 mg/kg/day to 250 mg/kg/day, with 29/38 receiving formulations with concomitant pathway competing excipients. The total amount could not be quantified in two cases due to lack of availability of information from the manufacturer. Four commonly used formulations contributed to higher intakes of PG. Only 1/16intensivists was aware of PG content in drugs, 16/16 would actively change therapy if intake was above European Medicines Agency recommendations.
Conclusions: Certain formulations used on PICU can considerably increase PG exposure to patients. These should be highlighted to the clinician to make an informed decision regarding risks versus benefits in continuing that drug or formulation.
LanguageEnglish
Article number583
PagesS197
Number of pages1
JournalIntensive Care Medicine
Volume39
Issue numberS1
DOIs
Publication statusPublished - Jun 2013
Event24th annual meeting of the European Society of Paediatric and Neonatal Intensive Care - Rotterdam, Netherlands
Duration: 12 Jun 201315 Jun 2013

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Propylene Glycol
Critical Care
Pediatrics
Drug Compounding
Excipients
Pharmaceutical Preparations
Kidney
Polypharmacy

Bibliographical note

Abstracts from ESPNIC 2013: 24th annual meeting of the European Society of Paediatric and Neonatal Intensive Care, 12–15 June 2013, Rotterdam (NL).

Cite this

Patel, C. ; Isaac, R. ; Langley, C. / Propylene glycol intake from medications used on paediatric intensive care. 2013 ; Vol. 39, No. S1. pp. S197.
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abstract = "Background: There are increasing reports of propylene glycol (PG) toxicity, which is used in many medications as a solvent for water-insoluble drugs. Polypharmacy may increase PG exposure in vulnerable PICU patients who may accumulate PG due to compromised liver and renal function. The study aim was to quantify PG intake in PICU patients and attitudes of clinicians towards PG.Methods: A snapshot of 50 patients’ medication intake was collected. Other data collected included age, weight, diagnosis, lactate levels and renal function. Manufacturers were contacted for PG content and then converted to mg/kg. Excipients in formulations that compete with the PG metabolism pathway were recorded. The Intensivists opinions on PG intake was sought via e-survey.Results: The 50 patients were prescribed 62 drugs and 83 formulations, 43/83 (52 {\%}) were parenteral formulations. Sixteen formulations contained PG, 2/16 were parenteral, 6/16 unlicensed preparations. Thirty-eight patients received drugs with PG. PG intake ranged from 0.002 mg/kg/day to 250 mg/kg/day, with 29/38 receiving formulations with concomitant pathway competing excipients. The total amount could not be quantified in two cases due to lack of availability of information from the manufacturer. Four commonly used formulations contributed to higher intakes of PG. Only 1/16intensivists was aware of PG content in drugs, 16/16 would actively change therapy if intake was above European Medicines Agency recommendations.Conclusions: Certain formulations used on PICU can considerably increase PG exposure to patients. These should be highlighted to the clinician to make an informed decision regarding risks versus benefits in continuing that drug or formulation.",
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Propylene glycol intake from medications used on paediatric intensive care. / Patel, C.; Isaac, R.; Langley, C.

Vol. 39, No. S1, 583, 06.2013, p. S197.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - Propylene glycol intake from medications used on paediatric intensive care

AU - Patel, C.

AU - Isaac, R.

AU - Langley, C.

N1 - Abstracts from ESPNIC 2013: 24th annual meeting of the European Society of Paediatric and Neonatal Intensive Care, 12–15 June 2013, Rotterdam (NL).

PY - 2013/6

Y1 - 2013/6

N2 - Background: There are increasing reports of propylene glycol (PG) toxicity, which is used in many medications as a solvent for water-insoluble drugs. Polypharmacy may increase PG exposure in vulnerable PICU patients who may accumulate PG due to compromised liver and renal function. The study aim was to quantify PG intake in PICU patients and attitudes of clinicians towards PG.Methods: A snapshot of 50 patients’ medication intake was collected. Other data collected included age, weight, diagnosis, lactate levels and renal function. Manufacturers were contacted for PG content and then converted to mg/kg. Excipients in formulations that compete with the PG metabolism pathway were recorded. The Intensivists opinions on PG intake was sought via e-survey.Results: The 50 patients were prescribed 62 drugs and 83 formulations, 43/83 (52 %) were parenteral formulations. Sixteen formulations contained PG, 2/16 were parenteral, 6/16 unlicensed preparations. Thirty-eight patients received drugs with PG. PG intake ranged from 0.002 mg/kg/day to 250 mg/kg/day, with 29/38 receiving formulations with concomitant pathway competing excipients. The total amount could not be quantified in two cases due to lack of availability of information from the manufacturer. Four commonly used formulations contributed to higher intakes of PG. Only 1/16intensivists was aware of PG content in drugs, 16/16 would actively change therapy if intake was above European Medicines Agency recommendations.Conclusions: Certain formulations used on PICU can considerably increase PG exposure to patients. These should be highlighted to the clinician to make an informed decision regarding risks versus benefits in continuing that drug or formulation.

AB - Background: There are increasing reports of propylene glycol (PG) toxicity, which is used in many medications as a solvent for water-insoluble drugs. Polypharmacy may increase PG exposure in vulnerable PICU patients who may accumulate PG due to compromised liver and renal function. The study aim was to quantify PG intake in PICU patients and attitudes of clinicians towards PG.Methods: A snapshot of 50 patients’ medication intake was collected. Other data collected included age, weight, diagnosis, lactate levels and renal function. Manufacturers were contacted for PG content and then converted to mg/kg. Excipients in formulations that compete with the PG metabolism pathway were recorded. The Intensivists opinions on PG intake was sought via e-survey.Results: The 50 patients were prescribed 62 drugs and 83 formulations, 43/83 (52 %) were parenteral formulations. Sixteen formulations contained PG, 2/16 were parenteral, 6/16 unlicensed preparations. Thirty-eight patients received drugs with PG. PG intake ranged from 0.002 mg/kg/day to 250 mg/kg/day, with 29/38 receiving formulations with concomitant pathway competing excipients. The total amount could not be quantified in two cases due to lack of availability of information from the manufacturer. Four commonly used formulations contributed to higher intakes of PG. Only 1/16intensivists was aware of PG content in drugs, 16/16 would actively change therapy if intake was above European Medicines Agency recommendations.Conclusions: Certain formulations used on PICU can considerably increase PG exposure to patients. These should be highlighted to the clinician to make an informed decision regarding risks versus benefits in continuing that drug or formulation.

UR - http://link.springer.com/10.1007/s00134-013-2950-8

U2 - 10.1007/s00134-013-2950-8

DO - 10.1007/s00134-013-2950-8

M3 - Meeting abstract

VL - 39

SP - S197

IS - S1

M1 - 583

ER -