title: Tablet/Capsule Size Variation Among the Most Commonly Prescribed Medications for Children in the USA: Retrospective Review and Firsthand Pharmacy Audit.
abstract: BACKGROUND
  Children are frequently asked to take tablets and capsules of different sizes and shapes to manage acute and chronic medical conditions. Medication size is an important factor that contributes to compliance, yet few studies detail size variation or pediatric pharmacy inventory.
  
  
  OBJECTIVE
  This study assesses the available sizes and size variations of common inpatient and outpatient pediatric medications and provides an inventory of the tablet and capsule sizes available in a children's inpatient hospital pharmacy.
  
  
  METHODS
  We derived the most frequently prescribed oral medications from US national databases, including the IMS, Vector One(®): National (VONA) and Pediatric Health Information System (PHIS). We analyzed a composite list using the National Library of Medicine Pillbox website, which provides size measurements. Medications from a children's inpatient pharmacy were audited and hand measured for comparison.
  
  
  RESULTS
  We created a list of the top 15 most prescribed inpatient and outpatient pediatric tablet/capsule medications and observed a wide variation in size: acetaminophen 500 mg ranged from 5 to 22 mm in length, median 15 mm. Common pediatric antibiotics were larger and ranged from 8 to 25 mm in length, median 17 mm. Hand-measured samples from the inpatient pharmacy were often the larger pill sizes, despite smaller alternatives being available.
  
  
  CONCLUSIONS
  We observed a marked variation in the sizes of common pediatric tablet/capsule medications, and pharmacies that serve children may not stock the most child-friendly medications. Tablet/capsule size does not appear to be considered when decisions about tablet and capsule medication selections are made. These results should increase awareness of these sizes and affect how physicians prescribe, how pharmacies order inventory, and how insurers and pharmaceutical companies pay for and produce pediatric medications.
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, 2242 Genome Sciences Bldg, CB#7231, 250 Bell Tower Dr, Chapel Hill, NC, 27599-7231, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Jacobsen
authors.affiliation: Eschelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Kathy
authors.initials: K
authors.lastname: Riley
authors.affiliation: Department of Quality and Safety, Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Lee
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, 2242 Genome Sciences Bldg, CB#7231, 250 Bell Tower Dr, Chapel Hill, NC, 27599-7231, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bradford
authors.affiliation: Division of Pediatric Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, 2242 Genome Sciences Bldg, CB#7231, 250 Bell Tower Dr, Chapel Hill, NC, 27599-7231, USA. ravi.jhaveri@unc.edu.
authors.forename: Ravi
authors.identifier: http://orcid.org/0000-0001-9921-0419
authors.initials: R
authors.lastname: Jhaveri
mesh_terms: D002648:Child; D016208:Databases, Factual; D006776:Hospitals, Pediatric; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D010607:Pharmacy Service, Hospital; D012189:Retrospective Studies; D013607:Tablets
chemical_list: D004364:Pharmaceutical Preparations; D013607:Tablets