SPECIALS
SOMETHING SPECIAL?
THE DISPENSING OF MEDICATIONS KNOWN AS “SPECIALS” HAS BECOME MORE COMMON IN RECENT TIMES, WITH THESE PRODUCTS BEING USED IN PREFERENCE TO THE EXTEMPORANEOUS PREPARATION OF THE PRODUCT WITHIN THE PHARMACY SETTING.
T
he use of specials may be appropriate for some patients, however, it is necessary that we pharmacists fully
understand where the use of special products is appropriate, and other aspects which will allow us to supply these products in a professional and effective manner.
WHAT ARE SPECIALS? In short, specials are unlicensed medicines that are formulated due to the absence of an existing suitable licensed product for a particular indication. Such products are probably very familiar to most dispensing pharmacists in both the community and hospital setting, and are often deemed necessary by the prescriber for a number of reasons including issues with formulation or the presentation of the product, rendering common licensed products unsuitable
14 - SCOTTISH PHARMACIST
for use within certain patients. Amongst others, specials may be prescribed for the reasons outlined in Box 1.
BOX 1. SOME POTENTIAL REASONS FOR THE
PRESCRIPTION OF SPECIALS1
• Allergy to ingredients within licensed products
• Flavour of an oral preparation is unacceptable to the patient
• Inability for an oral preparation to be swallowed (e.g. dysphagia)
• Patient may have a phobia or dislike for the conventional route of administration (for example, needle-phobia)
• A combination of products not available in a licensed product may be required
.
Specials can be produced in a seemingly endless number of forms, with the most commonly dispensed including topical products such as creams and ointments; oral preparations including liquids, capsules and tablets; ear, eye and nose drops; suppositories, pessaries, parenterals, and powders. As such, the area of specials is perhaps more complicated than initially imagined! However, it is necessary that pharmacists understand how and why these alternative formulations are prescribed and used, and be able to effectively counsel patients in this regard.
A SPECIAL OCCASION? Pharmacists may assume that specials are prescribed only rarely, however this appears not to be the case. Indeed, it is approximated that specials account for 1% of all prescriptions in the UK, equating to around 75,000 differing
formulations2 . As pharmacists will
. As a result of this elevated cost, the use of specials has attracted a large amount of criticism, with the expenditure on these products being likened to fraud, with pharmacists being accused of being accomplices in this activity3
be aware, even while this number appears to be quite small, the price of these special products leads to a large consumption of NHS resources. For example, NHS England alone spent upwards of £160 million on specials in 2010, with smaller areas such as Fife in Scotland spending nearly £2 million a year on these specialist products3,4
. This elevated cost
can be related to the prices of certain special preparations, which are often upwards of £1000 or more per pack, suggesting that pharmacists are being falsely accused of fraudulently procuring NHS funds.
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