Caring for Older People: Aids to compliance with medication

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Abstract
Daily dose reminders and monitored dosage systems Several types of daily dose reminders are available (see box). Most consist of a box divided into days of the week with several compartments for each day—they are suitable for tablets and capsules only. Effervescent, dispersible, buccal, and sublingual preparations or moisture sensitive medicines (such as Omeprazole) cannot be dispensed in compliance devices. Large solid tablets, or multiple tablets taken at a single time, may not fit into the individual compartments. “As required” (PRN) medication, if placed in a daily dose reminder or monitored dosage system, may be taken unnecessarily on a regular basis. Daily dose reminders are not included in the drug tariff and therefore are not prescribable. Patients or their carers have to purchase the device unless it is dispensed from a hospital. Some drugs are provided in calendar, “bubble” or “blister” packs. People with impaired manual function may have difficulty in manipulating the packaging. The legal and ethical aspects of dispensing medicines into daily dose reminders or monitored dosage systems are not clear.1 Medicines dispensed directly into daily dose reminders or monitored dosage systems should still comply with current labelling regulations. The labelling should allow identification of each drug in the monitored dosage system, and formulations that look alike should not be dispensed in the monitored dosage system. Recent data have questioned the stability of medicinal products in compliance devices. Medicines should not be kept in sealed monitored dosage systems for more than eight weeks. They should be stored in a cool dry place, protected from light, and kept away from children as most of these devices are not child resistant.

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