Case study No. 7. Use of scored tablets of first line antiretroviral drugs in HIV-infected children in resource limited settings: experiences from the ARROW clinical trial
Liquid formulations of antiretroviral (ARV) drugs are usually given to young children but dispensing different volumes of multiple syrups which changes as the child grows is complex for caregivers, particularly older grandparents. As liquids are also proven to be bulky and problematic to store (Acceptability of Tablets Case Study), solid formulations may be preferable. However in resource limited settings, there is lack of appropriate low bulk, solid formulations which can be crushed, dissolved or swallowed whole by young children, and which are made in sizes that allow for the necessary incremental dose adjustments associated with a child’s growth according to simple weight band tables. Scored tablets, with drug evenly distributed throughout enabling easy and accurate division in half, substantially increase accuracy of division compared with un-scored tablets. This improves dosing flexibility as the tablets are snapped in half by hand and are generally preferred. In addition, scored fixed dose combination tablets are easier for manufacturers as fewer tablets of different strengths are required for children. The children in the ARROW trial were the first worldwide to use scored tablets of Abacavir (ABC), Lamivudine (3TC) and Combivir (CBV).
Evidence For Action Case Study No. 07 July 2010, 2 pp.