IntroductionMulti-compartmentcompliance aids (MCA’s) are being increasingly used in both primary andsecondary care settings to assist patients with medicine compliance, in both asafe and effective manner.

The devices not only help patients to remember totake their medication, but also acts as a visual prompt for carers enablingthem to see whether their patients have had their required doses1.   Additionally, these aids are an indispensabletool in polypharmacy2, with the potential to reduce wastage3.MCA’s are particularly usefulfor the elderly population and the visually impaired who may have difficulty managingcomplex drug regimens and are looking to promote independence with their medicines4.The packaging allows days of the week to be incorporated, allowing patients tofollow a specific drug regime, organised by dosing intervals. Hence, minimisingerrors associated with administrating incorrect doses at incorrect times. The pharmacistmay arrange the aids, placing different medications in the same compartment;allowing them to keep track of the medication the patient is receiving everyday, ensuring it is taken at the desired time. However,MCA’s pose a concern regarding product stability as medicines are removed fromtheir manufacturers original packaging, and has even prompted pharmacists toestablish a database on product stability5. Repackagingmay even be warranted as unlicensed use of the product and may invalidate the statedexpiry date2.

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Theoriginal packaging has been designed with the appropriate pharmacopoeial andquality standards in mind1, and dosage forms are required to meetBritish Pharmacopoeial requirements including content uniformity. Other factorswhich are considered during drug design are the effects of humidity,temperature and oxygen. MCA’s cannot guarantee the same levelof protection, and the pharmacist must use their clinical judgment to prepareone or not. The compliance aids are not air tight and provide less moistureprotection than original packaging.

This may lead to chemical and physicaldeterioration, reducing efficacy and compromising patient safety.  Often systems are re-used without cleaning posingthe risk of chemical and microbiological contamination. Also,specific medication formulations cannot be repackaged (e.g. those which requirerefrigeration, dispersible tablets, hygroscopic preparations and solid dosecytotoxic medications including methotrexate).

The Royal Pharmaceutical Society also includes medicineswith variable dosing and a narrow therapeutic index such as warfarin6.