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Eprontia oral solution concentration conversion

A new oral solution, EPRONTIA (topiramate), was recently approved for the treatment of certain seizure disorders in patients 2 years and older, and for the prevention of migraines in patients 12 years and older. The concentration of this new product is 25 mg/mL, which differs from commonly compounded concentrations prepared by pharmacy.

The American Society of Health-System Pharmacists (ASHP) Standardize 4 Safety (S4S) initiative recommends 20 mg/mL as the standard concentration. However, some organizations also compound 6 mg/mL for smaller children to make doses easier to measure, and the Michigan Pediatric Safety Collaboration recommends a compounded concentration of 6 mg/mL. We are concerned about the risk of errors as pharmacies transition patients to the new commercially available topiramate concentration, 25 mg/mL. This is especially concerning for patients prescribed the 6 mg/mL concentration, as an error could lead to a significant overdose.

Organizations should establish a proactive plan to convert to the commercially available product, which should include identifying in the computer system all patients who currently receive an extemporaneous formulation of topiramate to ensure all active patients are converted to the new concentration within a defined period of time. Conversion charts (electronic or manual) should be prepared and validated, and the new strength and volume of each dose should be communicated to providers and patients/families before any prescription conversion. Eprontia doses should be prescribed in mg, not mL doses, and practitioners should clarify and discuss Eprontia doses based on the mg dose. Alert pharmacy staff to this new concentration and the potential for confusion and mix-ups. Pharmacies should consider tagging prescriptions for Eprontia for mandatory patient education, especially if the patient previously was using a different concentration. Using the teach-back method, pharmacists and nurses should also educate patients and/or caregivers about the new concentration, the corresponding volumetric dose, and how to measure each dose with an oral syringe.

Suggested citation:

Institute for Safe Medication Practices (ISMP). Eprontia oral solution concentration conversion. ISMP Medication Safety Alert! Acute Care. 2022;27(11):2-3.