Monitored Dosage System (MDS)
By Goh Kay Lai (CARiNG Pharmacist) | Kuala Lumpur | Tue Oct 25, 2016 12:35pm
Monitored Dosage System (MDS) is a method of dispensing medicines in a special tray with the days of the week and time of the day labelled on them. The fully trained pharmacy assistant or the pharmacist will fill this tray with the medicines that the patient is taking in the appropriate compartments. This addresses the issue of difficulty accessing the medicine and following
the regimen due to forgetfulness, confusion or even sight impairment.
People who should use the monitored dosage system are:
• Patients who find it hard to remember what to take and when to take it
• Patients who have complex medicine regimes where they have to take different
medicines on different days
• Patients who find it hard to remove medicines from its packaging
• Patients who have restricted use of hands such as patients with arthritis and
• Patients who are partially sighted
MDS doesn’t provide a complete solution because it is only suitable for medicines in solid dosage forms that are to be swallowed whole. Oral liquids, external formulations such as eye, ear and nasal drops, suppositories and powders cannot be put into an MDS. "When required" medicines are also not suitable to be dispensed in MDS.
The long term stability of medicines may be affected as not all tablets and capsules will remain stable once out of their original packaging. Some manufacturers do not have stability data on their products in MDS. There is also the risk of secondary dispensing errors and accidental poisoning in children due to lack of child resistant packaging.
Additionally, it may also be inconvenient, portability-wise, due to the large size of MDS. Confusion due to the arrangement of the medicine compartments into times of the day and days of the week may happen. Furthermore, urgent changes to medicine which is already been dispensed in the MDS will require re-dispensing of the MDS, which is time-consuming, costly and potentially confusing.
MDS is only suitable for medicine in solid dosage forms that are to be swallowed whole. Hence certain medicines are not suitable to be dispensed into MDS such as:
• Medicine with cytotoxic (toxic to living cells) potential
• Medicine which is sensitive to light.
• Medicine which require refrigeration
• Medicine which should be stored with a desiccant
• Medicine which should be stored in a glass container
• Medicine that says on the summary of product characteristic (SPC)
‘’Must be stored in Original container’’
• Medicine to be taken on "when required" basis
• External formulations
• Oral Liquids
Some medicines may be considered to be put in MDS based on the professional judgement of the pharmacist or doctor, which include:
• Medicine with special handling requirement
• Medicine that needs regular monitoring like warfarin
• Medicine that are not licensed for inclusion in the MDS
Pharmacist also cannot re-dispense medicines originally dispensed somewhere else, as the pharmacist would not be able to vouch for the proper sourcing or storage of the medicines.
Preparation of MDS
When the pharmacist receives a request for MDS, the pharmacist will assess the patient’s eligibility for MDS and ensure the patient or carer is counselled properly on the use of the MDS. The pharmacist will also assess suitability of the medicine, any drug interactions and dose or medicine changes before proceeding to assembly, labelling, followed by final checking to ensure the assembly and supply of medicines in the MDS is accurate.
Our pharmacists are always available to answer any questions about the medicine and MDS. They can demonstrate to new patients or their carers how to use the MDS and ensure that they understand exactly how to use it safely and appropriately. MDS is only available in selected CARiNG outlet.
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