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Background and Importance Manipulation of tablets (eg, splitting, crushing and/or dispersing in water) to achieve paediatric doses is common in paediatric wards. 1 Studies on dose accuracy after manipulation have shown large variations depending on formulation and method of manipulation.2 Previous observations on paediatric wards have shown enalapril tablets being crushed and dispersed in water as a common method of manipulation.3 Aim and Objectives To investigate dose accuracy obtained after manipulation of enalapril tablets using clinically relevant methods of manipulation.Material and Methods Enalapril tablets: Enalapril Krka 5 mg, Krka Sverige AB. Instrument: HPLC-system from Shimadzu Corp (Nexera, with Prominence DAD-detector). Analytical column: SupelcosilTM LC-8, 5 μm, 250x4 .6 mm (Supelco , Merck KGaA). Analytical assay: Enalapril Maleate Tablets, USP. Disintegration time: Whole tablets were added to 10 ml water in a medicine cup. Time until full disintegration of the tablet while stirring intermittently was recorded. Dose accuracy study: Tablets (one or two) were crushed and dispersed in 10 ml water in a medicine cup (n=6). After 30 seconds of stirring, samples of 1 ml, 5 ml or 8 ml were withdrawn with an oral syringe, extracting partial doses of 10%, 50% and 160% of a tablet. Tablets were also dispersed whole in 10 ml water and 5 ml withdrawn (50% of a tablet) after five minutes of intermittent stirring (n=6), regardless of full dispersal of the tablet.Results Enalapril Krka 5 mg had an average disintegration time of 13 minutes (12-14 minutes). Table 1 shows a summary of dose accuracy after manipulation for both methods of manipulation.Abstract 5PSQ-028 Table 1Dose accuracy after manipulation of Enalapril Krka 5 mg; average (min-max) Method of manipulation Partial dose % of intended dose Crushed 10% 96.0% (91.7-103.2%) Crushed 50% 100.5% (98.7-102.2%) Crushed 160% 98.1% (97.3-99.1%) Dispersed whole 50% 78.2% (73.-82.2%) Conclusion and Relevance Long disintegration time confirmed why enalapril tablets consistently were crushed in the ward. Crushing before dispersing tablets of enalapril provides accurate partial doses. It’s important to ensure that the whole tablet is dispersed in the liquid before extracting a dose.References and/or Acknowledgements 1. Bjerknes, et al. Acta Paediatrica. 2017;106:503–508.2. Brustugun, et al. Eur J Hosp Pharm. 2021;28:76–82.3. Svendsen, et al. (under review).Conflict of Interest No conflict of interest