Experiences in Paediatric Pharmacy

The biggest thing I have learned from my study of paediatric medicine at university and beginning my work in paediatric pharmacy is that children are not just smaller adults.

Although some disease states are similar in children, many can have notable differences in children, many drugs show very different pharmacokinetics in children compared with adults, at all levels of drug disposition and therefore the pharmacist is presented with many pharmaceutical and formulation challenges.

Pharmaceutical challenges are much more common with paediatric patients and I have discovered this when being a locum Pharmacist at paediatric hospitals. As a locum Pharmacist you need to have adaptability when dealing with different settings and patients so I thought I would share some of my thoughts on my experience being specifically placed within a paediatric setting.

On many occasions, depending on the age of the child, children may be unable to swallow tablets/capsules and the medicine and pharmacy team are required to look at other pertinent formulations such as suspensions, powders, oral solutions or dispersible tablets. When these are not available then other avenues need to be explored such as examining tablets and how this tablet dose can be manipulated such as crushing and dispersing a tablet, opening a capsule or cutting a tablet – and the documented evidence for this pharmaceutical care challenges. These all can have very important effect of the pharmacokinetics of the drug and need to be closely looked at for each patient.

It is great to see more and more liquid formulation products being licensed in the UK such as the recently licensed methotrexate liquid formulation. However from my experience there can be additional formulation challenges with the liquid medicines. The palatability of the liquid formulation can highly affect children’s compliance to a point where the child may refuse to take it for not having a favourable taste or in my experience from speaking to patients being ‘’too sweet’’. Moreover many pharmaceutical companies have adjusted their formulations to make them easier to measure and to give to the patient. If too viscous then it can be difficult to measure in a syringe or suspensions can be difficult to prepare in comparison to oral solutions for example.

Most doses are calculated on an individual basis and may be based on the patients’ weight, body surface area or age band. With many new formulations and varying strengths of liquids, this requires high attention to detail for the multidisciplinary team. In this sense the multiple liquid strengths available can involve complex calculations and dilutions to ensure the patient has been prescribed the optimal dose and that that the patient accurately receives the verified prescribed dose.

The excipients of many liquid formulations are important for the pharmacist to consider when issuing liquid formulations. For example high sorbitol content can cause diarrhoea, the patient may be fluid restricted and thus limited to the volume of liquid they receive when taking their medicines. The patient may be lactose intolerant or diabetic and therefore close observation would be required for the excipients of the liquid formulations. Finally, the pharmacist must maximise safety and reduce risk by ensuring liquids have a child resistant cap and looking at expiry dates of opened liquids that may be reduced by for example air moisture.

What challenges have you found when dealing with paediatric medicine?

Aidan O'Callaghan

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