Compounding is the art and science of preparing customized medications for patients. In recent years with the resurgence of compounding many physicians are now working with pharmacists to offer their patients the benefit of medicines tailored specifically for certain needs. Children are especially suited for custom compounded prescriptions, as commercially manufactured drug forms are often not the best solution.
The child that refuses to take his or her medicine because of the taste is a prime patient for compounded medication. Dozens of flavors are available to compounding pharmacists, who can enhance the taste and color of the medicine while maintaining the proper pH. Children usually won’t mind taking medicine when it tastes like bubblegum or even chocolate!
Most children can’t swallow tablets or capsules especially if they are taking several a day. To solve this problem your pediatrician and our compounding pharmacist can develop and prepare medication in alternate dosage forms your child won’t mind taking. These can include lollipops, gummy bears, syrups, suspensions and even freezer pops and transdermal gels all in customs dosages from infant to toddler and pre teen children.
Each child is, of course, unique. They vary in size and weight; some have allergies and varying degrees of drug tolerances. As a result, it is often a challenge to find a commercially available medication suitable for the individual needs of your child. A compounding pharmacist can be of help in formulating a medication which comes in the exact dose needed for a child of a certain age and size.
Many infants suffer from reflux, which causes them to spit up frequently. A commercially available ranitidine syrup often is prescribed to treat this condition, but many babies cannot tolerate its minty flavor. They frequently spit the medication back-up, defeating the purpose entirely. Compounding pharmacists, with the help of the pediatrician may try to conceal the mint flavor by adding various sweetening agents and flavor combination to the commercially available syrup. Or, a pharmacist may make a non-mint flavored ranitidine suspension. We have been successful using a combination of grape and cotton candy flavors in a ranitidine suspension and many infants are finally able to take this medication and successfully control the reflux.
Other medication problems arise when parents travel with their children. An example is an anti-malarial drug often prescribed for children traveling overseas. The dose needed by a child who can swallow tablets often is not available commercially in the exact milligram strength needed and may not be available in a liquid form for those who cannot swallow tablets. It is often prescribed in a compounded liquid form, yet it is quite likely not stable for the length of time that the family will be gone.
Parents cannot often crush the tablets and measure out an exact dose themselves, but a compounded pharmacist can make up capsules or powder packets in the required strength. The contents of the capsule or packet can be opened and mixed with a flavored suspension prepared by a pharmacist or other suitable vehicle at the time of administration. The dose is therefore customized to what the child needs. These options make it so that the long-term stability in liquid is no longer an issue.
Children with special needs, especially those with autism, experience many medication challenges. They often require drugs to be incorporated into suspensions because they cannot swallow capsules or tablets. Autistic children also take a multitude of vitamin supplements. They may need those to be incorporated in a suppository, Popsicle or other dosage form if the taste or volume makes it difficult for the parents to administer. Another unique dosage form used for administering such medications is an effervescent powder that can be used to make a fizzy drink. The flavor-masking potential of effervescence is quite powerful.
Physicians sometimes prescribe transdermal chelating agents for children with autism if other dosage forms and routes have posed problems. Special anhydrous penetrating bases are often required to help the drugs maintain stability along with appropriate penetration into the systemic circulation. The smell of some of the drugs can make applying them topically a challenge, yet a pharmacist can add appropriate fragrances or suggest alternate application sites to help with this problem.
Special factors must be taken into account when making compounds for autistic children: are all the ingredients (including flavors) gluten-free, casein-free, soy free and dye-free: Pharmacists are generally familiar with ingredients that are typically safe for autistic children and become a helpful resource for parents.
Pain relief is another area in which compounding can be helpful. Parents often ask pharmacist what their child can use to avoid pain from routine immunizations or other shots. Receiving shots can be very traumatic for some children. Many pediatricians do believe that preventing pain from immunizations is important. They often need options because a popular commercially available anesthetic can take at least 60 minutes to work once applied, and their usually is not ample time for the anesthetic to be given and take effect before the procedure is done.
Pediatricians can therefore request a topical anesthetic or a combination of anesthetics that have a quick onset and short duration of action. With compounded topical anesthetics, the doctors have the ability to select an appropriate percentage strength and combination for the age and weight of the child.
Throat pain from mononucleosis, strep throat or a tonsillectomy may seem unbearable for a child of any age. The child usually is prescribed oral liquid pain medication, but may not be able to swallow anything due to the severe throat pain. Some doctors have prescribed anesthetic lollipops to help with throat pain, and to potentially minimize narcotic use and potential nausea. The medicated lollipops can be made with extra-long sticks that can easily reach the back of the throat. (Parents should be warned to not allow them to eat the entire lollipop at once and to not eat food immediately after administration as it may numb the gag reflex.)
Compounded medications in various dosage forms, strengths, and flavors can help solve medication problems that may otherwise lead to non-compliance and perhaps treatment failures, and can help parents feel confident that the needs of their children are being met in the best possible way.