Sunday, 14 April, 2024
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Let children try standard pills before gummies – US pharmacist

The past decade has seen an explosion in the number of gummy vitamins available for both adults and children as an easy – and alternative – way to take vitamins or supplements.

But recently, writes Rachel Meyers in Medpage, the appropriateness of these dosage forms has been scrutinised, with the sugar content and reliability of delivering accurate doses coming into question. The US Food & Drug Administration (FDA) even convened a meeting in October to discuss the benefits of and concerns with these “candy-like” medications.

She writes:

One issue stressed at the meeting on medications and vitamins that are candy-like in taste and appearance is their potential for overdoses and poisoning as they become more desirable for children.

Fortunately, most vitamins and over-the-counter medications that are available are not highly toxic, but children can easily take enough to cause gastrointestinal symptoms.

Notably, multivitamins with iron in them can be particularly toxic to children.

I would also like to raise another question: why do we have to turn medications into “candy” to get children to take them? I have two children, aged 10 and 12, and the only options I’ve come across on the market for a multivitamin are chewable tablets and gummies.

My 12-year-old daughter has been able to swallow solid oral dosage forms (pills) for at least four years now. She isn't alone: in one study, the majority of children aged between six and 11 were able to learn to swallow a small tablet.

So why do we wait so long to teach them to swallow solid oral dosage forms? Why do we rely on oral liquids, chewable tablets and gummies?

Why do we assume that children won’t take them unless they are a liquid or in candy-like form? Kids should be encouraged to give standard “pills” a try before running to alternatives.

In my role as a paediatric pharmacist, I meet patients in our paediatric kidney centre, and these children learn early that it is in their best interest to learn to swallow tablets and capsules because the liquid versions taste so terrible.

My 12-year-old now has braces, so the gummies aren’t an option (she didn’t like the taste of them much anyway). She doesn’t like the taste of the chewable multivitamins either.

But there aren’t other options. There are no multivitamins for children (that I have been able to find) in tablet form. Adult multivitamins would provide too much of many of the vitamins, so I am stuck with having to split them and give her half of an adult multivitamin.

(Note that I consulted with the paediatric dietician with whom I work to ensure the doses wouldn’t exceed the recommended daily allowances for my daughter’s age.)

I propose that we move on from the assumption that for children to take a vitamin, it must be candy. Let’s change the status quo.

The interest in solid oral dosage forms for children in prescription medications has been growing in recent years, thanks to their longer shelf lives and increasing ability to accommodate dose flexibility.

Multi-particulate dosage forms, which encompass mini tablets, pellets, granules, and sprinkles, are slowly starting to make their way to the marketplace. Their small size makes them more acceptable to children and helps with dosing flexibility, which is needed since most medications for children are dosed based on weight.

Studies have shown that infants as young as two-days-old can swallow and not choke on mini tablets of 2mm. Clearly, if sized appropriately, children of any age can take solid oral dosage forms.

We can do better in the world of over-the-counter products for children.

Let’s move away from candy-like dosage forms and back to tablets, capsules, or mini-tablets for younger children. While we wait for the FDA to decide on next steps in the definition and regulation of candy-like products, I recommend working with parents of young patients to teach their children to swallow solid oral dosage forms.

I still have some teaching to do myself: my 10-year-old hasn’t learned to swallow pills yet, and when she was diagnosed with influenza a month ago, she complained bitterly about the taste and volume of her medication.

She told me she is eager to learn to swallow tablets and capsules so that she doesn’t have to take “that yucky medicine” again. Even at the young age of 10, she knows what’s best.

Rachel Meyers, PharmD, is a paediatric pharmacist and a clinical professor at Rutgers University’s Ernest Mario School of Pharmacy in New Jersey, USA.

 

PubMed article – Iron poisoning in children (Open access)

 

Clinical Paediatrics article – Pill swallowing ability and training in children 6 to 11 years of age (Open access)

 

PubMed article – Acceptability of Uncoated Mini-Tablets in Neonates: A Randomised Controlled Trial (Open access)

 

Medpage Today article – Medicine or Candy? Let's Reevaluate the Vitamins We Offer to Kids (Open access)

 

See more from MedicalBrief archives:

 

Big Pharma and naturopathy — 'unholy allies' in the supplementation scam

 

Plant-based gels ease swallowing of paediatric pills – MIT collaboration

 

FDA paediatric version of dolutegravir to treat children

 

 

 

 

 

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