If a specials medicine is being considered for a child, a liquid may not always be the answer. The Medicines for Children partnership points out that “children may prefer to swallow tablets rather than having unpleasant-tasting liquid medicines or crushed tablets mixed with food.” It has produced a leaflet giving advice on helping children to swallow tablets and capsules.12

An unpleasant taste may be a key barrier to medicines compliance for potentially 90 per cent of child patients. Palatability – the effect of the combination of factors in addition to taste, such as smell, texture and aftertaste – is almost as important. That taste may be exposed, too, if a tablet is crushed or a capsule opened.13,14

But if swallowing difficulties are being addressed with a liquid version, or a soluble/dispersible or chewable tablet can be made, masking the taste is more of an issue. Children have a strong aversion to bitterness and a greater preference for sweet flavours. In addition to metabolising the active medicinal ingredient differently at different ages compared to adults, this may also be the case with some excipients.14

For children who may have been prescribed an unlicensed medicine while in hospital, a significant concern for parents is obtaining that medicine once back at home. A qualitative study in 2017 explored parents’ concerns over the experience of trying to obtain hospital-initiated specials medicines in the community.15

Several problems were identified:

·       the GP being unwilling to prescribe the medicine

·       GPs prescribing a different dose to the hospital prescription

·       pharmacists unable to source a suitable medicine

·       delays in obtaining the medicine

·       labelling lacking details such as dosage instructions.

Parents said that among the reasons they had been given as to why a GP would not prescribe a hospital formulation were cost, and because the GP was “not allowed” to prescribe it.

Another issue was the quantity the GP would prescribe, not recognising the concerns that parents may have about running out before another batch could be made, or not having enough because of loss or spillage. A small quantity may not recognise that a child’s parents may be separated but have shared care responsibilities.

Parents understood that unlicensed medicines may not be immediately available from the community pharmacy, but were dissatisfied at how long an item could take to arrive.

Having to organise repeat prescriptions in good time and concerns over continued supply, eg if needing to replace a dropped bottle, were adding to the worry and stress. While some parents had kept spare supplies, the short-shelf-life had a bearing on how effective this option was.

Reviewing these concerns, the study’s authors called for earlier dialogue between the hospital and the GP. This would mean the GP has the necessary information to prescribe the medicine as well as to better monitor the patient, or to discuss concerns with the consultant before the child was discharged.

They also called for greater contact between hospitals and community pharmacies, to help source product and prevent dispensing and labelling issues. Involving the community pharmacy earlier could mean the parents were better informed about the waiting times for specials.