Oral liquid medicines for children: the issues of choice

• Published in: Archives of disease in childhood Vol. 109; no. 1; p. 75
• Main Authors: Wan, Mandy, Wignell, Andrew, Tomlin, Stephen
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01.01.2024; BMJ Publishing Group LTD
• Subjects: Bradycardia; Caregivers; Child Health; Children; Drug dosages; Ethics; Infants; Narcotics; Neonates; Neonatology; Oral administration; Overdose; Paediatrics; Pediatrics; Pharmacy; PostScript; Primary care; Tachycardia; Young Children; United Kingdom > UK; Neonatology; Paediatrics
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-325886

[...]having more than one concentration of the same drug in liquid form allows us to further tailor the volume to be administered. In two cases, a product of a different concentration was supplied but the change in volume required to administer the same dose was not effectively communicated to the parents.1 One infant received a suboptimal dose and experienced persistent tachycardia, while the second infant developed bradycardia due to a 10-fold overdose.1 The concentration range is even wider with bespoke extemporaneously prepared oral liquid medicines (or ‘specials’) which are frequently used in children due to the lack of age-appropriate licensed dosage forms. Work has shown that for neonates weighing ≤1 kg requiring very small doses as well as adolescents weighing >50 kg and needing an adult dose, a suitable dose volume can generally be accommodated using one concentration of a drug.2 3 A national list of recommended concentrations for a range of commonly prescribed oral drugs in children was published in the UK in 2018.3 A complimentary dashboard has since been developed to support staff in primary care to determine the extent to which these recommendations are being followed and to drive standardisation.4 By raising awareness of this standardisation initiative, we hope to engage our colleagues in working together towards implementing safer practices across systems of care from prescribing, to dispensing and to improving support for caregivers on medicines administration.