Purpose: Commercially available medications may not always meet the individual needs of a patient. Some patient populations, such as pediatric or bariatric patients, may require compounded alternative dosage forms for treatment. Taste of the medication can also be a significant barrier to compliance. Medications may be compounded into suitable dosage forms to meet the needs of these patients and improve compliance. There are also methods and excipients that can significantly improve taste of commercial products to also improve compliance with medications.
Methods: Using compounding resources, published literature, and relying on decades of experience in compounding, suitable dosage forms can be developed and prepared to meet the needs of individual patients and improve compliance with treatment. There is no single reference to look up this information. This presentation will give a good general overview with case examples. The case examples include masking bitter-tasting drugs (i.e. metronidazole suspension or omeprazole suspension) using certain excipients and vehicles, administering drugs transdermally for treatment of nausea or anxiety (i.e. promethazine or fluoxetine), and masking a commercial unflavored oral product (acetylcysteine) for use as a mouthwash for an adult patient who was suffering from oral lesions due to radiation therapy.
Results: Although it is very difficult to mask the taste of metronidazole and the proton pump inhibitors, certain excipients and vehicles can be used to adequately mask the bitterness. There are also techniques, such as using chocolate syrup before and after dosing to minimize the bitterness and improve compliance with pediatric patients. These substances are routinely used in the health-system's pediatric hospital.
An oncology patient who suffered from anxiety during her treatments could not take any oral form of fluoxetine, but required it to reduce her anxiety during treatment. Based on published literature, a transdermal fluoxetine PLO gel was prepared and administered. It was adequately absorbed and reduced the patient's anxiety during her oncology treatments.
A patient receiving radiation therapy developed painful oral lesions that was not responding to different traditional therapies and protocols. A mouth rinse made with the commercial acetylcysteine oral/inhalation solution needed to be used, but it was unflavored and not palatable at all. Stevia and a concentrated flavoring agent was added to the commercial product to make it palatable for the patient and improve compliance.
Conclusion: If a medication is not palatable or in a dosage form that the patient cannot use or take, the treatment is not an option or the patient may be non-compliant. Adding certain excipients to commercial products, using certain techniques, or compounding alternative dosage forms can help meet the medical needs of individual patients.
Learning Objectives:
List ancillary agents or excipients that can be used as masking agents for bitter or bad-tasting medications.
Identify special patient populations that may require alternative compounded dosage forms for treatment.
Describe compounded dosage forms that may be used for patients who cannot take oral medications.
