They’re hard to miss — the overwhelming number of gummy vitamins available for both adults and children. The past decade has seen an explosion in availability of these gummies as an easy way to take vitamins or supplements. But recently, the appropriateness of these dosage forms has been scrutinized, with the sugar content and reliability of delivering accurate doses coming into question. FDA even convened a meeting in October to discuss the benefits and concerns with these “candy-like” medications.
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 kids to take them? I have two children, ages 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 4 years now. She isn’t alone: in one study, the majority of children between the ages of 6 and 11 years were able to learn to swallow a small tablet.
So why do we wait so long to teach children 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 pediatric pharmacist, I meet patients in our pediatric kidney center, 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 pediatric dietitian who I work with 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 in order 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 2 days old can swallow and not choke on mini tablets of 2 mm. 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 FDA to decide on next steps in the definition and regulation of candy-like products, you can work with the parents of your 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 pediatric pharmacist and a clinical professor at Rutgers University’s Ernest Mario School of Pharmacy in New Jersey.
Source link : https://www.medpagetoday.com/opinion/second-opinions/108597
Publish date : 2024-02-06 13:31:02
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