How Specials Can Deliver Value to the NHS | Page 12

CASE STUDY 3
A child where the adult
dose was not appropriate

Background
A GP prescribed an anti-inflammatory drug in a dispersible tablet
formulation for a child with arthritis. A week later the mother returned
to the GP because the child was still in pain despite giving the medicine
as directed. The GP found out that the child had been given 50mg dispersible
tablets and parent told to dissolve these in 5ml of water then give the child 1ml
to provide a dose of 10mg. Dispersible tablets are designed to provide the full 50mg
dose. When dispersed in water a lot of the product fell to the bottom of the glass, so
taking 1ml out of the total volume resulted in a variable dose. On testing, this ranged from
between 2mg and 8mg and the 10mg required was rarely achieved. Had the child been given
a properly formulated Special, their pain could have been more adequately controlled.
(Adapted from Tomlin S, et al. Making medicines safe for children – guidance for the use of unlicensed medicine in
paediatric patients. Berkhamsted: MGP Ltd, February 2009)

Child where the adult dose pain relief was not appropriate
LOWEST RISK/PREFERRED CHOICE

UK-licensed medicine

Licensed anti-inflammatory prescribed
in adult dose for treatment of pain relief
in arthritis

Off-label use of UK-licensed medicine
Imported product licensed in (approved) country of origin

UK-manufactured Special
in MHRA-licensed facilities

Liquid formulation provided
controlled pain relief

An extemporaneously dispensed medicine
An imported product not licensed in the country of origin

Crushing or splitting licensed
tabl