How Specials Can Deliver Value to the NHS | Page 18

CASE STUDY 6 Child where licensed product was not suitable Background A two-year-old child was diagnosed with reflux and was prescribed a proton-pump inhibitor, with instructions provided to the parents to dissolve the tablet in 5ml of water prior to administration, as per the instructions on the patient information leaflet. The child’s parents followed the instructions and tried to dissolve the tablets. Every time the parents tried to give the child the medicine they spat it out. The parents persevered, but the child refused to take the medicine. The child continued to suffer from pain, particularly at night, which caused distress to the child and the parents. In desperation, after two weeks of interrupted sleep, the parents returned to the prescriber. The prescriber then prescribed the proton-pump inhibitor as a suspension. The child took the medicine and their symptoms improved, especially at night. For many other patients the licensed proton-pump inhibitor soluble tablets are the most suitable option. For this child, the proton-pump inhibitor suspension manufactured as an unlicensed Special was the most appropriate option, as it was palatable and easy for the parents to administer. In addition, the child successfully took the dose and no longer spat out the medication. Child with reflux LOWEST RISK/PREFERRED CHOICE UK-licensed medicine Licensed liquid formulation prepared by dissolving tablets. Bitter taste resulted in child’s refusal to take medication resulting in increased pain, particularly at night time. Off-label use of UK-licensed medicine Imported product licensed in (approved) country of origin UK-manufactured Special in MHRA-licensed facilities An extemporaneously dispensed medicine An imported product not licensed in the country of origin Crushing or splitting licensed tablets or capsules A non-UK-made unlicensed medicine or food supplement HIGHEST RISK/LAST CHOICE Adapted from RPS practical guidelines on supplying Specials Hierarchy may alter in particular patient groups; for example, neonates 18 Liquid suspension formulated and symptoms relieved