Taste: Does it really matter in oral medications?

Palatability has always been a problem of parents when it comes to giving of medications to their kids. This is one important factor for compliance of medications and therefore affects the length of duration to recovery from illness. Antibiotics are one of the most common problems for compliance because they are the ones with bitter taste.

More than 90% of pediatricians reported that a drug’s taste and palatability were the biggest barriers to completing treatment and that the lack of “child friendly” formulation will have an increase risk of about 40% for avoidable adverse events like giving suboptimal dosing and lack of adherence to medication regimens ¹.

Bitterness reduction and inhibition are important characteristics of a good oral form of medicines which has been progressively achieved in the development of taste‐masked formulations by the Drug Development and Industrial Pharmacy. Proven methods for bitterness reduction and inhibition have resulted in improved palatability and success has been achieved in the development of bitterless, tasteless, and taste‐masked formulations in recent years ².

Cefuroxime is one of those suspension that has bitter taste and has a granular consistency. Taste masking were therefore tried in order for it to be tolerable when swallowed. According to a study done by Du, Zhai etal, orange flavor effectively masked dry suspensions of a bitter drug, cefuroxime axetil ^3. Another study by Schwartz noted that with the chocolate syrup chaser, the aftertaste of cefuroxime axetil was rated as palatable as that of amoxicillin and more palatable than that of cefpodoxime proxetil or clarithromycin ⁴. Moreover, Cefuroxime given twice a day is as effective as amoxicillin/clavulanate three times a day but produces fewer adverse effects.

Various efforts of parents in giving medications leave them with few strategies to try and sometimes leads to frustrations. Here are few tricks that you may find effective and have not tried before.

1. Palatability can sometimes be improved with sweetener by adding sugar, flavor like chocolate with or after taking the medicine, refrigeration, and/or admixture with food/juice. Giving of ice chips before taking medications may also do the trick as it may numb the taste buds. Others would try placing the medicine on a refrigerated or iced spoon.
2. Smaller volumes are also better tolerated, unless dilution would help with the taste ⁵.
3. However, in real practice, the smaller the amount of medicine given the better is the tolerability and compliance.
4. Other methods that may help improve compliance will be to simplify the frequency of dosing like giving it once a day rather than twice a day if prescribing info permits .
5. Lastly, giving medicines by using medication syringes instead of spoon. Thus will have less surface contact of liquid medicine with the tongue.

Once-daily or twice-daily drug administrations are associated with compliance rates greater that 70%.⁵ It is always better to give it once a day as parents may tend to forget because of a lot of household chores or piled up work.

Among the flavors available, study would say that for boys, their preference would be banana-vanilla, orange, lime, and orange-lemon flavors. Whereas for girls, strawberry, grape, banana-pineapple, and strawberry-lemon flavors ⁶ .

So for physicians prescribing medications, it is very helpful therefore that we ask our patients and their parents of their preferred flavor or their struggle in giving medications before writing our prescriptions . And that in the part of the parents, to ask our friendly pharmacists of the flavors available for the prescribed medications. This will lead to less unpleasant experience for the kids and better compliance of medicines to a road to faster recovery time and less stressor to parents.

References:

1. Milne CP, Bruss JB. The economics of pediatric formulation development for off-patent drugs. Clin Ther. 2008;30(11):2133–2145.[PubMed] [Google Scholar] [Ref list]
2. Taste Masking Technologies in Oral Pharmaceuticals: Recent Developments and Approaches. Harmik Sohi, Yasmin Sultana & Roop K. Khar. Drug Development and Industrial Pharmacy. Vol. 30, 2004. Pages 429-448 | Published online: 25 May 2004. https://doi.org/10.1081/DDC-1200374772.
3. Development and evaluation of taste-masked dry suspension of cefuroxime axetil for enhancement of oral bioavailability. Asian Journal of Pharmaceutical SciencesVolume 8, Issue 5, October 2013, Pages 287-294. YuqianDu^a, YngleiZhai^b, JuhongZhang^c, ChunnuanWu^a, CongLuo^a, JinSun^a, ZhongguiHe. https://www.sciencedirect.com/science/article/pii/S1818087613000457
4. Enhancing children's satisfaction with antibiotic therapy: A taste study of several antibiotic suspensions. Richard H.Schwartz. Current Therapeutic Research. Vol 61, Issue 8. August 2000, Pages 570-581.
5. Gardiner P, Dvorkin L. Promoting medication adherence in children. Am Fam Physician. 2006;74(5):793-798. Https://www.uspharmacist.com/article/factors-affecting-adherence-to-oral-liquid-medications.
6. Which syrup flavor pediatric population prefers the most?April 2021. Asian journal of pharmaceutical and clinical research. Doi:10.22159/ajpcr.2021.v14i4.40599