Optimizing oral medications for children

• Published in: Clinical therapeutics 2008-11, Vol.30 (11), p.2120-2132
• Main Authors: Mennella, Julie A., PhD, Beauchamp, Gary K., PhD
• Format: Article
• Language: English
• Subjects: Administration, Oral; Animals; Biological and medical sciences; Child; Child Health Services - standards; children; Dermatitis; Drug Industry - methods; Drug Industry - standards; Drug Monitoring - methods; flavor; Handbooks; Humans; Internal Medicine; Medical Education; Medical sciences; medicines; Odors; Pediatrics; Pediatrics - methods; Pediatrics - standards; Pharmaceutical Preparations - administration & dosage; Pharmaceutical Preparations - chemistry; Pharmacology. Drug treatments; Senses; Taste; Technology, Pharmaceutical - methods; Technology, Pharmaceutical - standards
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2008.11.018

Abstract Background: Active pharmaceutical ingredients that taste bitter and/or irritate the mouth and throat are aversive to children as well as many adults. Effective methods of avoiding unpleasant tastes for adults (eg, encapsulating the medicine in pill, capsule, or tablet form) are problematic because many children cannot or will not swallow these. The unpalatable flavor of the medicine can thwart the benefits of even the most powerful of drugs. Failure to consume medication may do the child harm and can even be life-threatening. Objectives: This article provides an overview of the current knowledge of the sensory capabilities and preferences of children as it relates to flavor, defined here as the combined input of taste, smell, and chemical irritation. The methods used to evaluate flavor perception in children are reviewed. Recent scientific advances are summarized that shed light on why the bitter taste of oral pharmaceuticals is an ongoing formulation problem and how discoveries of novel flavor molecules and modulators of bitter tastes hold considerable promise for the future. Alternative methods for evaluation of the palatability of medicines are described. Methods: The Eunice Kennedy Shriver National Institute of Child Health and Human Development sponsored a Pediatric Formulation Initiative workshop on December 6 and 7, 2005, in Bethesda, Maryland. Information for this article was gathered from literature reviews that were then discussed during this workshop as well as during several conference calls with the Taste and Flavor Working Group members. Terms for the MEDLINE search (1970-2007) included infant, children, taste, olfaction/smell, flavor, chemical senses, palatability, sensory testing, pharmaceutical , and medicines. Results: Children have well-developed sensory systems for detecting tastes, smells, and chemical irritants, and their rejection of unpalatable medications is a reflection of their basic biology. Sugars, salt, and other substances reportedly reduce the bitterness of several pharmaceuticals. Adding pleasant flavor volatiles such as bubble gum may help induce children to consume a medicine, but such volatile compounds are not effective in suppressing the strong bitter tastes associated with some medications. Also, because individual experiences and culture mainly determine which odors are attractive, a universally appealing volatile flavoring agent may be difficult to identify. Sensory panelists who are sensitive to the pediat