NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Kid's corner: Specials

Kid’s Corner: Specials

Specials may be required if a particular preparation is required but not available; for example a liquid for an unusual dose, or to overcome swallowing difficulties; or where a patient has an allergy, intolerance or be unsuitable for an ingredient, eg alcohol as an ingredient for an infant.

 

Specials are made to varying formulations by different companies (the exact contents can differ every time) and may have very limited safety, stability or efficacy testing. As these are not licensed products, there are liability implications for those involved in prescribing and dispensing. NHSGGC has issued detailed guidance.

 

Paediatric “special” prescriptions

It is important to ensure continuity of supply when children have been started on specials in Yorkhill Hospital. Continuing on the same strength reduces the potential for dose errors. Yorkhill try to limit the range of different strengths used to one per product where possible. This allows staff, parents and carers to become familiar with a single product. Yorkhill pharmacy issue a letter to parents to give to their community pharmacy with information on strength and supplier for the special required for their child. Other paediatric units have similar policies.

 

Calcium carbonate case study

Calcium carbonate preparations are used as phosphate binders in patients with chronic kidney disease. There are several licensed preparations available but not all are suitable for children. The first choice for young children is dispersible calcium carbonate 250mg tablet. Although unlicensed, this is a more suitable strength and form for children who can be as young as six months old.

 

A three year old boy was discharged on dispersible calcium carbonate 250mg tablets, one tablet three times a day; and a month’s supply was given on discharge. At clinic follow up, his mum said that they were struggling to give the medication. It was no longer a small dispersible tablet, but a large pink tablet which they had to half and he had to chew. It transpired that the GP had prescribed Calcium 500®; half a tablet with each meal. The GP has inadvertently prescribed two and a half times the intended dose. This was resolved by discussion with the GP and the child was prescribed the correct dose and formulation.

 

Communications links with GPs and community pharmacists have been improved to minimise the risk of mis-selection of calcium carbonate preparations.

 

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