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  1. Ceri Gaskell
  1. Bristol Royal Hospital for Children


    Situation Patient I is a 15 year old female with ornithine transcarbamylase deficiency prescribed L-arginine 1.5 g three times daily and sodium benzoate 4.2 g three times daily. By taking her medication and controlling her diet she is able to lead a normal life and does well at school. However she struggles with the palatability of her medication and has not been able to transition to solid dosage forms. She has therefore been stabilised on an unlicensed sodium benzoate liquid and has L-arginine capsules which she takes by opening and dispersing the contents in water. This creates problems for the patient because the volume of sodium benzoate liquid that she needs is very large. This means it has been difficult to come to collect supplies from our pharmacy due to the volume that needs to be carried and transported in one go, and also makes going away on holiday difficult. In addition, the liquid version is more expensive than other options so being able to convert to tablets would be a cost saving measure.

    Background Previous attempts to encourage her to take tablets and alternative options such as licensed sodium phenylbutyrate granules have failed. A recommendation was therefore made by the pharmacist to try using Pill Glide swallowing spray as an aid to help her learn to swallow sodium benzoate tablets, in conjunction with nurse-led teaching. Pill Glide is a flavoured spray that helps patients swallow tablets and capsules more easily. It comes in a number of flavours that patients can choose from and can be used for as long as it is beneficial.

    Outcome Patient I found the spray useful in helping her to swallow sodium benzoate tablets and swallow her L-arginine capsules whole and has now successfully transitioned from using sodium benzoate liquid. This has benefitted the patient by reducing the need collect and transport large volumes of liquid, and by helping her to transition to adulthood. Importantly it has also enabled a significant cost saving, with a saving of £367/month by switching her from liquid sodium benzoate to sodium benzoate tablets and Pill Glide.

    Lessons learned Pill Glide is a useful potential option to help patients who struggle to take solid dosage forms. Liquid medicines are usually much more expensive than tablets and capsules, and therefore helping children with chronic conditions to transition to taking tablets and capsules could be an important cost-saving measure. In addition it could improve compliance in taking medicines where there is no liquid form available or where patients find liquid forms unpalatable. The option of Pill Glide has now been rolled out to other specialties such as renal and respiratory patients where there may also be cost savings and patient benefits for those who find transitioning to solid dosage forms difficult.

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