From the Guidelines
Methotrexate tablets can be made more palatable for small children by crushing the tablets and mixing them with a small amount of sweet food or using flavored suspensions, as suggested in the most recent guidelines 1. To improve the palatability of methotrexate tablets for small children, several strategies can be employed.
- Crushing the tablet and mixing it with a small amount of sweet food like applesauce, chocolate syrup, or jam can mask the bitter taste.
- Asking the pharmacist about flavored suspensions of methotrexate that are commercially available or can be specially compounded is another option.
- Some parents find success with having children suck on an ice pop before taking the medication to numb taste buds, or offering a favorite drink immediately after administration. It's crucial to never modify extended-release formulations and to consult with the child's healthcare provider before altering any medication, as methotrexate requires precise dosing for conditions like juvenile arthritis or leukemia 1. If palatability remains an issue despite these strategies, discussing alternative administration routes such as injectable forms with the doctor may be necessary, considering the benefits of parenteral administration of methotrexate, which likely results in higher bioavailability and may increase efficacy 1. Always administering the entire dose is essential to ensure proper treatment, and folic acid supplementation is recommended during treatment with methotrexate to mitigate drug-related adverse effects 1.
From the Research
Palatability of Methotrexate Tablets for Small Children
- Methotrexate tablets can be made more palatable for small children by considering the design of the formulation and its palatability 2.
- Palatability is defined as the overall appreciation of an oral medicinal product in relation to its smell, taste, aftertaste, and feeling in the mouth 2.
- 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 3.
- Sugars, salt, and other substances can reduce the bitterness of several pharmaceuticals, and adding pleasant flavor volatiles such as bubble gum may help induce children to consume a medicine 3.
Alternative Formulations
- Liquid oral formulations, such as a methotrexate solution, can be a more palatable option for children than tablets 4.
- A study found that a methotrexate solution composed of injectable methotrexate, water, Ora Sweet, and sodium bicarbonate was stable for at least 120 days and had a pleasant formulation 4.
- However, there is no direct evidence on making methotrexate tablets more palatable for small children, but alternative formulations such as liquid oral solutions can be considered 4.
Considerations for Pediatric Medications
- The development of oral pediatric forms by the pharmaceutical industry is still insufficient, and more research is needed to create palatable and effective medications for children 2, 3.
- Sensory panelists who are sensitive to the pediatric palate, and new techniques involving animal models, isolated parts of the receptor cells, and electronic devices that detect taste and flavor can be used to evaluate the palatability of medications and predict compliance among pediatric populations 3.