Pharmacist Lina Stočkutė-Plytnikė from “Gintarinė Pharmacy” often faces this dilemma when consulting parents about oseltamivir prescribed for flu treatment. This medicine has a bitter taste and can also cause nausea and vomiting, so it is not always easy to administer it to a sick child, according to a press release.
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“Parents have a very practical question – how to agree with a child who is sick with the flu and feeling unwell to take a medicine with an unpleasant taste, and in some cases, the dose may need to be repeated if the child vomits it up. I have experienced this myself. When my daughter had the flu, we agreed that I would administer the medicine with a syringe, and after that, she could eat her favorite candy. Sometimes such a simple agreement greatly facilitates the whole process,” says L. Stočkutė-Plytnikė.
When to repeat the dose and when not to?
According to the pharmacist, when deciding what to do if a child vomits the medicine, one of the first things to consider is the time elapsed since taking it: “It is often recommended to follow the 30-minute rule: if the child vomited the dose within 30 minutes, the same dose is recommended to be repeated, but if more time has passed – not to repeat it. However, I would consider this a general recommendation. Before repeating the dose, it is important to read the specific medicine’s leaflet – some medicines’ instructions specifically indicate what to do if vomiting occurs after taking them.”
The form of the medicine is also important
When assessing how much medicine the body could have absorbed, its form and active substance are also important. Syrup, suspension, tablet, capsule, or extended-release preparation are absorbed by the body over different times.
“Liquid preparations are usually absorbed faster than tablets because they do not need to be broken down. Extended-release medicines work differently – the active substance is released gradually and acts longer. The active substance itself and how the body absorbs the medicine also matter. For example, paracetamol, ibuprofen, some antihistamines such as cetirizine or loratadine are absorbed quite quickly,” explains L. Stočkutė-Plytnikė.
Clues can also be given by what parents notice when the child vomits. If the medicine is clearly visible in the vomit, it is likely that at least part of it was not absorbed. However, even in such a case, it is impossible to determine exactly how much active substance has already entered the body.
If part was spat out – do not repeat the entire dose
Even more uncertainty arises when the child spits out, dribbles from the mouth, or spills only part of the syrup while struggling. Parents may feel safer giving an additional dose, but in such a situation, it is possible to accidentally exceed the prescribed amount.
“If we clearly see that the child spat out the entire dose before swallowing it, in most cases it can be repeated. It is a completely different situation when part of the dose was swallowed and part was spat out or dribbled. It is impossible to determine exactly how much entered the body, so it is better not to give an additional full dose,” warns the pharmacist.
If the child vomits, it is worth changing the form of the medicine
For children who cannot yet swallow tablets, syrups, suspensions, or oral solutions are usually prescribed, which also allow more precise dosing according to the child’s weight. However, if the child vomits strongly, in some cases another form of the medicine may be more suitable.
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“A suppository can be more practical when the child vomits strongly or cannot swallow the oral form of the medicine. For example, paracetamol for children is made both as an oral form and as suppositories. However, their absorption differs, so the effect of suppositories may start more slowly,” emphasizes L. Stočkutė-Plytnikė.
However, one should not independently change one form of medicine to another. This also applies to injections – they are prescribed when the medicine cannot be safely taken orally and such treatment is necessary, and the decision on the appropriate preparation and its form is made by a healthcare professional.
Mixing with a favorite drink is not always a good solution
When a child refuses medicine because of its unpleasant taste, parents sometimes try to hide it in juice, milk, or yogurt. However, this creates another problem: if the child does not eat or drink everything, it will again be unclear what dose of the medicine they actually received.
“It is best to administer the medicine separately first, using an oral syringe. If it is necessary to mask the taste, then a favorite drink can be given afterward, unless the specific medicine’s instructions indicate otherwise,” advises the pharmacist.
Moreover, food and drinks can affect the absorption or effect of some medicines. For example, milk and its products can interfere with the absorption of some active substances, and grapefruit can alter the metabolism of some medicines and thus affect their action. Also, one should not crush or chew tablets or open capsules at their own discretion – especially if the preparation is coated with a special film or designed to release the active substance gradually.
Milliliters are the same, but the medicine dose is different
Liquid medicines should not be measured with a regular kitchen teaspoon – their volume varies, so it is more accurate to use the dosing syringe or special spoon included in the package. However, L. Stočkutė-Plytnikė emphasizes that it is important not only to measure the amount of medicine accurately but also to check the concentration indicated on the package.
“One bottle of 5 ml may contain 100 mg of active substance, another – 200 mg. This means that the same amount of liquid can represent a completely different dose of medicine. This is especially important if this time you bought a preparation with a different concentration than before – then you cannot follow the old dosing instructions,” warns the pharmacist.
According to her, when dosing medicines, it is important not to confuse milligrams with milliliters, and when using a suspension – to check whether it needs to be shaken before measuring the dose. It is also necessary to carefully distinguish between a single dose of medicine and the maximum allowed daily dose.
