Liquid Medications: Tips and Tricks to Enhance Palatability by Pharmacist Hootan Melamed

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By default, most liquid medications contain a very bitter taste that is highly unsavory, making it painful for children and, in many cases, causing them to not cooperate when you try to administer these medications.

However, there is a great talent that goes into compounding medications, such that any trained pharmacist can improve these medications using natural or artificial PCCA (Professional Compounding Centers of America) approved flavors, such that these medications become much more savory for both, human and animal consumption.

Important considerations by Hootan Melamed

Pharmacist Hootan Melamed says that there are a number of things to take into consideration when flavoring liquid medication; the most important of which is obviously the flavoring used and how it creates a palatable aroma, because the smell of the medicine plays a big part in how willing the patient is to consume it.

Equally – if not more – important is how the flavors interact with the API (Active Pharmaceutical Ingredient) and the excipients in the medicine. While most flavors used will not damage the effectiveness of the API, the flavor of the API needs to be identified, so that it works well with the flavor used.

Finally, the kind of flavoring used – oil-based or powder-based – is also very important to consider if you – the pharmacist – are compounding the medicine for animals or for humans. For example, medicines for animals are usually oil-based, so that the medication has a longer expiry date.

Most common flavoring agents

The flavoring compounds used for liquid medication are powder-based, water-based or oil-based, and knowing which one to use is an integral part of the compounding process.

Water-based solutions would use water-soluble flavors in concentrations ranging from 1-4% and other flavors can also be used therein to offset the taste of the API as well as to mask each other’s aftertastes. Two of the most popular flavor enhancers used when compounding water-based medicines are: Artificial marshmallow (PCCA #30-2699) and vanilla (PCCA #30-1526 and PCCA #50-3624).

Oil-based flavors can be used in water-based medicines, but would necessitate emulsifying agent to be mixed. These flavors are popular for extending the expiry date and for being far more effective in masking the bitter flavor of the medicine. However, the concentrations for this type of flavoring are much lower, ranging from 0.1-1%.

Most flavoring agents used are artificial, because they have pH 7 which is considered neutral, designed to not affect the effectiveness of the API.

Using flavors

Dr. Hootan Melamed stresses that the effectiveness of the medication is decided by how well the flavors are compounded, so that you can achieve a clean and balanced flavor. Even more important is to keep in mind that none of these artificial flavors have any sweeteners in them, so to achieve the best taste possible from these flavoring agents, the pharmacist has to have the expertise to know precisely what sweeteners to add, so as to offset the strong tastes from the other artificial flavors used.

For reference, the best sweeteners to use are:

  • PCCA #30-4539 (Steviol Glycosides)

  • PCCA #30-4398 (Acesulfame Potassium FCC)

  • PCCA #30-1466 (Saccharin Sodium USP Dihydrate)

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