小朋友最怕食藥，若是癌症、長期病患等病童更要承受「苦上加苦」。香港兒童醫院藥劑部團隊花盡心思，想出不同餵藥方法，三招幫助家人應付病童「扭計」不吃藥及不懂吞嚥等問題，以提升藥物依從性，亦保障病童和家長用藥安全。
該院藥劑部部門經理潘文康表示，兒科藥物種類多，但本港市面未必能找到合適的劑型，因此要採用藥丸變藥水等不同調藥方法，甚至要四處搜羅合適的調藥配件。該院藥劑師巫利鴻補充：「如罕見代謝病病童每日要食十數粒維他命，對他們來說非常辛苦，所以我們會按不同情況為其制訂最合適的用藥方法，令病童更易入口。我們亦特設藥療服務中心，為有特別配藥需要的病童和家長講解不同藥物的藥性及副作用、示範正確用法和如何在家中調藥，保障藥物療效及安全性。」
年幼病童易抗拒味道較苦的藥，家人有時需要磨碎藥丸方便服用，味道會更苦澀。其實，個別藥物如治療病童睡眠障礙的褪黑激素可用果汁、奶或乳酪等「送藥」，但家人事先必須諮詢藥劑師，確保不會影響藥物功效。
有長期病患的病童，如心臟病、腎病等一般服用的藥物較多，對於部分不懂吞嚥藥丸的年幼病童，藥劑部會參考外國文獻，在不影響藥物功效的前提下，把藥丸製成藥水。當藥劑師確認藥物名稱及劑量後，配藥員會把適量藥丸放入磨丸機，將其磨成粉末，再用磨缽逐次加入無色調劑，調和成液體及避免粉末沉澱，之後倒入有刻度的量筒之中搖勻，完成後會冷藏存放。
當口服化療藥物沒有合適劑型時，家人或需要在家中為子女磨碎藥丸。為免他們在處理過程中吸入這類高風險藥物的微細粉末，藥劑部從外國引入研磨藥丸及即製藥水的密封式袋子，供其使用。家人可先把所需的藥丸放入密封袋，再把已裝了開水的口服餵藥器對接袋口，然後將藥袋內的藥丸壓碎成微細粉末，再將餵藥器的水注入袋內，待與藥丸粉末混合成藥水，便可用餵藥器抽取適當的份量服用。
團隊表示，該院本著以兒童為本和家庭友善為先，積極改良調藥方法，並計劃與大學合作研究，把更多不同種類的藥丸製成藥水，確保其藥效及穩定性不受影響，亦希望能從科研角度嘗試改變藥水苦澀難吃的味道，盼病童吃到的都是「甜口良藥」！
Taking medicine can be a nightmare for children, especially those suffering from cancers or chronic diseases. The Pharmacy Department of the Hong Kong Children’s Hospital (HKCH) uses three tricks to help child patients who are reluctant or unable to gulp down medicine, in order to enhance their medication adherence and safety.
Freddie Poon, Department Manager (Pharmacy) at HKCH, states that a vast variety of medicines are used in paediatrics, but suitable formulations for children can be lacking in the local market. To cope with this challenge, they have adopted various dispensing methods such as changing pills into with liquid form, and looked around for suitable dispensing equipment. Calvin Mo, Pharmacist of HKCH, adds that, “Children with uncommon inborn errors of metabolism may need to take over a dozen vitamin pills each day, which is painful. To make it easier for them to take the medicines, we design individualised medication regimen based on their specific condition. In addition, our Pharmaceutical Care Centre offers education to patients and parents on the properties and side-effects of different medicines, as well as the proper ways to mix at home, in order to ensure efficacy and safety.”
Young patients tend to say no to bitter medicines, and parents may crush pills into easy-to-swallow bits, which makes them even more bitter. Actually, some medicines can be taken together with juice, milk or yogurt, such as melatonin used for treating sleep disturbances. Still, it is not recommended to randomly choose a drink without seeking advice from a pharmacist, as this may undermine the medicine’s efficacy.
Chronic patients like those with heart and kidney diseases are usually treated with large amount of medicines. To help young patients who cannot swallow pills, the Pharmacy Department would take reference of foreign literature and compound pills into liquid form while maintaining their efficacy. After the pharmacist has verified the name and quantity of the medicine, the dispenser will put the required pills into a grinder. A suspending solution will then be mixed with the powdered pills in a mortar until fully dispersed. Lastly, the mixture will be shaken in a graduated cylinder. The final product will be refrigerated.
When no suitable formulation of oral chemotherapy medicines is available, parents may inevitably need to crush the pills at home. To protect them from inhaling the fine particles of these high-risk medicines during the process, the Pharmacy Department has sourced a sealable pill crusher from overseas. Parents are taught to put the pills in the pouch and connect it with a water-filled syringe. After crushing the pills into powder, they will inject water through the syringe into the pouch and mix with the powder until it is evenly dispersed. The right amount of liquid will be extracted for the children.
Echoing the hospital’s children-centred and family-friendly theme, the team is always looking for ways to improve the medicine-taking experience of patients. In future, studies will be conducted with universities on converting more types of pill into liquid form while retaining their efficacy and stability. They will also explore how to mask the unpleasant and bitter taste of medicines to make them more appealing to children.