Case studies

A child where the adult dose was not appropriate
A GP prescribed an anti-inflammatory drug in a dispersible tablet formulation for a child with arthritis. A week later the mother returned to the GP because the child was still in pain despite giving the medicine as directed. The GP found out that the child had been given 50mg dispersible tablets and told to dissolve these in 5ml of water then give the child 1ml to provide a dose of 10mg. Dispersible tablets are designed to provide the full 50mg dose. When dispersed in water a lot of the product falls to the bottom of the glass, so taking 1ml out of the total volume resulted in a variable dose. On testing this ranged from between 2mg and 8mg and the 10mg required was rarely achieved. Had the child been given a properly formulated special, their pain could have been more adequately controlled. (adapted from Tomlin S, et al. Making medicines safe for children – guidance for the use of unlicensed medicine in paediatric patients. Berkhamsted: MGP Ltd, February 2009.)

An allergy to an ingredient in the licensed product
A special was required when a patient developed an allergy to benzalkonium chloride, which was used as a preservative in a licensed eye drop. The eye drops were used to treat bacterial infections of the eyelid and eyeball and without treatment the patient could suffer severe loss of sight or, in the worst case, blindness. One of the members of the APSM was able to produce the eye drops without the benzalkonium chloride so that the patient was able to have the treatment they needed.