Sweet success - making a bitter pill easier to swallow

Researchers from Perth Children’s Hospital (PCH) and The University of Western Australia (UWA) have successfully trialled a new approach to the problem of convincing reluctant young patients to swallow bitter-tasting medication before their surgery. 

The team conducted a clinical trial over a 28-month period to assess the taste, tolerability and absorption rates of the chocolate-tasting, chewable tramadol compared to an oral liquid formulation based on tramadol capsules. 

Tramadol is an opioid pain medication that can be prescribed to treat postoperative pain in children. 

The children who participated in the trial were given the novel chewable tramadol tablet or oral tramadol liquid before anaesthetic was administered.

Led by PCH Consultant Paediatric Anaesthetist and Chair of Paediatric Anaesthesia at UWA Professor Britta von Ungern-Sternberg and UWA Professor of Pharmaceutics Lee Yong Lim, the trial successfully proved you could make bitter drugs taste palatable. 

Professor von Ungern-Sternberg said anaesthetists and other clinical staff regularly encountered challenges due to children’s reluctance or refusal to swallow bitter-tasting medications.

“Some medications can taste horrible which can prove challenging for many children to swallow, particularly for anxious children and those in pain after surgery,” she said.  

The response from participants and their families in the trial was overwhelmingly positive in demonstrating a preference for the new tramadol chewable tablet, which proved more palatable.

Jemma Neal, mother of a chronically ill child and a parent member of PCH’s Anaesthesia Research Consumer Reference Panel, said when you have a child who needs to undergo multiple surgeries, anything that can alleviate stress makes a huge difference.

“Each procedure becomes more traumatic; tramadol tastes horrible and advances such as this can have a massive positive impact.

“I definitely see the value and importance of this and other ideas the team is investigating, in alleviating the anxiety of surgery”, Ms Neal said. 

Laboratory tests also showed that the new formulation achieved absorption rates reflecting more accurate dosing, compared to the liquid formulation which was made from tramadol capsules.

Professor von Ungern-Sternberg said one of the advantages of the tablet used in the trial was that the dosage could be adjusted for children of different sizes and ages, which was significant given there’s no licensed paediatric tramadol formulation currently available in Australia. 

Professor von Ungern-Sternberg said 80 per cent of drugs had no paediatric guidelines nor any formulation for children, making these drugs unavailable for children or only in adult formulations.

Results from the trial could potentially have a wider application, specifically for adult patients who find it difficult to swallow traditional tablets or capsules.

“The trial showed our medication could be easily chewed so it could potentially benefit cancer patients and older people who may struggle to swallow,” she said.  

“Parents who have participated in our study are asking why the use of this medication is not widely available. 

“For some families and carers, trying to give their children unpleasant tasting medication, multiple times a day, can cause significant stress.

“We’ve got the data, we know it is safe and we know it works in helping to address some of the barriers we face with young patients who refuse to take medication so we hope we can make thisformulation more widely available.” 

A paper on the clinical study has been published in the journal, Anaesthesia.