Christchurch Medicines Information Service

• Tablets can be safely crushed or capsules opened and dispersed in liquid or mixed with soft food.
• An alternative route (e.g. buccal, sublingual, transdermal, rectal) is feasible.
• Patients could be taught how to swallow tablets:
  • Difficulty swallowing medicines (Healthify)
  • Encouraging children to swallow tablets or capsules (BPAC)

• Adjusting frequency is appropriate e.g. alternate-day dosing if the medicine has a long half-life.
• Rounding the dose to a half or quarter of a tablet is appropriate.

• Some formulations will disperse in water without crushing, while others need to be crushed first.
• Disperse in 10-20 mL of water and mix well in an oral dispenser.
• Give the mixture, or aliquot of the mixture, immediately.
• Prepare each dose freshly and discard the remainder.

• Use New Zealand standardised formulae whenever possible. These are usually supported by stability data, and reduce the risk of errors due to pharmacies compounding different strengths.

  • https://www.psnz.org.nz/practicesupport/oralliquid
  • https://www.pharmac.govt.nz/pharmaceutical-schedule/extemporaneously-componded-products-and-galenicals/standard-formulae

Modifying a standardised formula should generally be avoided to prevent stability issues.

• However, it is usually acceptable to substitute sugar-containing bases with sugar-free bases (e.g. Ora Blend® with Ora Blend SF®).
• It is not advisable to use a sugar-containing base if the stability study has been done with a sugar-free base as adding sugar may cause chemical instability.
• Use the same brand of pharmaceutical specified in the formula if possible.
• If considering compounding a liquid without stability data, this should be discussed with the prescriber, as there may be risks of inappropriate or inconsistent dosing if the product is unstable.
• To reduce the risk of microbial contamination, a 30-day expiry in the fridge is generally recommended for products containing a preservative, or a 7-day expiry for products without a preservative.

Buffered to pH 4.3

Equivalent to a 1:1 mix of Ora Plus® and Ora Sweet®

Bases available overseas such as SyrSpend SF pH4®, Oral Mix®, Oral Mix SF®, FlavorPlus®, and FlavorSweet® are similar to Ora Blend®

Buffered to pH 4.0 to 4.5

Contains preservatives and sugar (sucrose)

Buffered to pH 4.2

Contains preservatives

Buffered to pH 4.0 to 4.4

Does NOT contain sugar (contains saccharin as sweetener)

Buffered to pH 4.2

Equivalent to 1:1 mix of Ora Plus® and Ora Sweet SF®

Common preservatives are ascorbic acid, benzyl alcohol, metacresol, hydroxybenzoates (parabens), sodium metabisulfite.

Pharmac standard formula: methyl hydroxybenzoate 10% solution. Use 1 mL of the 10% solution per 100 mL of oral liquid mixture.

Pharmac link to Standard Formulae

Common suspending agents are methylcellulose, carboxymethylcellulose, xanthan gum, hypromellose.

Common sweeteners are aspartame, glycerol, saccharin, sorbitol, sucrose (sugar), xylitol

Common buffers are citrate (to maintain acidic conditions), phosphate (to maintain neutral conditions), bicarbonate (to maintain alkaline conditions)