US Pharm. 2018;43(5):3.

Specialty pharmacy—a rapidly growing tool in several healthcare sectors—is positioned to serve the healthcare needs of younger patients, too. According to several articles in this month’s Pediatric & Adolescent Health focus issue, the need for pharmacists well versed in handling specialty medications for this population may grow in the coming months and years.

For example, in the CE article, “New Therapeutic Options for the Management of ADHD,” author Clayton English, PharmD, BCPS, BCPP, says that since 2012, new formulations of methylphenidate and amphetamine have been approved for the management of attention-deficit/hyperactivity disorder (ADHD) and that their utility lies in their inherent added dosing flexibility and long-acting options, desirable characteristics for patients with swallowing difficulties. ADHD is a common neurodevelopmental psychiatric disorder that originates in childhood and often persists into adulthood.

One of the newer medications for treating this disorder—ER methylphenidate oral suspension—requires special handling by a pharmacist. Prescribed for children with ADHD who are aged 6 years or older, ER methylphenidate oral suspension is supplied as a powder composed of cationic polymer matrix particles. “The particles bind the racemic mixture of methylphenidate through an ion-exchange mechanism, and reconstitution with water is required prior to dispensing,” Dr. English writes.

Based on clinical trial results, the dispensing complexity may well be worth it. In a double-blind trial phase, patients took part in a dose-optimization open-label phase, after which they were randomized to receive the active optimal dose of ER methylphenidate oral suspension or placebo. After the week of treatment, patients in each group were crossed over and received the opposite product. The primary efficacy outcome was change in the Swanson, Kotkin, Agler, M-Flynn, and Pelham (SKAMP) Rating Scale-Combined score at 4 hours post administration of ER methylphenidate oral suspension, and SKAMP scores were significantly improved with ER methylphenidate oral suspension versus placebo.

Judging by recent trends, the need for more flexibility in medication management is likely to climb. In this issue’s TrendWatch column, titled “Health-Related Office Visits by Children and Adolescents,” Somnath Pal, BS (Pharm), MBA, PhD, reports, “Although 60.5%, 23.7%, and 12.7% of children [aged 12-17 years], respectively, were reported by their parents to be in excellent, very good, or good health, 19.8% had special healthcare needs regarding a chronic medical, behavioral, or developmental condition that affected their functionality.”

So, add medications requiring special handling, along with pharmacist expertise, to the toolkit of strategies for treating patients with ADHD. As Dr. English points out, “Pharmacists can assist in tailoring dosage-form selection to meet the needs of [ADHD] patients requiring stimulant therapy.”

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