When a Spoonful of Sugar Isn’t Enough
Addressing the special needs of autism patients
By Guest Blogger Tricia Heitman, PharmD
Caring for a child with autism can be overwhelming. Contributing to the challenge is the fact that the very characteristics of autism make it exceedingly difficult to treat the symptoms, or simply help the child to feel better. Because of the extreme sensory and dietary issues experienced by many autistic patients, each child will have his or her own set of unique likes, dislikes, allergies and food intolerances that make commercially-prepared medications difficult or impossible to administer. There is, though, a solution through pharmacy compounding.
Compounding is the art and science of preparing customized medications for patients, and while its practice dates back to the origins of pharmacy, modern technology and research have recently allowed more pharmacists to customize medications to address very specific needs not met by major manufacturers. Compounded dosage forms are most needed by patient groups that don’t respond well to the more widely-available forms of medication, such as pills or injections, and children with autism exemplify this type of patient.
Because of sensory issues, autistic children may have an aversion to cold or things that are hard, such as cough drops. Some will not take liquids, and many cannot or will not swallow capsules or tablets. A child may have an aversion to certain textures, colors or flavors in the medicine being presented. Those attributes are all easily interchanged with compounding, and a compounding pharmacist will be able to customize a medication that is specific to each child’s needs.
Delivery of the medication can be another challenge for parents. Most drugs can be compounded into almost any form, so when capsules or injections are impossible, the pharmacist can provide a different delivery method, such as nasal or sublingual sprays, lozenges, oral suspensions, medicated popsicles or gummy treats. If those aren’t suitable, many medications can be compounded into other innovative forms for oral administration. There are even dosage forms using lollipops and fizzing powders dissolved in water. The possibilities are virtually endless, and the combined expertise of the child’s physician and local compounding pharmacist will determine the ideal choice for each patient.
As another option, there are special “transdermal” creams that can actively carry many drugs, across the skin, into the bloodstream. The parent can usually put it either on the wrist, between the shoulder blades, or the back of the knee because there is good blood flow there and it’s less likely to be rubbed off. Your compounding pharmacist can determine if your child’s medication is appropriate for this delivery method.
Gastrointestinal problems accompany almost all cases of autism, so specialized diets play a significant role in many treatment plans. Many children respond particularly well to diets that are free of gluten, casein (milk), dyes, preservatives, sugar, soy, eggs, carbohydrates, or any allergen specific to the patient. Some children with autism are restricted to a diet called The Specific Carbohydrate Diet, by Elaine Gotschell, while others follow The Gluten and Casein Free Diet. In either case, it can be very difficult to find commercially-available medication that meets dietary restrictions. Fortunately, compounding pharmacists are able to work within the parameters of almost any diet or food sensitivity.
Nutritional support is one of the first aspects of autism treatment, and many biomedical practitioners that take a more holistic approach will start with a specialized diet and then move to supplements. This usually involves a long list, including pharmaceutical-grade multivitamins, fish oil, probiotics, enzymes, amino acids, magnesium, zinc and others. Some children require more than 10 supplements a day, but if they won’t swallow capsules, already stressed parents can be thrown into a panic. Compounders can help by offering individualized vitamin or amino acid mixtures, and flavored syrups into which all of the daily supplements can be mixed and then administered without incident.
Parents struggling to give medication or nutritional supplements to a child with autism might ask their doctor: “Is this a situation where compounding might help?” To find a pharmacy nearby, go to www.findacompounder.com. The site also offers tips and questions for finding the perfect compounding pharmacy for your family. Taking the time to find a compounder in your area can help to make your life a little easier.
Patricia Heitman, PharmD, graduated from the University of Houston College of Pharmacy in 1999 and completed her PharmD residency there in 2000. She is now a full-time pharmacy consultant with Professional Compounding Centers of America (PCCA), Her passions include pediatric compounding, especially the treatment of autism, and women’s health.