Omar's Case

Omar's Case

Omar is an athletic, 14 year-old boy who loves to play football. Over the past year, however, he has had several episodes of tonsillitis, which have affected his school performance and caused him to miss important football matches. When his tonsils are infected, Omar is easily fatigued and his breathing becomes more difficult, giving him restless nights. His physician decides to remove the tonsils when Omar experiences yet another episode of tonsillitis.

The Challenge
When Omar recovers from surgery and the anaesthetic effect weakens, his throat starts to hurt badly. His physician does not want to prescribe a painkiller that contains either acetylsalicylic acid (associated with an increased risk of post-operative bleeding) or paracetamol associated with an increased risk of post-operative nausea [1].

[1] Rømsing J, Østergaard D, Drozdziewicz D et al. Diclofenac or acetaminophen for analgesia in paediatric tonsillectomy outpatients. Acta Anaesthesiologica Scandinavica. 2000; 44(3):291-95.

Diclofenac seems the most suitable option. Since Omar will not be able to swallow a solid dosage for a couple of days following surgery, his physician decides to prescribe suppositories. Omar is going through puberty, however, and feels uncomfortable with this route of administration. His physician therefore consults the hospital pharmacy about compounding a diclofenac suspension, although he is a little worried about diclofenac’s very bitter taste.

The Solution
Omar’s physician calls the hospital pharmacist and explains his concerns. The pharmacist is quick to respond, as she has recently added Fagron’s Diclofenac sodium & SyrSpend® SF PH4 kit to her stock. The pharmacy can compound a 5 mg/ml diclofenac suspension within minutes. The kit comes with pre-weighed diclofenac, which can be compounded directly into the patient dispenser, preventing compounding errors and saving valuable time in the pharmacy. The kit has a three-year shelf life, so it is always in stock.

SyrSpend® SF PH4 is a sweetened, starch-based suspension that has excellent taste-masking properties and a neutral flavor. It is therefore highly suitable for compounding with bitter-tasting diclofenac. A flavor concentrate can be added to customize the suspension to Omar’s liking. The suspension form further allows the physician to customize the dose of diclofenac to Omar’s specific needs. As it is stored in the refrigerator, the suspension also helps to soothe his sore throat.

The Cure
Three days after surgery, Omar’s throat is healing successfully. The pain has eased and Omar has switched to incidental oral paracetamol. He is expected to make a full recovery in time to play for his team against its biggest rival next Saturday!