P41 Pharmacists input in managing paediatric patients on the ketogenic diet
Authors: Deane Lizanne 
Published: April 2023

Aim

One of our aims were to create a reference list with individualised carbohydrate content of oral medications that were regularly used in this cohort of patients. This list would also be tailored to the generic brands that are currently used in our Trust. The second aim was to be able to make interventions whilst these patients are inpatients by using this list. The third aim was to design a visual aid to help other healthcare providers understand which medications were suitable or unsuitable. The last aim was to raise awareness and deliver a presentation to our other paediatric pharmacists who were unaware of these patients.

Methods

First a few drug charts were reviewed retrospectively to see which medications are commonly prescribed for them. Then we made use of a ketogenic diet resource called Matthews Friends to obtain carbohydrate contents of a few medications. Secondly, we referred to the Summary of product characteristics (SmPC), some manufactures do list the carbohydrate contents of their products. Lastly, we contacted individual manufacturers by email and enquired specifically about the carbohydrate content in their products if we were having difficulty in obtaining it. A visual aid was constructed by listing different types of carbohydrates and further categorising medications which are commonly used in pain, constipation, reflux, and seizures. Medications were grouped under these categories based on carbohydrate content.

Results

A total of 40 extra medications were added to our reference list. These included antibiotics, antiepileptic, and other miscellaneous medications. Paediatric pharmacists were able to make more interventions based on this list by advising on alternative formulations. A presentation was delivered at our local weekly paediatric teaching session informing our other pharmacists about these patients. A visual aid was also developed which act as a quick reference to which medications are more acceptable than others.

Conclusion

The ketogenic diet is an effective nonpharmacological treatment for intractable childhood epilepsy.1For a ketogenic diet to be effective a strict control of carbohydrate intake is essential. Many of these patients are only allowed 5–15 g of carbohydrates per day. Careful consideration of carbohydrate content and drug formulation of medications are vital whilst on this diet. Pharmacists play an integral role in minimising amount of carbohydrate in medicines and recommending the use of low or no carbohydrate preparations where suitable.2This can only be achieved by having a reference list. Unfortunately, there is no standard data base, and it is time consuming to compile such a list and it can easily go out of date. The best way forward would be for manufactures to add it to the Summary of product characteristics (SmPC) and patient information leaflets (PIL) in the same way as lactose is listed. This will also enable care givers to make informed decisions regarding medications for their children.

References

Kossoff EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Christina Bergqvist AG, Blackford R,et al. Optimal clinical management of children receiving dietary therapies for epilepsy: updated recommendations of the international ketogenic diet study group.Epilepsia Open2018;3(2):175–92.

Bailey A, McArtney R. Ketogenic diet – information for pharmacists.NPPG Neonatal & Paediatric Pharmacist Group. 2014.