P43 Ketogenic diets – how can pharmacy help?

Situation Ketogenic dietary treatments are established, effective, non-pharmacologic for drug resistant childhood epilepsy. They generally consist of a high fat and low carbohydrate diet. Medications, particularly in liquid formulation, often contain potentially significant amounts carbohydrate, upon ingestion, can rapidly reverse ketosis leading to seizure activity. Methods Prior initiation or during the early stages diet, ketogenic diet team seek pharmacy advice on appropriateness individual patient’s medications with overall aim reduce content as much possible. The assessment process consists identifying current brands their indications, further investigating quantities ‘problem’ excipients either by reviewing product information liaising directly manufacturer. Liquid formulations medications, even when marked sugar-free, large other sweetening agents that be sources – although there an increasing number recently launched using no calorific value, thus not concern. Tablets/capsules used they minimal carbohydrate; however, manipulation is required quantity our patients require administration medicines via enteral feeding tube. There many factors consider switching between formulations, which clinicians should made aware, this may influence choice formulation/therapy. For example: Is medication brand specific? Are bioequivalent? Will feed/food interactions differ formulations? Exposure new excipients. Change licensing status. doses achievable formulation? Similarly, use formulation tube pose more issues consideration. example, manipulated administered successfully tube? change pharmacokinetics drug? absorption affected? Relevant COSHH assessment/risks. majority provided will considered off-label unlicensed, it important review literature carefully. Outcome Over previous years, patient cohort has expanded, involvement expertise increased. We have been able play prominent role direct care, offering suitable alternatives regarding medication. vast enquiries received enabled us document build comprehensive internal database (at present we >70 drugs), significantly time taken investigate provide future patients. In 2021 alone 49 enquiries, involving at least 16 over 50 different drugs. Lessons Learned Communication key help decision making dieticians adapt doses/diet allow appropriate friendly formulations. Product SmPC PIL useful resources content, all excipient listed. Bench tests whether practically flushed