A mini-tablet that dissolves in the mouth in six seconds could radically improve the treatment of heart failure in babies and young children.
The tablet is just 2 mm wide (barely the width of a peppercorn) and contains enalapril, a commonly used drug that lowers blood pressure and improves blood flow to the heart.
It can be introduced into the mouth without the child realizing it, for example while sleeping, where it is dispersed in saliva before being swallowed.
Researchers hope the fast-dissolving tablet, called Aqumeldi, will improve treatment adherence among younger children with heart failure who have difficulty swallowing pills, resulting in fewer symptoms such as shortness of breath and slow growth.
Around 1,400 babies a year in the UK develop heart failure, where the heart becomes too weak to pump blood around the body.
The tablet is just 2mm wide (barely the width of a peppercorn) and contains the commonly used drug enalapril (file image)
Around 1,400 babies a year in the UK develop heart failure, where the heart becomes too weak to pump blood around the body (file image)
This is almost always due to congenital birth defects, such as structural abnormalities in the heart that prevent it from circulating blood properly.
As a result, vital organs, muscles and tissues are deprived of oxygen.
Medications commonly used to treat heart failure in adults include beta blockers to slow the heart and prevent it from exhausting itself; diuretics to help remove excess fluid in the legs and feet that builds up during heart failure; and medications to dilate blood vessels and lower blood pressure, relieving pressure on the heart.
But many of them are large tablets that children find difficult to swallow. Moreover, tests have been carried out mainly on adults, while trials in children have been few (partly because the number of people affected is smaller and because of the ethics of giving experimental drugs to babies).
One solution has been to cut adult pills into pieces to offer smaller doses to young children, but this makes it difficult to get an accurate and safe dose, meaning the medicine might not be effective or cause side effects.
A child-friendly form of one of the main heart failure medicines, called Entresto, is available on the NHS as granules that are sprinkled on soft foods (such as yoghurt) for children to eat. However, this is dependent on them finishing their meal to receive the full dose.
Commonly used drugs to treat heart failure in adults include beta-blockers to slow the heart and stop it from exhausting itself, but this new tablet is called enalapril (file image)
But drug companies hope the new mini-tablet could be a better alternative to enalapril (File image)
The new mini-pill could be a better alternative. Proveca Pharma, the Manchester-based company that makes it, says it uses nanotechnology to compress the necessary drug particles into a more compact formula.
Aqumeldi has been approved by the Medicines and Healthcare products Regulatory Agency. Several NHS trusts in Leicester were the first to prescribe it and others are expected to follow suit.
A recent trial at Heinrich Heine University in Düsseldorf, Germany, in which Aqumeldi was administered to 89 children with heart failure, showed that it consistently delivered the prescribed dose accurately and was easy to use.
Commenting on the development, Stephen Tomlin, Director of the Paediatric Medicines Centre at Great Ormond Street Hospital, said: “Most new medicines are not tested in children and are not formulated appropriately for them. Using a dispersible mini-drug like this is fantastic as it allows children to take an easy-to-use pill without needing to swallow it.”
