Author: Fantus, Bernard, 1874-1940
Professor of Pharmacology and Therapeutics, College of
Medicine, University of Illinois, Chicago.
C. V. MOSBY COMPANY
Copyright 1915, by C. V. Mosby Company
C. V. Mosby Company
CANDY MEDICATION has given such delightful results in practice among children that the author believes it should be more widely known and used. A formulary to serve as the common meeting ground for the prescribing physician and the dispensing pharmacist seems absolutely necessary to make this form of medication more generally available; and it is mainly to supply this formulary that this little book has been published.
Researches conducted by the author in the Pharmacologic Laboratory of the University of Illinois during the past five years, as well as the experience gained by the use of this form of medication in private practice, form the basis of this publication.
To give the best results, the sweet tablets described in this formulary should be freshly prepared on physician’s order; thereby securing efficiency and palatability to the highest degree, and enabling the physician to prescribe the dose and combination needed for the particular case in hand. To bring these tablets into the category of extemporaneous preparations, the author has elaborated the process of “fat covering” which makes the preparation of these tablets no more difficult than the making of pills or of suppositories.
In the pages that precede the formulary, an attempt has been made to present the principles that have been used in the elaboration of the formulae, so that formulae for other medicaments suitable to this form of administration may be developed.
Concise directions on the care and use of the tablet machine have been included, to enable any pharmacist equipped with an inexpensive tablet machine to prepare these tablets without difficulty.
The author is keenly aware of the fact that there are probably still some imperfections in the formulae given herein; though he has spared neither time nor labor in making them as perfect as possible. Therefore, comments and criticisms, as well as suggestions, are most welcome, and will receive careful consideration.
It is the author’s hope that this booklet may be instrumental in robbing childhood of one of its terrors, namely, nasty medicine; that it may lessen the difficulties experienced by nurse and mother in giving medicament to the sick child; and help to make the doctor more popular with the little ones.
BERNARD FANTUS, M.D.
Chicago, March, 1915.
|III.||The Uses of Sweet Tablets||16|
|IV.||The Making of Sweet Tablets||23|
|V.||The Tablet Machine||27|
|VI.||The Construction of Formulae for Sweet Tablets||31|
|Choice of Flavor||31|
|Subduing of Tastes||31|
|Choice of Color||34|
|VII.||Formulae for the Preparation of Sweet Tablets||35|
|VIII.||Formulae for Stock Preparations||72|
THE IDEA of presenting medicine in candy form is really very old. The term confection, which originally meant a medicinal compound being derived from the Latin word “conficere,” to put together, has been applied since the days of classical antiquity to mixtures of medicinal substances with saccharine matter. The only official relics of this once very extensive class of preparations are the confection of rose and the confection of senna; both of which, however, are also practically obsolete. The reason for this is not difficult to find. Neither of them come up to our modern ideas of a confection. We may officially call them a confection, but a youngster would be disrespectful enough to disagree with the pharmacopoeia.
More closely akin to candy are lozenges, and yet they are not real candy. The only one among them that is pleasant is the santonin lozenge; and it is the only one that is popular. An especially good imitation of candy form are the deservedly popular so-called German worm lozenges. It was acquaintance with these that led the writer to seek for other real candy medicaments. He could find only two such upon the market: viz., Calomel Tablets under the name of “Aromatic Calomel,” and Phenolphthalein Tablets under various fanciful trade-names, such as “Purgen,” “Phenolax,” etc., unless “Candy Cathartic Cascarets,” and the French candy laxative known as “Tamar Indien” were also to be included.
Convinced that administration in candy form would be ideal for children, the author took a number of years ago a course of instruction with a candy-maker, in the hope of finding in the confectioner’s art some new form of pleasant administration for medicine. He made sulphur taffy and cod-liver oil chocolate creams; but these and a large number of other attempts were unsuccessful. It may be of interest, in this connection, to note that, in 1911, Sir James Sawyer published in “The Lancet” a process for the production of what he calls “cremulae” or medicated chocolate creams. They were prepared by evaporating a mixture of sugar and of milk to the consistency of paste, in which various medicaments might be incorporated, and which is then covered with chocolate, as in the popular chocolate drop. This is, as will be seen, a troublesome process. The author’s studies in the candy shop seemed to point to “fondant” as the most suitable candy form for purposes of medication. “Fondant”, however, has the disadvantage of becoming hard with age. Free from this objection and closely similar to the “fondant” is a rather lightly compressed tablet made of finely powdered cane sugar. And so finally the tablet form was chosen as the best and most convenient for candy medication—a form which was already in successful use, as has been stated, for the administration of calomel and of phenolphthalein. For such tablets the term tabellae dulces, or sweet tablets, might be proposed.
TO BE SUCCESSFUL, sweet tablets must meet the following requirements:
1. They must be perfectly delicious sweets, attractive in form, color, and odor; and free from the slightest suspicion of disagreeable or medicinal taste.
2. They must disintegrate rapidly in the mouth; for a sick child will usually not suck candy as a healthy youngster would.
3. To constitute a real advance in therapeutics, it must be possible for the average pharmacist to prepare them extemporaneously, so that the physician may be able to fit the medicament to suit the case, and that the pharmacist may not be forced to carry in stock a large assortment of these more or less perishable goods.
In view of these exacting requirements, it may seem remarkable that over fifty different medicaments are at present available for administration in the form of sweet tablets. This has been accomplished by taking advantage of the fact that some medicines are practically tasteless; that modern synthetic chemistry has enriched our resources in this direction by the production of a large number of tasteless, or almost tasteless, and yet active substances; and that many of the isolated active principles of drugs are easily disguised. In some cases a chemical trick is successful, e. g., using a little alkali or a little acid to render the substance less soluble in the mouth. Some of the bitterest alkaloids, e.g., strychnine, have been rendered available for candy medication by the use of finely powdered fuller’s earth, or of Lloyd’s Reagent, to be described later. Quite a number of almost insoluble substances of slight but lingering taste can be made perfectly pleasant by saccharinization.
THE USES OF SWEET TABLETS.
IT MAY seem strange that modern pharmacy which boasts of so many elegant and palatable preparations suitable for adults, has thus far done so little to render medicine more acceptable to children; and yet attractiveness and palatability are even more important for the little ones than for the grown-ups. Syrups have hitherto been our chief aids in making medicines more pleasant for children. Unfortunately, however, many a child has had its palate offended by liquid medicines to such a degree that it abhors spoon-medicine of any kind, and will struggle even against the most palatable. When one witnesses the struggling of the average child against the average medicine, one cannot but wonder whether at times the struggle does not do more harm than the medicine can do good, and wish that we had other means of administering medicines to the little ones. As all children love candy, this would seem the form most desirable for them. For one who has not used candy medication there is a revelation in store in the positive enjoyment and eagerness with which children take these sweet tablets. And many a petted child that has grown up into a sensitive woman, who believes she cannot swallow a pill, also cannot and will not take medicine. It so happens that just these are often excessively fond of candy and will take candy medicine. Another use for candy medication is in the treatment of the insane, who frequently will not take medicine, but may take it in candy form.
It may be of interest to see how many indications may be met, confining oneself entirely to the list of candy medicaments:
1. For effect upon the alimentary tract:
Bismuth Subnitrate or subcarbonate.
Bismuth Subnitrate or Subcarbonate.
Mercury with Chalk.
Resin of Podophyllum.
Resin of Jalap.
Lactic acid ferment.
2. For effect upon the respiratory system:
3. For effect upon the circulatory system:
4. For effect upon genito-urinary system:
5. For effect upon skin:
6. For effect upon nervous system:
Iron carbonate, saccharated.
Iron, quinine, strychnine.
In Rheumatic Fever:
Acetylsalicylic acid (Aspirin).
Of course, a large variety of combinations of these could be elaborated.
It, therefore, seems established that we have, in candy medication, a method of fairly extensive applicability; an almost complete therapeutic armamentarium of the greatest possible value in the treatment of children. For the tiny infant this method is, of course, unsuitable as well as unnecessary. As soon, however, as the youngster commences to know what candy is, it is ready for candy medication. It is particularly during the ages of from three to ten that this form of administration is indicated.
Several objections have been raised against this method. Perhaps the most serious one lies in the danger of poisoning, from the fact that children enjoy these tablets so much that they are likely to eat a large number of them at one time, should the mother be careless enough to leave them within reach. The only way to prevent such an occurrence is not to prescribe more tablets than would constitute a safe dose should all of them be taken at one time. It is better to have the patient get a new supply daily than to have a single case of death or serious disturbance occur from this source.
Another objection that has been raised is that the dose of some of the medicines is very small. In the case of such remedies as sulphur and chalk the author admits that the dose is perhaps too small to be of practical importance. In the case of most other medicaments, however, the smallness of dose is of advantage rather than of disadvantage, in that it necessitates administration at short intervals. If the administration of small doses frequently repeated until the desired effect is obtained is a good principle in practice, it is particularly so in pediatrics. For are not all the vital processes of the child much more rapid than those of the adult; are not its bowel movements, its urinations more frequent, does it not need nourishment more often? Then why not medicine?
THE MAKING OF SWEET TABLETS.
IT IS GENERALLY supposed that tablet making is an art, requiring special expertness and expensive machinery. Now while both of these ideas are correct when the preparation of a large variety of tablets and of large quantities is contemplated, they are erroneous in regard to the making of prescription quantities of these sweet tablets, which present a comparatively simple and relatively uniform problem in tablet making.
Though the process of making moulded tablets was introduced by Dr. Robert M. Fuller of New York before the Academy of Medicine on February 21, 1878, in a paper entitled: “Dose-Dispensing Simplified,” the simplification was evidently not such that druggists could notice it; for moulded tablets have not become popular among them, perhaps mainly because they require drying. Likewise are compressed tablets, which were introduced even earlier by Professor Brockeden of England in 1844, considered unsuitable for extemporaneous preparation, as granulation of the powder by moistening is believed to be necessary; and this, of course, also requires drying.
A step in the direction of rendering tablet making available for extemporaneous preparation was made in 1909 by A. Schleimer by advocating the use of cacao butter in lieu of granulation of the powder and subsequent drying. This brings tablets into the category of extemporaneous preparations. All that is necessary is to add three percent of cacao butter to the powder, and it is ready for immediate compression in a tablet machine. Having found that cacao butter is liable to become rancid on keeping of some tablets made with it, the author experimented to find a substitute devoid of this tendency, and found it in paraffin of low melting point. For tablets that are not to be kept for any length of time, cacao butter is preferable, as it melts readily and is digestible. The amount of paraffin, however, that enters into the composition of each tablet is so small that in spite of its indigestibility, it seems that it could not meet with any but theoretic objection. Either of these materials, in form of fine shavings, is added to the extent of three to five per cent. with just sufficient trituration to distribute fairly well. Excessive trituration lessens the efficiency of the lubricating agent. If the tablet has a tendency to stick to the punches, the material can be worked better if a little talcum, say three per cent. is added to the powder by stirring it in with a spatula rather than by trituration. This process renders tablet making no more difficult or time-consuming than the making of pills or capsules.
The author has succeeded in still further simplifying the process by the preparation