Do difficulties in swallowing medication impede the use of hydroxyurea in children?

Use of hydroxyurea (HU) in children with sickle cell disease (SCD) may be hampered by its formulation as a capsule and the limited availability of liquid HU.

At four Pediatric SCD clinics, parents of children with SCD ages 5-17 years were surveyed about their children's medication use and ability to swallow medication. Data were stratified by HU therapy and analyzed using descriptive statistics, Chi square tests, Fisher exact tests and univariate analysis.

Of the 116 parents surveyed, 97% were the primary caregiver. One fourth (26%) of parents reported that their child's difficulty swallowing medication interfered with daily medication use. Age-related differences were found in ability to swallow medication, but not by HU use. Children taking HU were more likely to take multiple daily medications, with more frequent dosing schedules. Among 65 HU users, children using the liquid formulation (28%, n = 18) were younger than capsule users (P < 0.0001). Nonetheless, half of liquid HU users were aged 8-13. Children using liquid HU were more likely to have difficulties swallowing medication than those who use HU capsules (OR 4.29, 95% CI 1.14-16.18, P = 0.032). Few had received training for swallowing medication.

One fourth of surveyed parents viewed swallowing as challenging to daily medication use. These findings suggest that difficulty swallowing capsules is a fairly frequent barrier to for children prescribed HU, especially for younger children. HU use appears more likely in families with daily and more complex medication schedules. Coaching for swallowing capsules may improve HU utilization and adherence.