Creation of the Ew Meds List-a comprehensive list of bad-tasting liquid medicines

Background The direct link between poor palatability and nonadherence is well-documented. It is essential to assess which medicines are known to be poorly tolerated due to taste, find alternatives that may be more palatable, and highlight home taste-masking interventions to mitigate poor palatability. Objective To increase awareness about medicine palatability, we created the Ew Meds List - a comprehensive list of bad-tasting oral liquid medicines and evidence-based recommendations to mask poor palatability. Methods EMBASE searches were conducted using the terms child, bitter, flavor, masking, and adherence. Articles containing scored medicine taste perception were used to rank medicines to assess eligibility for the Ew Meds List . All scales were aligned to a 5-point Likert scale with 1 being "dislike it very much" and 5 being "like it very much." Medicines scoring less than 2.5 were added to Ew Meds. Medicines scoring 2.5 and above were added to "Better Tasting Meds." Studies with taste-masking evidence related to specific medicines were used to create evidence-based taste-masking recommendations. Pharmaceutics literature provided flavoring recommendations to mask basic taste properties, like bitter or sour. Results Twenty articles contained ranked taste perceptions for 32 medicines. Of those, 18 met criteria as Ew Meds, and 14 for better-tasting meds. Eleven medicines had evidence-based masking recommendations. Additional sections were created to address common taste masking recommendations and food science flavor masking techniques. Conclusion Pharmacists can make medicines more manageable for children by using the guidance provided in the Ew Meds List to improve the palatability of oral liquid medicines, recommend taste masking, or use better-tasting medicines when available. Research is needed to expand this list and document the efficacy of common taste masking practices.