Orally dissolving film strips could pose hazard to kids

Have you seen or even purchased one of the commercially-available thin film strip products intended for use as mouth fresheners? Products like Meltz Super Thin Mints and Listerine PocketPaks are packaged in a small container that allows removal of one flavored strip at a time. They’re about the size of a postage stamp. Once placed in the mouth the strip dissolves immediately. These can be carried easily in a purse or briefcase for convenient use after a meal or coffee.

by Michael R. Cohen, R.Ph.

Published Oct. 7, 2013, 10:01 a.m. ET

Have you seen or even purchased one of the commercially-available thin film strip products intended for use as mouth fresheners? Products like Meltz Super Thin Mints and Listerine PocketPaks are packaged in a small container that allows removal of one flavored strip at a time. They're about the size of a postage stamp. Once placed in the mouth the strip dissolves immediately. These can be carried easily in a purse or briefcase for convenient use after a meal or coffee.

It's important to know that the same technology is now being used for some medications too. Formerly available only as tablets or capsules, products like simethicone (Gas-X Thin Strips®), and melatonin, a natural sleep aid, come this way. There are also two prescription film strip products on the market, Zuplenz, for nausea and vomiting and Suboxone, for treatment of opioid dependence in adults. I'm hearing too that more prescription products and even a vaccine that uses this technology might be on the way. Benadryl, Theraflu and Children's Triaminic were available over-the-counter in film strips but have since been discontinued, probably because of poor sales. Other film strip products are currently in development.

I mention all this because all of these products are flavored and may be attractive to children. This past week a mother contacted us to let us know that a child at her son's school shared what he thought were breath mint film strips with several children before it was recognized that the film strips actually contained melatonin, a hormone produced by the body that's involved in the management of sleep and wake cycles. The product is more of a dietary supplement than a drug. It's available over-the-counter in strip form and the containers look just like the widely-available breath mint strips.

Fortunately, melatonin is unlikely to be toxic to anyone at almost any dose and none of the children who placed strips in their mouth were harmed. Most concerning would be Suboxone, which was introduced recently to replace the "unsafe" pill form at about the same time the patent ran out on the Suboxone tablet. The strips are packaged individually but I wouldn't be surprised to learn that a child was able to get into a package to remove the strip.

The melatonin case is similar to another situation I wrote about this year where a group of 9- and 10-year old children were taken to hospitals after they had ingested what they thought were breath mints but were actually nicotine replacement lozenges. The "mints" had also been brought to school by a classmate.

It's easy to see how patients, especially children, can mistake medicated oral film strips with breath mints as the packaging looks similar and both are advertised in various flavors. While this dosage form offers convenience and ease of administration to patients who can't easily swallow pills, we all know that kids like to mimic adult behaviors. So please, use caution and treat strips that contain drug or natural substances like any other medication. Secure purses and drug storage and don't refer to them as candy. If you are the one using them, don't do it in front of children.