New oral liquids are hitting the market – here’s what to expect for your pharmacy.
In this episode, TRC Healthcare Associate Editor and Clinical Pharmacist Vickie Danaher, PharmD, discusses a growing wave of first-time oral liquid formulations for familiar medications, including ADHD therapies, diabetes meds, antihypertensives, and more. She breaks down why these liquid options are emerging, which patients may benefit most, and what pharmacists and technicians need to watch for when dispensing.
You’ll hear practical insights on dosing, storage, and stability, along with counseling pearls and pitfalls that commonly lead to medication errors. Plus, Vickie highlights cost considerations and key distinctions between liquid products and their tablet or capsule counterparts, helping pharmacy teams stay ahead as these formulations become more common in practice.
This is an excerpt from our November 2025 Pharmacy Essential Updates continuing education webinar series.
CE Information:
TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.
Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights:
- Article: Look Out for First-Time Rx Oral Liquids
- Article: Include Directions for Oral Liquid Meds in “mL”
- Technician Tutorial: Oral Dosage Forms
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Transcript:
This transcript is automatically generated.
00:00:04 Narrator
Welcome to Clinical Capsules from TRC Healthcare, your trusted source for practical, evidence-based updates.
00:00:10 Narrator
On this episode, Associate Editor and Clinical Pharmacist Vickie Danaher breaks down a surge of newly approved first-time oral liquid formulations for common medications.
00:00:22 Narrator
She shares where they fit into practice, dosing and storage considerations, and other key things healthcare professionals need to know before dispensing in an excerpt from our popular Pharmacy Essential Updates webinar series.
00:00:34 Narrator
This podcast offers Continuing Education credit for pharmacists and pharmacy technicians. Please log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:00:48 Narrator
None of the speakers have anything to disclose.
00:00:51 Narrator
Catch new episodes of Clinical Capsules every 2nd and 4th Tuesday—bringing concise, actionable insights from TRC experts straight to your ears.
00:01:00 Narrator
Let’s take a closer look…
00:01:07 Vickie Danaher
Now let’s focus on new drugs and discuss several recently approved oral liquid formulations that you might start seeing prescriptions for or have patients asking about.
00:01:19 Vickie Danaher
And as we’ve been monitoring what new drugs and dosage forms are being approved, we notice an interesting trend, which is that many common medications that have traditionally only been available as tablets or capsules are now being introduced in liquid formulations for the first time.
00:01:34 Vickie Danaher
So our article on this topic says more meds will be available as first-time oral liquids.
00:01:41 Vickie Danaher
For example, there will now be oral suspensions for hydrochlorothiazide, lamotrigine, and losartan, as well as oral solutions of hydrocortisone, lisdexamfetamine dimesylate, ramipril, sitagliptin, and trazodone.
00:01:58 Vickie Danaher
For each of these, we’ll discuss their clinical applications and dispensing considerations in just a bit.
00:02:02 Vickie Danaher
But before we do that, one question that popped into my mind was why are we suddenly seeing so many common medications becoming available as oral liquids for the first time?
00:02:13 Vickie Danaher
And I think this is being driven by several factors.
00:02:16 Vickie Danaher
For instance, oral liquid dosage forms provide more options for patients with dysphagia or difficulty swallowing pills, especially in our older patients or pediatric patient populations.
00:02:28 Vickie Danaher
Oftentimes, we know that these patients have had to crush tablets or open capsules, which can affect drug stability and dosing accuracy.
00:02:36 Vickie Danaher
In general, commercially available liquid formulations can also reduce the need for compounding, which can decrease preparation time and potential variations in the final product.
00:02:48 Vickie Danaher
They also allow for more flexible dosing and often contain flavoring agents to improve palatability or tolerability.
00:02:58 Vickie Danaher
On the other hand, there are some notable disadvantages of oral liquid dosage forms.
00:03:03 Vickie Danaher
For instance, they carry a higher risk of dosing or measurement errors compared to solid dosage forms, and they usually cost more than their tablet or capsule counterparts.
00:03:13 Vickie Danaher
So we should anticipate prior authorizations and be ready to help patients navigate that process.
00:03:20 Vickie Danaher
Oral liquids typically are also less stable and have shorter half-lives.
00:03:25 Vickie Danaher
And they’re less portable and more challenging to store than tablets or capsules, since they may have more stringent storage requirements such as refrigeration.
00:03:35 Vickie Danaher
So all of these things are factors to consider when thinking about whether an oral liquid dosage form may be more appropriate than a tablet or capsule for a specific patient.
00:03:46 Vickie Danaher
Now let’s dive into each of the new oral liquids and key points to be aware of in terms of their approved indication, dosing, and stability.
00:03:53 Vickie Danaher
And we can begin with the first lisdexamfetamine dimesylate oral liquid approved, which comes as a 10 milligram per mL oral solution and goes by the brand name Arynta.
00:04:06 Vickie Danaher
And we could think of this as the liquid version of Vyvanse, which is available in capsules or chewable tablets, as well as generically.
00:04:16 Vickie Danaher
Lisdexamfetamine dimesylate oral solution is approved for ADHD in patients six years and older, as well as binge eating disorder in adults.
00:04:26 Vickie Danaher
And like Vyvanse, it’s a Schedule II controlled substance with the same restrictions and precautions to limit the risk of misuse.
00:04:35 Vickie Danaher
Now keep in mind that patients who have trouble swallowing pills already have the option of opening up lisdexamfetamine dimesylate capsules
00:04:43 Vickie Danaher
and dissolving the contents in water or sprinkling them in applesauce, or they can take the lisdexamfetamine dimesylate chewable tablets.
00:04:54 Vickie Danaher
But some may still prefer a liquid to avoid manipulating the solid dosage forms, or if a more precise or specialized dosing is needed.
00:05:04 Vickie Danaher
So if patients transition from the capsules or chewables to the oral solution, emphasize that the medication’s effects should be similar.
00:05:13 Vickie Danaher
Educate to store the oral solution at room temperature and to use the dosing syringe and bottle adapter that comes with the product to draw up the dose.
00:05:21 Vickie Danaher
And also point out that the oral solution has a 30-day expiration after opening, which is more restrictive than the shelf life of the capsules or chewables.
00:05:33 Vickie Danaher
Next is sitagliptin 25 milligrams per mL oral solution, brand name Brynovin, for type 2 diabetes in adults.
00:05:43 Vickie Danaher
Brynovin contains the same active ingredient as Januvia tablets, which have been widely used for years.
00:05:49 Vickie Danaher
But while Januvia tablets are available in 25, 50, and 100 milligram strengths, they shouldn’t be crushed or split according to the manufacturer’s recommendations.
00:06:00 Vickie Danaher
If patients get the new sitagliptin oral liquid, be aware that the recommended dosage is 100 milligrams, which equals 4 mL taken orally once daily.
00:06:11 Vickie Danaher
It also costs about $300 per 120 mL bottle, whereas the price for a similar amount of generic tablets is usually about $80.
00:06:22 Vickie Danaher
Another big difference is that sitagliptin 25 milligrams per mL oral solution requires refrigeration, unlike the tabs, which we know are stored at room temperature.
00:06:32 Vickie Danaher
So this could impact portability and convenience for some patients.
00:06:36 Vickie Danaher
It could also lead to big problems in the pharmacy if not stored properly, so make sure that your staff knows about this requirement to avoid waste or lost revenue.
00:06:45 Vickie Danaher
Also advise patients who get sitagliptin oral solution to discard the product 90 days after opening.
00:06:53 Vickie Danaher
Leaping from diabetes to diuretics, let’s now look at the hydrochlorothiazide 10 milligram per mL powder for oral suspension.
00:07:03 Vickie Danaher
This product goes by the brand name Inzirqo, and it’s approved for high blood pressure in both adults and children, as well as edema or swelling from congestive heart failure or other conditions like the other hydrochlorothiazide pills we’re used to dispensing.
00:07:19 Vickie Danaher
But keep in mind, this hydrochlorothiazide oral suspension costs about $400 per 80 mL bottle, compared to just pennies per each generic tablet.
00:07:30 Vickie Danaher
It also requires reconstitution, and patient education should emphasize shaking well before each use and discarding 30 days after reconstitution.
00:07:40 Vickie Danaher
In addition, explain that it’s caramel peppermint flavored and it should be kept at room temperature.
00:07:48 Vickie Danaher
Moving along, we have the first hydrocortisone oral solution, or Khindivi, which is approved for adrenal insufficiency in kids five years and older.
00:07:58 Vickie Danaher
We know that hydrocortisone tablets have been available for many years in 5 milligram, 10 milligram, and 20 milligram strengths.
00:08:06 Vickie Danaher
But for pediatric patients with adrenal insufficiency, these tablet strengths often don’t align well with the weight-based dosing needed.
00:08:14 Vickie Danaher
And splitting or crushing the tablets can lead to dosing inaccuracies.
00:08:19 Vickie Danaher
So the liquid concentration of 1 milligram per mL allows for much more precise dosing adjustments than the tablets, especially for smaller children.
00:08:29 Vickie Danaher
However, there’s a substantial cost difference between the tablets and the solution, which is a major consideration.
00:08:35 Vickie Danaher
The oral solution costs about $11,000 per 473 mL bottle, plus it’s a specialty med, so patients will need to get it from another pharmacy.
00:08:46 Vickie Danaher
But we still do want to be familiar with this product in case patients come to us with questions.
00:08:51 Vickie Danaher
So we can note that the hydrocortisone oral solution is berry flavored. It can also be stored in the refrigerator or at room temperature, but either way it should be discarded 120 days after opening.
00:09:05 Vickie Danaher
Another important feature to note is that it may be administered through a G-tube, which is beneficial for patients who cannot take medications orally. tube, which is beneficial for patients who cannot take medications orally.
00:09:15 Vickie Danaher
Next is trazodone 10 milligram per mL oral solution or Raldesy, which is approved for major depressive disorder in adults.
00:09:24 Vickie Danaher
We sometimes do see patients getting trazodone tablets added on to an SSRI like escitalopram or another antidepressant for its sedating properties.
00:09:34 Vickie Danaher
However, some people find the trazodone tablets to be relatively large, especially with the higher strengths, and that can make it a challenge for patients with swallowing difficulties. So this new liquid might be an option in those situations.
00:09:48 Vickie Danaher
But there’s also a big cost difference between generic trazodone tablets and this branded solution. So insurance coverage should be verified before transitioning patients.
00:09:58 Vickie Danaher
The solution costs about $400 to $500 per bottle depending on the package size.
00:10:05 Vickie Danaher
Additionally, the solution should be stored at room temperature and discarded 30 days after opening.
00:10:11 Vickie Danaher
It’s also important to demonstrate to patients how to use the provided dosing syringe and bottle adapter to ensure accurate dosing.
00:10:20 Vickie Danaher
Lamotrigine is another medication approved as a first-time oral liquid, with the 10 milligram per mL oral suspension, or Subvenite, joining the oral tablets and capsules which have been around for years.
00:10:34 Vickie Danaher
Orally disintegrating tablets or chewable formulations of lamotrigine have also been available for patients with swallowing difficulties.
00:10:42 Vickie Danaher
But if patients still need the lamotrigine oral suspension, be aware that it’s ready to use and doesn’t require reconstitution.
00:10:51 Vickie Danaher
However, patients should still be counseled to shake it well before use, keep it at room temperature, and throw it away 90 days after opening.
00:11:00 Vickie Danaher
And then the last two new oral liquids we’ll cover today are either ACE inhibitors or ARBs for high blood pressure or other heart conditions.
00:11:09 Vickie Danaher
So the ACE inhibitor is ramipril, which will now come in a 1 milligram per mL oral solution called Vostally.
00:11:17 Vickie Danaher
Like the ramipril capsules that we’re used to dispensing, the oral solution is approved for hypertension in adults, cardiovascular risk reduction in high-risk patients, or patients who have heart failure after a heart attack.
00:11:30 Vickie Danaher
And the dosing for these indications is the same regardless of capsule or solution.
00:11:35 Vickie Danaher
But one unique call out here is how ramipril oral solution should be stored.
00:11:40 Vickie Danaher
So we’ll need to keep it in the refrigerator in the pharmacy before dispensing, but then we can tell patients to keep it at room temperature after opening.
00:11:50 Vickie Danaher
And also remind to discard 60 days after opening.
00:11:55 Vickie Danaher
Finally, we have losartan 10 milligram per mL oral suspension, which goes by the brand name Arbli.
00:12:01 Vickie Danaher
Like its name suggests, this med is an ARB, or angiotensin receptor blocker, approved for hypertension, stroke risk reduction, and diabetic nephropathy.
00:12:11 Vickie Danaher
But it costs about $600 per bottle, which is much more than the pills.
00:12:15 Vickie Danaher
If you dispense losartan oral suspension, keep in mind that it’s ready to use and it doesn’t require reconstitution, even though it’s a suspension.
00:12:24 Vickie Danaher
Let patients know that it’s peppermint flavored, and that it should be kept at room temperature, shaken well before each use, and discarded 60 days after opening.
00:12:35 Vickie Danaher
Now let’s close out this section with some practical pearls for dispensing oral liquids that can help prevent errors and improve patient outcomes.
00:12:43 Vickie Danaher
First, we want to always clarify both the concentration and the dose in milligram and milliliter.
00:12:49 Vickie Danaher
And be particularly vigilant when patients transition from a compounded preparation to commercial products, as concentrations may vary significantly.
00:12:59 Vickie Danaher
For instance, the losartan product, Arbli, which we just discussed, is a 10 milligram per mL concentration, but losartan liquids that are compounded are often made in a 2.5 milligram per mL concentration.
00:13:12 Vickie Danaher
So a four-fold dosing error could occur if the volume isn’t adjusted.
00:13:18 Vickie Danaher
Similarly, Vostally or ramipril oral solution is 1 milligram per mL, but compounded ramipril is often 2 milligram per mL.
00:13:28 Vickie Danaher
So patients could accidentally get twice the amount or half the amount indicated if this isn’t taken into account.
00:13:36 Vickie Danaher
Watch for prescriptions with doses in teaspoonful or tablespoonful. These are actually error-prone and we should be converting these to milliliters to reduce error risk.
00:13:49 Vickie Danaher
Remind technicians not to automatically substitute between oral liquids and other dosage forms, as this usually requires prescriber approval.
00:13:58 Vickie Danaher
Technicians especially can also ensure appropriate auxiliary labels are included, such as a shake well label when indicated, to remind patients and caregivers on proper administration.
00:14:10 Vickie Danaher
Give a metric-calibrated measuring device, such as an oral syringe, if the product doesn’t come with one, and educate about accurate dosing.
00:14:18 Vickie Danaher
For instance, encourage patients and caregivers to mark devices with a permanent marker to indicate how much liquid needs to be drawn up.
00:14:25 Vickie Danaher
Also tell them to avoid using household spoons to measure medication. Some household spoons measure between 2 and 10 mL so they aren’t accurate.
00:14:35 Vickie Danaher
Use the teach-back method to confirm understanding. For example, ask the patient to demonstrate how they’ll measure their medication before they leave the pharmacy.
00:14:46 Vickie Danaher
And that closes out our discussion today on first-time prescription oral liquids and practical tips for dispensing them.
00:14:54 Narrator
Thanks for listening—we hope today’s episode gave you practical insights you can use right away.
00:14:59 Narrator
Now that you’ve listened, pharmacists and pharmacy technicians can receive CE credit. Just log into your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.
00:15:10 Narrator
We’ve linked the resources we mentioned—and more on today’s topic—right in the show notes. Those links will take you straight to our websites, where you’ll find even more concise, evidence-based charts, articles, and tools.
00:15:22 Narrator
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00:15:39 Narrator
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00:15:52 Narrator
Thanks for listening… stay sharp, stay current—and join us next time on Clinical Capsules!
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