Granule medications for children with neurofibromatosis type 1
Granules are one of several medication preparations. They are small, dry pieces of medication that people can take if they have trouble swallowing pills or capsules. Granules are especially helpful for young children.
Giving a child granules can help improve their cooperation when taking medications, as granules make it easier to cover the taste of the medication and make the medication easier to swallow. But not every medication is available in granules (most medications for children are given as a liquid suspension).
Koselugo (selumetinib) is a Food and Drug Administration (FDA)-approved medication to help treat children with neurofibromatosis type 1 (NF1) who are at least 1 year of age. It
In general, granules work just as well as capsules when people follow the prescription directions. For Koselugo, the NF1 medication, a 2026 study showed that the granule formulation was comparable to the capsule and had a manageable safety profile.
Testing in adults showed that there was no significant difference in how the medication was absorbed when people took it as a single dose of either the granule or capsule at the same dosage amount (either with food or on an empty stomach). This indicates that the granules are just as good as the capsules.
For Koselugo, a parent or caregiver can open the medication capsule and sprinkle the granules onto or mix them into soft foods like yogurt or fruit purees. They should then feed the medication to the child within the recommended time frame.
It is acceptable to mix some granule medications with liquids, but people should NOT mix Koselugo with liquids and should not crush or chew the granules.
The package insert for Koselugo lists some specific soft foods that people can mix the medication with. It is important that parents follow the specific instructions that come with their child’s medication.
The dosage for medications depends on the specific diagnosis and the medication a person will be taking. The dosages for most oral medications for children are based on weight. Koselugo dosing is based on body surface area (BSA).
A child’s BSA is calculated using their height and weight. Therefore, the dose will increase as the child grows. A doctor may also adjust the dose if the child experiences any adverse reactions (side effects). The doctor will write the child’s dosage on the prescription.
A parent or caregiver should always read the medication label and the pharmacy materials that come with the medication, along with any information from the child’s doctor.
If a child spits out (or vomits) the medication or does not take the entire dose within the recommended time frame, they will not get the full treatment. The package insert for the medication gives instructions on what to do, and the parent or caregiver should also contact the child’s doctor.
DO NOT repeat the dosing without speaking to the prescriber first.
For Koselugo, if a child does not finish the dose within 30 minutes, the parent should discard what is left of that dose and give the next dose at the scheduled time. If a child vomits up the dose, they should just take the next scheduled dose (do not repeat the dose).
If a child misses a dose, a parent should give that dose as soon as possible — unless the next dose is due within 6 hours. In that case, they should skip the missed dose and give the next dose at its scheduled time.
A parent or caregiver should be sure to speak with the child’s doctor if the child is not tolerating the medication or is refusing to take it.
A child may not like the taste or texture of the medication, so a parent or caregiver can mix it into a food they WILL like (and one that is approved for this use). For most medications, mixing them into a sweet, sticky food like chocolate syrup or ice cream works best to hide the taste/texture.
A child may gag, spit, vomit, or refuse the dose altogether. It is important to mix the medication into the smallest amount of food possible to make sure the child gets the full dose. A parent can give the dose in multiple bites, as long as the child eats it within the recommended time frame.
A parent can mix Koselugo into 1 to 3 teaspoons of yogurt or specific fruit purees and give it to the child within 30 minutes of mixing. The package insert provides the recommended time frame for the specific medication, or a parent can ask their child’s doctor.
Dr. Mia Armstrong is an ABMS board certified pediatrician and a fellow of the American Academy of Pediatrics (FAAP).