Case report of an undisintegrated magnesium oxide tablet in the stool in an elderly patient taking food thickener

Mabuchi, Suguru; Ouchi, Shuji; Suzuki, Risa; Sasaki, Mari; Nakamura, Marie; Izumimoto, Norihiko; Hakamada, T; Toyoshima, Kenji; Abe, Yasuko; Kaneko, Eiji; Shimokado, Kentaro

doi:10.1111/ggi.13104

Cited by 11 publications

(12 citation statements)

References 5 publications

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“…The diameter, thickness, and weight of those tablets ranged from 6.0 to 9.0 mm, 2.0–4.7 mm, and 75–375 mg, respectively, indicating that LVFX-OD tablet (diameter: 16.0 mm, thickness: 6.9 mm, weight: 1,400 mg) is larger than these tablets. Moreover, undisintegrated magnesium oxide tablets have been reported to be excreted via the stool of a patient administered the drug with FT [6]. Based on the above observations, it can be assumed that when magnesium oxide, voglibose OD, and mitiglinide tablets, which are smaller than LVFX-OD tablets, were orally administered after immersion in FT, the tablet may have remained for a long time in the gastrointestinal tract with the tablet surface covered in FT (undisintegrated tablet).…”

Section: Discussionmentioning

confidence: 99%

“…Their usefulness is not limited to just food as they are also used for administering oral medications such as tablets [4, 5]. However, undisintegrated tablets have been observed in the stool of patients who were orally administered magnesium oxide tablets immersed in FTs [6]. Furthermore, FTs have been shown to affect the disintegration and dissolution of magnesium oxide tablets [7, 8], thereby reducing their laxative effects.…”

Section: Introductionmentioning

confidence: 99%

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Effect of food thickener and jelly wafer on the pharmacokinetics of levofloxacin orally disintegrating tablets

Tomita

Nishimura

Goto

et al. 2019

Heliyon

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This study was designed to determine the effects of a food thickener and deglutition aid jelly for oral administration, jelly wafer, on the pharmacokinetics of levofloxacin orally disintegrating tablets. With an increase in immersion time, the disintegration time of levofloxacin orally disintegrating tablets immersed in food thickener was prolonged, whereas that of the tablets immersed in jelly wafer was shortened. The dissolution behavior of non-immersed levofloxacin orally disintegrating tablets was not similar to that of tablets immersed in food thickener, but was similar to that of tablets immersed in jelly wafer. The time to reach the maximum systemic levofloxacin concentration was the same for non-immersed orally disintegrating tablets and tablets immersed in food thickener and jelly wafer. Moreover, there was no significant difference in the maximum concentration after administration between non-immersed orally disintegrating tablets and tablets immersed in food thickener or jelly wafer. These findings suggest that drugs with a high bioavailability, such as levofloxacin, enter the systemic circulation even when administered with a food thickener or jelly wafer.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of food thickener and jelly wafer on the pharmacokinetics of levofloxacin orally disintegrating tablets

Tomita

Nishimura

Goto

et al. 2019

Heliyon

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“…Furthermore, tablets and capsules are relatively inexpensive with respect to acquisition costs and switching to other formulations frequently results in an increase in cost. If the formulation is unlicensed, this can result in a very significant cost increase [25][26][27].…”

Section: Medicine Administrationmentioning

confidence: 99%

“…Consequently, whilst they may be easier for the patient to swallow they may increase risk of aspiration and subsequent problems which can arise from this. With evidence appearing which suggests that thickeners can negate the effect of a medicine [25][26][27], the decision to thicken a liquid will often not be evidence based and will require careful monitoring of the patient to ensure that the treatment is still effective.…”

Section: Medicine Administrationmentioning

confidence: 99%

Optimising Medicines Administration for Patients with Dysphagia in Hospital: Medical or Nursing Responsibility?

2020

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Dysphagia is common—not only associated with stroke, dementia, Parkinson’s but also in many non-neurological medical problems—and is increasingly prevalent in ageing patients, where malnutrition is common and pneumonia is frequently the main cause of death. To improve the care of people with dysphagia (PWD) and minimise risk of aspiration and choking, the textures of food and drinks are frequently modified. Whilst medicines are usually concurrently prescribed for PWD, their texture is frequently not considered and therefore any minimisation of risk with respect to food and drink may be being negated when such medicines are administered. Furthermore, evidence is starting to emerge that mixing thickeners with medicines can, in certain circumstances, significantly affect drug bioavailability and therefore amending the texture of a medicine may not be straightforward. Research across a number of hospital trusts demonstrated that PWD are three times more likely to experience medication administration errors than those without dysphagia located on the same ward. Errors more commonly seen in PWD were missed doses, wrong formulation and wrong preparation through medicines alteration. Researchers also found that the same patient with dysphagia would be given their medicines in entirely different ways depending on the person administering the medicine. The alteration of medicines prior to administration has potential for patient harm, particularly if the medicine has been designed to release medicines at a pre-defined rate or within a pre-defined location. Alteration of medicines can have significant legal implications and these are frequently overlooked. Dispersing, crushing or mixing medicines can be part of, or misconstrued as, covert administration, thus introducing a further raft of legislation. Guidance within the UK recommends that following identification of dysphagia, the ongoing need for the medicine should be considered, as should the most appropriate route and formulation, with medicines alteration used as a last resort. The patient should be at the centre of any decision making. Evidence suggests that in the UK this guidance is not being followed. This article considers the clinical and legal issues surrounding administration of medicines to PWD from a UK perspective and debates whether medicines optimisation should be the primary responsibility of the prescriber when initiating therapy on the ward or the nurse who administers the medicine.

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“…It is essential that magnesium oxide tablets disintegrate and dissolve in the stomach to exert their effects. Although magnesium oxide tablets rapidly disintegrate in water in seconds, non-disintegrated tablets in the stool of patients who swallowed the tablets with food thickeners have once been reported 9 . However, the reasons for this observation are not clear.…”

Section: Introductionmentioning

confidence: 99%

Appropriate usage of food thickening agents to prevent non-disintegration of magnesium oxide tablets

Matsuo

Sato

Kudo

et al. 2020

Sci Rep

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Food thickening agents are used to aid the administration of medicine to elderly patients with dysphagia. Magnesium oxide tablets are sometimes administered with food thickening agents. Non-disintegration and disintegration delay of these tablets in the body are problems associated with food thickening agent use. However, the appropriate usage of food thickening agents for administering tablets is not established. Here, the reasons for the non-disintegration of magnesium oxide tablets administered with food thickeners and appropriate usage of food thickeners were examined using a disintegration test of newly opened and moisture-absorbed magnesium oxide tablets. Immersion of magnesium oxide tablets for 10 and 30 min in xanthan and guar gum-based food thickening agents caused disintegration delay and non-disintegration in the first fluid (pH 1.2). However, tablets immersed for 1 min quickly disintegrated. The disintegration of xanthan gum-based food thickening agents was faster than guar gum-based food thickening agents. Moisture absorption by magnesium oxide tablets caused a significant delay in their disintegration in water. The tablets that absorbed moisture disintegrated within 1 min in the first fluid, even when immersed in food thickening agents for a short time. Overall, a short immersion of magnesium oxide tablets in food thickening agents can avoid non-disintegration.

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Case report of an undisintegrated magnesium oxide tablet in the stool in an elderly patient taking food thickener

Cited by 11 publications

References 5 publications

Effect of food thickener and jelly wafer on the pharmacokinetics of levofloxacin orally disintegrating tablets

Effect of food thickener and jelly wafer on the pharmacokinetics of levofloxacin orally disintegrating tablets

Optimising Medicines Administration for Patients with Dysphagia in Hospital: Medical or Nursing Responsibility?

Appropriate usage of food thickening agents to prevent non-disintegration of magnesium oxide tablets

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