Dynamics of Capsule Swallowing by Healthy Young Men and Capsule Transit Time from the Mouth to the Stomach

Chisaka, Hiromi; Matsushima, Yasuyuki; Wada, Futoshi; Saeki, Satoru; Hachisuka, Kenji

doi:10.1007/s00455-006-9054-3

Cited by 16 publications

(21 citation statements)

References 20 publications

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“…A further drawback is that lodging of placebos was only surveyed by structured questionnaire and not verified by imaging, thus potentially underestimating the proportion of placebos being lodged. 10 In conclusion, this study showed for the first time that 2 targeted techniques to facilitate tablet and capsule intake were remarkably effective and easy to adopt in the general population including patients with swallowing difficulties, and should therefore be generally recommended. This analysis includes the subjective (Likert scale) ranking of all participants whether they were ultimately able to swallow the "intervention placebo" or not.…”

Section: Lean-forward Technique For Capsulesmentioning

confidence: 73%

Two Techniques to Make Swallowing Pills Easier

Schiele

Schneider

Quinzler

et al. 2014

The Annals of Family Medicine

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To evaluate whether 2 techniques (the pop-bottle method for tablets and the lean-forward technique for capsules) ease swallowing of tablets and capsules, we conducted a cross-sectional study including 151 adults of the general German population. Participants swallowed 16 differently shaped placebos, rated their ease of swallowing on an 8-point Likert scale, and swallowed the 2 dosage forms that they had rated most difficult again using the appropriate technique. The pop-bottle method substantially improved swallowing of tablets in 59.7% (169/283) and the lean-forward technique for capsules in 88.6% (31/35). Both techniques were remarkably effective in participants with and without reported difficulties swallowing pills and should be recommended regularly. INTRODUCTIONA mong ambulatory patients who report difficulty in swallowing pills, 1 in 3 experience vomiting, gagging, choking, or having tablets blocked in the throat.1,2 Therefore, the modification of dosage forms (58.8%) and nonadherence (9.4%) are frequent 1,2 and can worsen medical conditions and increase health care costs.3 Given that tablets and capsules differ markedly in physical properties such as size, shape, and density, optimal swallowing techniques likely differ, too. 4 This study aimed to evaluate the influence of 2 techniques on the swallowing of tablets (the pop-bottle method) and capsules (the lean-forward technique). METHODSAfter obtaining ethical approval and written informed consent, we enrolled 151 participants of the general population (52.3% women, mean age 45.8 years (range 18 to 85 years), 55.6% reporting difficulties swallowing solid dosage forms) in a single-blind experiment (German Clinical Trials Register Number: DRKS00004174). We manufactured 16 differently shaped placebos (capsules; round, oval, and oblong tablets) in 4 size groups.In the pop-bottle method, the tablet is placed on the tongue, the lips are tightly closed around the opening of a flexible PET (polyethylene terephthalate) bottle, and the tablet is swallowed in a swift suction movement to overcome the volitional phase of swallowing. 5 In the lean-forward technique, capsules are swallowed in upright position with the head bent forward (Figure 1 and Supplemental Patient Handout). 6The participants randomly swallowed all dosage forms with their eyes closed, using 20 ml of non-carbonated water, and rated the ease of swallowing on an 8-point Likert scale (0 = very easy, 7 = very difficult to swallow). Structured questionnaires were used to assess participants' ability to swallow placebos (eg, sensation in throat during swallowing). To evaluate the impact of the 2 swallowing strategies, within each of the 2 largest dosage-size groups (large mean ± SD: 474 ± 5.5 mm 3 , very large 834 ± 9.2 mm 3 ), the dosage form that caused the greatest difficulty was picked as intervention placebo and then swallowed using the pop-bottle technique (for tablets) 5 or the lean-forward technique (for capsules) 6 and rated again. Julia T. Schiele, PhD 551The Wilcoxon signed-rank test ...

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Section: Lean-forward Technique For Capsulesmentioning

confidence: 73%

Two Techniques to Make Swallowing Pills Easier

Schiele

Schneider

Quinzler

et al. 2014

The Annals of Family Medicine

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“…This value is higher than the Australian population demographic of community pharmacy customers in the same city (16.5%) (Lau et al, 2015) or patients taking three or more different solid oral dose forms (22.5%) (Marquis et al, 2013). However it is similar to the 26% of the general population reported in Norwegian population (Andersen et al, 1995, Chisaka et al, 2006, Wright, 2002, Kottke et al, 1990) and 32% of adolescents in Denmark (Hansen et al, 2008).…”

Section: Discussionmentioning

confidence: 57%

“…Although the difficulty in swallowing solid dose medication has been documented in nursing home residents and people with dysphagia (Paradiso et al, 2002, Wright, 2002, Chisaka et al, 2006, Kottke et al, 1990, much less information is available regarding non-dysphagic individuals. A survey of the general population in Norway (n=6,158) reported that 26% of the population had issues swallowing medications (Andersen et al, 1995), though another study found only 6% (16/268) of pain centre patients refused to take part in their study because of difficulties with medication swallowing (Overgaard et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Oral medication dose form alteration: patient factors and the effect of adding thickened fluids

Radhakrishnan¹

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Solid oral dosage forms such as tablets and capsules are often crushed and mixed with foods or fluids to aid drug delivery for those who cannot or prefer not to swallow them whole. Some people have a physiological problem limiting swallowing (dysphagia), and their fluids are thickened to ensure safe swallowing; these thickened fluids are also used to deliver crushed medication in replacement of water. This thesis explores the issues surrounding the swallowing of whole tablets and capsules, their modification by crushing and the influence of coadministration with thickened fluids on absorption pharmacokinetics. The literature review (Chapter 1) examines the physiology and pathophysiology of swallowing and considers the particular issues surrounding swallowing tablets and capsules. It also explores the possible consequences of crushing the medications and mixing the powder with vehicles such as jam, honey, yoghurt and thickened water.This thesis contains two sections. In Section A (Chapter 2), the potential influence of psychological issues, oral sensation, sensory effect and motor ability of an individual on swallowing pills was investigated. It is hypothesised that swallowing tablets and capsules will be an issue in people with a memory of gagging on food and medication, strong gag reflex, heightened taste sensation, or who tend to chew their food for extended periods.Volunteers (153) completed a written survey and one-on-one assessments. Psychological issues were addressed by questions on memory of choking incidents on food or medication, and regularity of medication use. Sensory effects were assessed by measuring the person's gag reflex, taste receptor density, size of the mouth (mallampati classification), and on food neophobia. Motor effects were assessed as efficiency in chewing a jelly snake. Finally, the volunteers were observed swallowing a capsule and the quantity of water used, and head position was recorded.In the survey, 33% of the population reported that they have had trouble swallowing medication.These people were more likely to have choked on medication in the past, have a smaller mouth cavity, and a medium or high taste receptor density. There was no relationship between trouble swallowing medication and gag reflex, food neophobia, chewing efficiency, quantity of water used to swallow, and head position.In Section B (Chapters 3, 4, and 5), the effect of crushing medication and mixing with water thickened with a commercial thickening agent on absorption pharmacokinetics was studied.ii Paracetamol tablets were used as the model drug, and saliva samples were used to measure the PK profile. Chapter 3 assessed the inter-and intra-individual variability as the coefficient of variation of paracetamol in saliva. Volunteers took whole tablets of paracetamol (2 x 500 mg) on two different days separated by a week. Saliva production was stimulated using citric acid and paracetamol levels in the saliva were measured using high-performance liquid chromatography. Non-compartmental pharmacokinetic analy...

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“…Individuals who do not have a problem with swallowing food and drink can still manifest a psychological aversion to swallowing solid dosage forms (Hansen et al, 2008). Factors such as the type of formulation, size, shape and surface characteristics of medications as well as a patient's body position are crucial for the delivery of medications (Chisaka et al, 2006, Hansen et al, 2008.…”

Section: Chapter Investigation Of Drug Delivery From Thickening Agentmentioning

confidence: 99%

“…Factors such as the type of formulation, size, shape and surface characteristics of medications as well as a patient's body position may impact the method of delivery of medications (Hansen et al, 2008, Chisaka et al, 2006.…”

Section:  Psychological Aversionsmentioning

confidence: 99%

Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

Torres¹,

Juliana²

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Medications are often crushed and mixed with foods or fluids to aid drug delivery for those who cannot or prefer not to swallow whole tablets or capsules. Dysphagic patients have the added problem of being unable to safely swallow fluids, so thickeners are added to ensure safe swallowing. These thickened fluids are then also used to deliver crushed medications in replacement of water. This thesis explores the influence of thickened water co-administration on drug release in gastric fluid, the effect of rheological properties of these agents and their contribution to describing the mechanism of release. The literature review (Chapter 1) examines oral dosage form administration, rheological properties of these agents as a means to ensure medication delivery and mechanisms of drug release. It is highlighted that thickened fluids have the potential to alter drug release but prediction of the effect of co-administration is not currently reported.Chapter 2 investigates the delivery of medications with thickened fluids as an indicator for potential compromise of drug bioavailability. In vitro dissolution in simulated gastric fluid is investigated for crushed atenolol immediate release tablets mixed with thickened fluids. Five commercial viscosityincreasing agents of varied polysaccharide composition are used at three thickness levels prescribed for dysphagic patients (levels 150, 400, 900). All types of thickening agents are non-Newtonian shear thinning fluids. The greatest thickness (level 900) significantly restricts dissolution, and products that are primarily based on xanthan gum also significantly delay dissolution at the intermediate thickness level (level 400). The interactions of the polysaccharide chains, particularly the rigid rod type conformation of xanthan gum, traps drug molecules within it resulting in impaired dissolution. Under the conditions of this experiment, the higher concentrations of thickening agents remain in large lumps rather than disintegrating into the media. Drug release is generally affected to a greater extent by high-viscosity fluids than low-viscosity fluids at 50 s -1 , but viscosity at this single shear rate of 50 s -1 is not a good indicator for effect on drug dissolution because viscosity changes with shear rate. The determination of other rheological parameters such as viscoelasticity and the effect of breaking up of the structures may be required.To investigate whether it is possible to improve drug release from thickened fluids, in Chapter 3 the effect of the state of aggregation of the active ingredient with thickened fluids is investigated.Paracetamol is the model drug because it is available in a range of formulations with the drug in solution (elixir, dissolved effervescent tablet) or dispersion (suspension). Xanthan gum, which causes the greatest restriction on dissolution (Chapter 2), is used at level 900 as the thickener.ii Crushed tablets with thickener are prepared using manual (i.e. the standard method in clinical practice) or mechanical mixing. The unthickene...

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Dynamics of Capsule Swallowing by Healthy Young Men and Capsule Transit Time from the Mouth to the Stomach

Cited by 16 publications

References 20 publications

Two Techniques to Make Swallowing Pills Easier

Two Techniques to Make Swallowing Pills Easier

Oral medication dose form alteration: patient factors and the effect of adding thickened fluids

Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

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