Effect of the rheological properties of the liquid carrier on the in vitro swallowing of solid oral dosage forms

Abstract

Solid oral dosage forms (SODF) are the most popular oral drug delivery forms, but they can be difficult to swallow, especially for patients suffering from swallowing disorders. This study investigated the dynamics of different combinations of liquid carriers and SODF during the oral phase of swallowing using an in vitro model. The rheological properties of the carriers were characterized using shear and extensional rheometry, and their effect on bolus velocity, bolus shape, post‐swallow residues, and SODF position within the bolus was evaluated. The latter has been identified as a novel and promising variable to discriminate between alternative formulations. When swallowed with water, capsules and tablets did not impact significantly the velocity of the bolus, but they lagged behind the liquid bolus, suggesting that low viscosity Newtonian fluids are not efficient carriers for SODF. Increasing the viscosity of the carrier at high shear rates improved the ability of the liquid to transport the SODF but also increased the amount of post‐swallow residues. At equivalent shear viscosity, elastic and extensional properties of carriers influenced positively the position of the SODF in the bolus. Capsules and tablets were transported toward the front of these boluses, during the oral phase of swallowing, which is considered beneficial to avoid SODF sticking to the mucosa in the following stages of swallowing. Thin elastic liquids appear as an interesting option to promote safe swallowing of capsules and tablets. Clinical studies are, however, necessary to confirm this positive effect in healthy and dysphagic patients.

Exploring the interaction of viscosity and nipple design on feeding performance in an infant pig model

“…Most studies looking at the effect of viscosity on swallow safety are concerned with the characteristics of the bolus such as size, shape, and cohesion (Gould et al, 2017; Hadde et al, 2021; Hadde & Chen, 2021; Lavoisier et al, 2021), but focus less on how viscosity affects suckling, the acquisition and intraoral aspect of feeding prior to the swallow (see Mayerl et al, 2021). Suckling performance will depend on how much intraoral pressure the infant can generate, and how easily milk is able to flow out of the nipple.…”

“…There are two potential mechanisms to explain this. The infants could be generating more intraoral pressure when feeding on the thick milk, and/or the xanthan‐thickened milk could be undergoing shear thinning (Lavoisier et al, 2021). In this case, we cannot evaluate the possibility of each, as the two are confounded.…”

“…In the case of breast milk, this behavior aids in the transport through the ductal system (Alatalo & Hassanipour, 2016) and may also be important at different stages of the digestive process for the infant. If the milk‐nipple system is properly tuned to not reduce feeding rate, shear‐thinning thickeners are among the more promising thickening agents on account of their favorable swallow properties, for example, reduced pharyngeal residues, cohesive boluses, and improved bolus cohesion (Hadde et al, 2019; Lavoisier et al, 2021). Prior work indicates that tongue kinematics are affected by changing viscosity (Mayerl, Edmonds, et al, 2021) and the implications of these kinematic changes on infant development are not fully understood, as more studies highlight potential disadvantages to the use of thickened fluids (Brooks et al, 2022; Steele et al, 2021; Stewart & Burr, 2021).…”

Implementing a medication lubricant for pill dysphagia on an acute care ward using Plan-Do-Study-Act cycles

“…The characteristics and effectiveness of Gloup for pill dysphagia are well established 12. Fluoroscopy studies have demonstrated its superiority over water and other food vehicles in terms of tablet transit time 13.…”

Food texture and texture modification for dysphagia management

“…In organizing this special issue, our main consideration has been on the fundamental principles and feasible techniques of texture modification for adult dysphagia. For this purpose, a number of leading scientists have been approached for a contribution in topics including the effect of bolus rheology of texture-modified foods on the degree of modification (Stading, 2021a); relationship between masticatory variables and bolus characteristics of meat with different textures (Pematilleke, Kaur, Adhikari, & Torley, 2021); textural properties and muscle activities during mastication of normal and ultrasonically softened sticky rice (Wattanapan, Saengnil, Niamnuy, Paphangkorakit, & Devahastin, 2021); extensional rheology and tribology of polysaccharide solution (Funami & Nakauma, 2021); the physical properties of texture-modified foods (Stading, 2021b); the effect of the rheological properties of thickened fluids on the in vitro swallowing of solid oral dosage forms (Lavoisier, Shreeram, Jedwab, & Ramaioli, 2021); and microwave treatment to modify textural properties of high-protein gel applicable as dysphagia food (Pure, Yarmand, Farhoodi, & Adedeji, 2021).…”