PP-017 Dysphagia patients need semisolid oral dosage forms prepared by thickening liquids

Abstract

Background Dysphagic patients are at risk of protein-energy malnutrition and dehydration as well as being incompliant to pharmacotherapy. Causes of dysphagia include neurological conditions (such as stroke, dementia, paraplegia/tetraplegia), otorhinolaryngology (ORL) tumours, etc. If parenteral medicines are not available, an oral dosage form of the right consistency should be prepared. Purpose To present two general formulas for semi-solid dosage forms suitable for dysphagic patients. Materials and methods A suitable texture of oral preparations and food was predefined by an interdisciplinary focus group from the hospital pharmacy, nutrition support team, ORL physicians and logopedic therapists as being a thick puree or like a milk pudding, being able to keep its shape and not needing mastication. Viscosities of a series of thickened test preparations conforming to these requirements were determined using a parallel plate MCR 302 Anton Paar viscometer. Results Viscosities of semi-solid preparations suitable for dysphagic patients range between 1600 and 2300 cP (=mPa.s, at 20°). Two general formulations for thickening liquids leading to this viscosity range can be recommended: Gellan Gum Formula: Gellan Gum (E 418) is a fermented polysaccharide from Pseudomonas Elodea. It is dissolved at 2(m/V)% in an aqueous drug solution of approximately 50°C, filled into a mould and kept at 2–8°C for 1–2 h for gelification. Alginate Formula: Sodium Alginate (E 401) is a polysaccharide from brown algae. A final concentration of 1(m/V)% is dissolved in one half of a calcium-free aqueous drug solution heated to boiling point. This solution I is cooled to 2–8°C for 3–4 h. Solution II consists of calcium lactate 1(m/V)% final concentration dissolved in the second half of the starting drug solution. The gel forms readily by mixing solutions I and II as soon as cross-linking of alginate is induced by calcium. These preparations yield gel-like textures starting from any aqueous drug solution. The thickened masses can be cut into slices corresponding to a needed dose. Conclusions Thickened solutions meeting the need of dysphagic patients can be prepared easily using sodium alginate or gellan gum. In contrast to starch-based preparations, they are not sensitive to amylase, thus will not be affected from an undesirable thinning effect with risk of aspiration. No conflict of interest.

Optimizing Texture Modified Foods for Oro-pharyngeal Dysphagia: A Difficult but Possible Target?

“…Many studies have been carried out with regard to xanthan gum and guar gum and their use as thickening agents for the preparation of dysphagic foods. Only few studies have involved other types of thickeners (hydrocolloids) which are commonly used as additives in the food industry ( 18 , 71 ). Moreover, the use of a single type of polysaccharide thickeners may not be optimal to meet all requirements for dysphagic foods.…”