Swallowing difficulties with oral drugs among polypharmacy patients attending community pharmacies

Marquis, Julien; Schneider, Marie‐Paule; Payot, Valérie; Cordonier, Anne-Christine; Bugnon, Olivier; Hersberger, Kurt E.; Arnet, Isabelle

doi:10.1007/s11096-013-9836-2

Cited by 88 publications

(142 citation statements)

References 12 publications

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“…Incidences of medication related swallowing difficulties might have contributed to these findings, as this a wellknown problem across all ages. A small number of studies investigating this issue in the general adult 205 population have reported prevalence rates between 9% to 40% (Marquis et al, 2013, DeRoche et al, 2003, Schiele et al, 2013. Remarkably, these studies have indicated a gender effect, with a significantly higher frequency of difficulties among females compared to males.…”

Section: Tablets and Capsulesmentioning

confidence: 99%

Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children’s Acceptability of Oral Formulations (CALF) Study

Ranmal¹,

Cram

Tuleu³

2016

International Journal of Pharmaceutics

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A lack of evidence to guide the design of age-appropriate and acceptable dosage forms has been a longstanding knowledge gap in paediatric formulation development. The Children's Acceptability of Oral Formulations (CALF) study captured end-user perceptions and practices with a focus on solid oral dosage forms, namely tablets, capsules, chewables, orodispersibles, multiparticulates (administered with food) and mini-tablets (administered directly into the mouth). A rigorous development and testing phase produced age-adapted questionnaires as measurement tools with strong evidence of validity and reliability. Overall, 590 school children and adolescents, and 428 adult caregivers were surveyed across hospitals and various community settings. Attitudes towards dosage forms primarily differed based on age and prior use. Positive attitudes to tablets and capsules increased with age until around 14 years. Preference was seen for chewable and orodispersible preparations across ages, while multiparticulates were seemingly less favourable. Overall, 59.6% of school children reported willingness to take 10mm diameter tablets, although only 32.1% of caregivers perceived this size to be suitable. While not to be taken as prescriptive guidance, the results of this study provide some evidence towards rational dosage form design, as well as methodological approaches to help design tools for further evaluation of acceptability within paediatric studies.

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Section: Tablets and Capsulesmentioning

confidence: 99%

Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children’s Acceptability of Oral Formulations (CALF) Study

Ranmal¹,

Cram

Tuleu³

2016

International Journal of Pharmaceutics

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“…7,8 There are a number of safety and efficacy concerns around modified medicines such as reduced dose accuracy, reduced drug stability and the potential to affect the pharmacokinetic and pharmacodynamic profile of the drug in vivo. [9][10][11][12][13][14] Guidelines advise that modifications should only be undertaken as a "last resort" 15 when "other methods have been considered".…”

Section: Introductionmentioning

confidence: 99%

The knowledge, attitudes and beliefs of patients and their healthcare professionals around oral dosage form modification: A systematic review of the qualitative literature

Gillicuddy

Kelly

Crean

et al. 2017

Research in Social and Administrative Pharmacy

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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: 51%

“…New Zealand (Tordoff et al, 2010) 75-85 316 Community-dwelling 14% Germany (Schiele et al, 2013) 18-80 1051 General practice 37.4% Switzerland (Marquis et al, 2013) 19-96 410 Community pharmacy customers 9% ongoing, 13.4% past Australia (Mercovich et al, 2014) NA 160 Aged care facilities (two) 18% UK (Liu et al, 2016) 65+ 156 Community pharmacy customers 7.8% Australia (Lau et al, 2015) 25-60 369 Community pharmacy customers 16.5%…”

Section: +mentioning

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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Swallowing difficulties with oral drugs among polypharmacy patients attending community pharmacies

Cited by 88 publications

References 12 publications

Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children’s Acceptability of Oral Formulations (CALF) Study

Age-appropriate and acceptable paediatric dosage forms: Insights into end-user perceptions, preferences and practices from the Children’s Acceptability of Oral Formulations (CALF) Study

The knowledge, attitudes and beliefs of patients and their healthcare professionals around oral dosage form modification: A systematic review of the qualitative literature

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

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