“According to our survey, two-thirds of patients and carers thought that opening a capsule or breaking a tablet would not make a difference to the tolerability or efficacy of the treatment.”
– Greener, Geriatric Medicine. 2008; 259
“A pretty problem” can refer to a problem without an obvious solution. However, there is nothing pretty about such a situation. When people are desperate, they create temporary fixes. Unfortunately, this can be dangerous when it comes to medicine. For example, when patients with dysphagia can’t swallow their medication, they and their caregivers often resort to “solutions” that lead to noncompliance or unsafe medication practices, such as crushing pills.
Patients with dysphagia often chew tablets or capsules they can’t swallow. This can change the efficacy of the medication and is particularly dangerous for enteric-coated and controlled-release drugs. Such noncompliance can cause stomach ulcers, overdoses and adverse effects.
Crushing or grinding enteric-coated and controlled-release drugs is just as bad and also common. According to an article by Keele University, 21% of U.S. critical-care nurses routinely crush enteric-coated medications for feeding tube use, and 15% routinely crush sustained-release drugs. The act of crushing and grinding medications can harm not only the patient, but also the caregiver and family members. For example, crushing or grinding medications such as chemotherapy can expose anyone nearby to cytotoxicity.
Some patients can only swallow tablets or capsules by drinking excessive amounts of water. This, too, can lead to noncompliance. In a 2009 Nursing Standard article, the authors write, “Another consideration is the volume of liquid required to disperse the product which may need to be taken into account in patients subject to fluid restrictions.”
Other attempts to overcome the challenges of dysphagia include emptying capsules and taking only the contents, taking medications with food when directed otherwise and cutting tablets in half. All of these “solutions” are forms of noncompliance and can lead to other health problems, or in extreme cases, death. Orbis Biosciences® uses Precision Particle FabricationTM technology to develop format-flexible medication that’s appropriate for many types of patients, including those with dysphagia. Solutions like ours prevent the need for quick fixes and reduce noncompliance. Providing these alternative formats for patients with dysphagia means trouble swallowing will be less of a problem, pretty or otherwise.