Depending on the Tab or Cap, and the type of medicine, modifying these dosage forms can lead to reduced effectiveness of the medication, and increased risk of adverse effects. especially in hospitalized patients. Any alternative method then?
In my hospital pharmacy we prepare oral solutions for young persons or adults who cannot swallow tablets. It is possible to prepare oral sirynges. You have to check the stability of your drug carefully.
But what would we do in case of film coated or sustain release formulation?
Yes, drugs manufactured as a solution / syrup could be the first option. Alternatively, sublingual or mouth dissolving preparations may be used, provided the drug is absorbed effectively through the oral mucosa. Further, the type of disorder and the pharmacological nature of the drug would determine whether any alternative routes/modes of administration are feasible.
Say for instance, Potassium chloride prolong release film coated tablets.
You should move toward suppositories and it depends on the drug which you want to administer.
Potassium chloride is readily available in the form oral syrup, in the concentration of 7.5% ,which is one millimole per ml.
For the other medications, i would always suggest to get the formulated preparations in order to avoid the safety and stability considerations, having said that "extemporaneous " preparation is the solution for the majority of the unavailable ready formulations, there are various evidence based preparation guidelines for the extemporaneous preparation with details including methodology,resources required and the storage and stability aspects. Its wise to have a compounding guide readily available in the hospital where you work and at least for the preparations that are recurrently used by the special patient population ,for instance:Peds,NGT route,geriatrics,etc.,
Use the pop-bottle method for swallowing tablets and the lean-forward technique for capsules (Ann Fam Med 2014;12:550-552)
Even for Modified release capsules or tablets there is some manufactures which put in their mind such patients, and thus prepare the modified release capsule in a form of microencapsulated modified release small particles, in other words you can open the capsule and sprinkle it with liquids and give it to the patient who have difficulty in swallowing
The simplest way is to crush the tablet or sprinkle the contents of a capsule into some water or juice. This could increase the bioavailabilty and produce an intensified response or side effects. If the product is an ER or XL formulation, this could be dangerous as it would destroy the time-releasing properties of the dosage form.
Best to try it a few times with 1/2 the dose, and if no problems, return the to labeled dose. Another approach would be to get a standard dosage form, not an ER or XL.
The route shall depend on the formulations. sustained release or timed released capsules may have granules with different dissolution rates. Hence instead of oral, rectal route may also be considered if a suitable dosage form is available. In other cases suspension or liquid oral dosage form should be preferred. Again the availability of such suitable dosage form is pre requisite
Agree with Gurudas. In the US many drugs can be formulated by compounding pharmacies when a suitable dosage form is not readily available from a manufacturer.
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