Chewable

Isosorbide is rapidly absorbed and undergoes rapid first-pass metaboHsm by the Hver. The bioavaUabUity of the subHngual and chewable tablets is 59% and 22%, respectively, for the regular tablet. Isosorbide is metabolized to isosorbide-2-mononitrate and isosorbide-5-mononitrate, both of which have pharmacologic activity. The elimination half-Hves of subHngual and po isosorbide dinitrate ate 1 and 4 h, respectively. Those of the 2- and 5-mononitrate metaboHtes are 1.5—3.1 h and 4—5.6 h, respectively. The two metaboHtes prolong the elimination half-life of the dinitrate. Adverse effects with isosorbide are similar to those described for nitroglycerin (99). 

It is important not to chew capsules before swallowing they must be swallowed whole. The patient also should not chew tablets unless labeled as chewable. Some tablets have special coatings that are required for specific purposes, such as... 

Adults and children older than 15 years 10 mg PO in the evening children 6 14 years 1 5-mg chew-able tablet daily, in the evening children 2—5 years 1 4-mg chewable tablet daily, in the evening... 

Helidac—Each dose includes four tablets two round, chewable pink tablets (bismuth), one white... 

AH-Chew Tablets—phenylephrine HC1, chlorpheniramine maleate, methscopolamine nitrate D.A. Chewable Tablets—phenylephrine HC1, chlorpheniramine maleate, methscopolamine nitrate Dallergy Syrup or Tablets—phenylephrine HC1, chlorpheniramine maleate, methscopolamine nitrate Dehistine Syrup—phenylephrine HC1, chlorpheniramine maleate, methscopolamine nitrate Extendryl Syrup—phenylephrine HC1, chlorpheniramine maleate, methscopolamine nitrate Pannaz Tablets or Syrup—phenylephrine HC1, chlorpheniramine maleate, methscopolamine nitrate Rescon-MX Tablets—phenylephrine HC1, chlorpheniramine maleate, methscopolamine nitrate... 

Tegretol Chewable tablet 100 mg Target serum concentration for bipolar I disorder. 

Ti me to reach peak serum concentrations Distribution 0.5-3 hours (regular-release) 4-12 hours (extended-release) 0.25-1 hours (oral solution) 4.5 hours (regular-release) 1.5 hours (suspension) 3-12 hours (extended-release tablets) 4.1-7.7 hours (extended-release capsules) higher peak concentrations with chewable tablets 4.5 hours (range of 3-13 hours) 1 -4 hours (VPA) 3-5 hours (DVPX single dose) 7-14 hours (DVPX extended-release multiple dosing) 1 -4 hours... 

Finally, another unique formulation is a chewable tablet available to women who have difficulty swallowing medications. Ovcon 35 (norethindrone/ethinyl estradiol) has all 28 tablets in chewable form and has added spearmint flavoring.30 Along with each of these unique oral contraceptives, there are preparations currently being studied that contain 24 active pills and 4 placebo pills per pack, shortening the hormone-free period.1... 

Drug absorption is highly variable in neonates and infants [21,22]. Older children appear to have absorption patterns similar to adults unless chronic illness or surgical procedures alter absorption. Differences in bile excretion, bowel length, and surface area probably contribute to the reduced bioavailability of cyclosporine seen in pediatric liver transplant patients [22a]. Impaired absorption has also been observed in severely malnourished children [22b]. A rapid GI transit time may contribute to the malabsorption of carbamazepine tablets, which has been reported in a child [23]. Selection of a more readily available bioavailable dosage form, such as chewable tablets or liquids, should be promoted for pediatric patients. 

Both solid and liquid dosage forms may contain saccharin. Saccharin is a nonnutritive sweetening agent, which is 300 times as sweet as sucrose. In a survey of sweetener content of pediatric medications, seven out of nine chewable tablets contained saccharin (0.45-8.0 mg/tablet) and sucrose or mannitol. Seventy-four of the 150 liquid preparations investigated contained saccharin (1.25-33 mg/5 mL) [62], Saccharin is a sulfanamide derivative that should be avoided in children with sulfa allergies [54],... 

Because of the high incidence of lactose intolerance in the general population, lactose is not recommended as a sweetener for pediatric populations [70]. Aspartame, a phenylalanine derivative, is incorporated in many chewable tablets and sugar-free dosage forms. Aspartame-containing products should be avoided in children with autosomal recessive phenylketonuria [54]. 

Chewable tablets and sprinkle capsule formulations have been very well received by both patients and their parents for use in children with full dentition (older than 3 years, [75-77]. This is potentially a very fruitful area for future research and development. Pharmaceutical preparations developed for administration to young children need to have consistent bioavailability when administered with food [78]. 

The dosage forms most commonly employed for pediatric formulations are liquids and chewable tablets. A perceived unpleasant taste is much more evident with these dosage forms than when a drug is administered as a conventional solid oral dosage form. Second, it is widely believed that children younger than the age of 6 years have more acute taste perception than older children and adults. Taste buds and olfactory receptors are fully developed in early infancy. Loss of taste perception accompanies the aging process. 

Smell, taste, texture, and aftertaste, therefore, are important factors in the development of pediatric dosage forms. In a study of six brands of OTC chewable vitamins, flavor type and intensity, soft texture, and short aftertaste were critical factors in product preference. The flavor and texture attributes of the bestselling product were significantly different from the other brands [97]. 

Chewable Tablets. It has already been noted that most elderly patients experience a decrease in their ability to chew efficiently [125,137,138,143]. Therefore, by virtue of their design, chewable tablets are not often recommended for use by elderly patients (particularly those who are edentulous) 155-163,164], Most chewable formulations also rely on an adequate amount of chewing action to obtain full release of their ingredients (e.g., chewing promotes the foaming action provided by some chewable antacid products). So, aside from being difficult form the elderly patient to use, full benefit of a chewable dosage form may not be achieved by these patients. Additionally, the use of chewable tablets by denture wearers may cause local irritation in the oral cavity [155]. 

S. Abdel-Rahman, D. Blowey, R. Kauffmann, and G. Kearns, Comparative bioavailability of loracarbef chewable tablet vs. oral suspension in children, Pediatr. Infect. Dis. J., 17(12), 1171 (1998). 

C. Comaggia, S. Gianetti, D. Battino, T. Granato, A. Romeo, F. Viani, and G. Limido, Comparative pharmacokinetic study of chewable and conventional carbamazepine in children, Epilepsia, 34, 158 (1993). 

A U V spectrophotometric method for niclosamide determination in chewable tablets at 333 nm was described [46]. The excipients did not interfere in the determination. 

There are many trade-name products for calcium carbonate (e.g., Calel-D, Caltrate, Os-Cal). Only calcium carbonate alternative dosage forms (i.e., chewable, liquid, power) are specifically listed. 

Sublingua (/chewable 2-5 1-2 hours 2.5-5 mg three times daily... 

C-ll, C-lll, C-IV, controlled substance schedule 2, 3, and 4, respectively cap, capsule chew tab, chewable tablet CINV, chemotherapy-induced nausea and vomiting liquid, oral syrup, concentrate, or suspension OTC, nonprescription Rx, prescription supp, rectal suppository tab, tablet. 

If each Tegretol (carbamazepine) chewable tablet contains 100 mg of carbamazepine, how many Tegretol tablets can be made from 1 kg of carbamazepine ... 

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