Swallowing problems

The physiological changes and other aspects in the elderly makes this even more complicated. Example of this is decreased stomach acidity decreased motility decreased blood-flow to liver and gastrointestinal tract changed pharmacokinetics and -dynamics polypharmacy swallowing problems bad nutritional status and lack of documentation. 

Sore tln-oat, swallowing problems. Demulcent lozenges containing surface anesthetics such as ethylamino-benzoate (benzocaine) or tetracaine (p. 208) may provide relief however,... 

Symptoms of dehciency include vision problems and light sensitivity, mouth and nose sores, swallowing problems. 

NMS is characterized by such symptoms as severe dyskinesia or akinesia, temperature elevation, tachycardia, blood pressure fluctuations, diaphoresis, dyspnea, dysphagia, and urinary incontinence (Coons et al., 1982). The DSM-IV-TR establishes criteria of severe muscle rigidity and elevated temperature plus 2 more of 10 associated features, including sweating, swallowing problems, tremor, incontinence, changes in level of consciousness from confusion to coma, mutism, elevated heart rate, unstable blood pressure, elevated white count, or laboratory evidence of... 

Both children and the elderly experience swallowing problems with oral formulations. A limited market already exists in pediatric therapeutics which addresses this problem. Although development of rectal formulations for the elderly has not been addressed extensively, with the expanding number of patients in this age group, the need for acceptable alternatives to oral dosing may increase efforts to develop rectal formulations. 

A prescription for an oral liquid can be assessed as discussed in Sect. 2.2. A request for a standard oral liquid formulation will appear to be reasonable in many cases. However, if the request for an oral liquid comes from swallowing problems with oral solids, some alternatives should be considered before the formulation of an oral liquid is started. 

Request Because of Swallowing Problems with Oral Solids... 

If the request for the preparatimi, whether standardised or not, originates from swallowing problems with oral solids, some specific alternatives should be taken into consideration before starting the formulation and preparation. These alternatives are ... 

Active substances with intermediate solubility may cause the greatest challenge. When the solubility is too low for a solution but too high for a suspension (because the risk of crystal growth, see Sect. 18.1.6) the best option seems to be to choose a solid dosage form in combination with instructions for the patient how to handle in case of swallowing problems. 

In older literature the circumvention of the hepatic first-pass effect is mentioned as an advantage for rectal administration of medicines. This is now known to be an invalid argument, since two out of three rectal veins end up in the portal vein. Rectal administration can be useful when a patient is vomiting, has swallowing problems, is unconscious, experiences severe gastro-intestinal complaints when taking the medicine orally (e.g. indomethacin), or for active substances with an unpleasant taste (especially for children). 

The British Pharmacopoeia [2] gives requirements for the dissolution rate of oral suspensions in the general monograph for Unlicensed Medicines . These quality requirements are similar to the advice of the Ph. Eur. for capsules and tablets. The dissolution rate of an oral suspension, being prepared in pharmacies for instance for patients with swallowing problems or for children, and how it compares to the comparable licensed oral dosage form, is an important consideration when designing such liquid medicines. 

Swallowing problems often make patients ask for a liquid dosage form of (licensed) medicines that are on the market only as a tablet or capsule. Or worse, they may crush tablets that are to be taken as a whole. The careful choice of active substance and dosage form is an important step in pharmaceutical care for this kind of patients. Instruction about easier swallowing may be worthwhile. But even then some adaptation of the medicine may be necessary. Any... 

Fig. 37.5 PillDrmk device for crushing tablets in case of swallowing problems (Photo bnesa, France, with permission)...

According to some guidelines, prescribers are to indicate on the prescription if a tablet should be cmshed before administration, preferably after consulting a pharmacist. As this does not always happen, it would be more practical if not only the prescriber but also the pharmacist would know when a patient has swallowing problems, or an enteral feeding tube. In that case, he or she can take into consideration if manipulations with the dosage form are allowed for each new prescription. 

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