Crushed tablets: does the administration of food vehicles and thickened fluids to aid medication swallowing alter drug release?

Manrique, Yady J., Lee, Danielle J., Islam, Faiza, Nissen, Lisa M., Cichero, Julie A. Y., Stokes, Jason R. and Steadman, Kathryn J. (2014) Crushed tablets: does the administration of food vehicles and thickened fluids to aid medication swallowing alter drug release?. Journal of Pharmacy and Pharmaceutical Sciences, 17 2: 207-219. doi:10.18433/J39W3V

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Author Manrique, Yady J.
Lee, Danielle J.
Islam, Faiza
Nissen, Lisa M.
Cichero, Julie A. Y.
Stokes, Jason R.
Steadman, Kathryn J.
Title Crushed tablets: does the administration of food vehicles and thickened fluids to aid medication swallowing alter drug release?
Journal name Journal of Pharmacy and Pharmaceutical Sciences   Check publisher's open access policy
ISSN 1482-1826
Publication date 2014-01-01
Year available 2014
Sub-type Article (original research)
DOI 10.18433/J39W3V
Open Access Status File (Publisher version)
Volume 17
Issue 2
Start page 207
End page 219
Total pages 13
Place of publication Edmonton, AB, Canada
Publisher Canadian Society for Pharmaceutical Sciences
Language eng
Formatted abstract
Purpose. To evaluate the influence of co-administered vehicles on in vitro dissolution in simulated gastric fluid of crushed immediate release tablets as an indicator for potential drug bioavailability compromise.

Methods. Release and dissolution of crushed amlodipine, atenolol, carbamazepine and warfarin tablets were tested with six foods and drinks that are frequently used in the clinical setting as mixers for crushed medications (water, orange juice, honey, yoghurt, strawberry jam and water thickened with Easythick powder) in comparison to whole tablets. Five commercial thickening agents (Easythick Advanced, Janbak F, Karicare, Nutilis, Viscaid) at three thickness levels were tested for their effect on the dissolution of crushed atenolol tablets.

Results. Atenolol dissolution was unaffected by mixing crushed tablets with thin fluids or food mixers in comparison to whole tablets or crushed tablets in water, but amlodipine was delayed by mixing with jam. Mixing crushed warfarin and carbamazepine tablets with honey, jam or yoghurt caused them to resemble the slow dissolution of whole tablets rather than the faster dissolution of crushed tablets in water or orange juice. Crushing and mixing any of the four medications with thickened water caused a significant delay in dissolution. When tested with atenolol, all types of thickening agents at the greatest thickness significantly restricted dissolution, and products that are primarily based on xanthan gum also delayed dissolution at the intermediate thickness level.

Conclusions. Dissolution testing, while simplistic, is a widely used and accepted method for comparing drug release from different formulations as an indicator for in vivo bioavailability. Thickened fluids have the potential to retard drug dissolution when used at the thickest levels. These findings highlight potential clinical implications of the addition of these agents to medications for the purpose of dose delivery and indicate that further investigation of thickened fluids and their potential to influence therapeutic outcomes is warranted.
Keyword Pharmacology & Pharmacy
Pharmacology & Pharmacy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: School of Chemical Engineering Publications
Official 2015 Collection
School of Pharmacy Publications
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Citation counts: TR Web of Science Citation Count  Cited 12 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 14 times in Scopus Article | Citations
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Created: Thu, 15 May 2014, 21:25:33 EST by Charna Kovacevic on behalf of School of Pharmacy