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Oral drug therapy in elderly with dysphagia: between a rock and a hard place!

Authors Logrippo S, Ricci G, Sestili M, Cespi M, Ferrara L, Palmieri GF, Ganzetti R, Bonacucina G, Blasi P

Received 8 September 2016

Accepted for publication 19 November 2016

Published 31 January 2017 Volume 2017:12 Pages 241—251


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Walker

Serena Logrippo,1,2 Giovanna Ricci,3 Matteo Sestili,4 Marco Cespi,2 Letizia Ferrara,4 Giovanni F Palmieri,2 Roberta Ganzetti,4 Giulia Bonacucina,2 Paolo Blasi2

1School of Advanced Studies, 2School of Pharmacy, 3School of Law, University of Camerino, Camerino, 4Italian National Research Centers on Ageing (INRCA), Ancona, Italy

Abstract: Demographic indicators forecast that by 2050, the elderly will account for about one-third of the global population. Geriatric patients require a large number of medicines, and in most cases, these products are administered as solid oral solid dosage forms, as they are by far the most common formulations on the market. However, this population tends to suffer difficulties with swallowing. Caregivers in hospital geriatric units routinely compound in solid oral dosage forms for dysphagic patients by crushing the tablets or opening the capsules to facilitate administration. The manipulation of a tablet or a capsule, if not clearly indicated in the product labeling, is an off-label use of the medicine, and must be supported by documented scientific evidence and requires the patient’s informed consent. Compounding of marketed products has been recognized as being responsible for an increased number of adverse events and medical errors. Since extemporaneous compounding is the rule and not the exception in geriatrics departments, the seriousness and scope of issues caused by this daily practice are probably underestimated. In this article, the potential problems associated with the manipulation of authorized solid oral dosage forms are discussed.

Keywords: geriatric medicine, dysphagia, compounding, modified-release formulations, gastrointestinal tract toxicity

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