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How common are medication-related swallowing difficulties in the community?

Swallowing difficulties are common in older people and can complicate medicines management, but there is little data to show the extent of this problem in the community. So five years ago, I conducted a survey working with pharmacists to try and ascertain how common medication-related swallowing problems are in the community.

17 pharmacies took part and in total 792 questionnaires were collected from customers aged over 60. The survey showed that 60% had experienced difficulties swallowing their tablets or capsules at some time. Worryingly 69% had missed taking their medication completely because it proved too difficult to swallow and 68% had resorted to tablet crushing (a potentially hazardous practice). Yet only 40% told their doctor or pharmacist about their swallowing difficulties.

Since the results were published in 2005, there seems to be more understanding of the need to ensure patients are willing and able to swallow their prescribed solid medication. However, I believe the time is right to see if things have changed and would like to set up another survey.

Any pharmacy interested in participating should email me at blog2@rosemontpharma.com

Swallowing difficulties need to be identified early following stroke

After a stroke, about 75% of patients have some sort of swallowing problem, yet in spite of NICE guidelines on acute stroke management, less than a third of patients are even admitted to a specialist stroke unit within 24 hours.

This is a very worrying situation as dysphagia significantly increases the likelihood of disability and death after a stroke. It’s also a major risk factor for pneumonia which leads to a third of all stroke related deaths.

NICE recommends that patients diagnosed with acute stroke should have their swallowing screened “by an appropriately trained healthcare professional” before being given any oral foods, fluid or medication. Patients with stroke related dysphagia should not be given solid tablets or capsules as these may cause choking and even oesophageal damage if a tablet becomes lodged in the patient’s throat.

It’s devastating enough for a person to have a stroke but there is no excuse for not putting effective interventions in place to ensure that swallowing problems are identified and managed appropriately, within the first 24 hours of a person having a stroke.

Why is it not a good idea to crush tablets?

Many people who have trouble swallowing often resort to crushing their tablets to make them easier to swallow. This can be a dangerous thing to do and along with opening capsules should not be done unless you have checked with your pharmacist first.

Tablets can be ‘sugar coated’, ‘enteric coated’ or coated to modify how the medicine is released into the body. Each of these coatings is there for a different reason.

A sugar coating or film coating surrounds the tablet to make it taste better. Crushing these tablets may not seriously affect how the tablet works but may cause it to taste very unpleasant.

If a tablet has an ‘enteric coating’, it should never be crushed before being taken. The coating is designed to hold the tablet together in the stomach, which could be to:

• Protect the stomach from the medicine
• Protect the medicine from the stomach
• Release the medicine after leaving the stomach e.g. in the intestines

‘Modified release’ means the medicine inside the tablet has been modified so that it is released slowly and doesn’t require to be taken as often. Also the amount of medicine in the body increases slowly and reduces the chance of side effects. If this type of ‘modified release’ is crushed and taken the whole dose is released and absorbed quickly which could be harmful.

If tablets are difficult for you to take then consult your GP or pharmacist and ask for a liquid alternative.

The Rosemont Packaging System Explained

I thought it may help all our customers out there if I explained how our packaging design works to aid product recognition.

As you may be aware, there are two parts to the packaging design, a colour and an icon.

The icons represent the different BNF (British National Formulary) categories that the product fall under, such as cardiovascular, gastrointestinal, and we even have an icon for Specials. This icon appears on the front of the carton (where there is one) and the label.

When it comes to colours, there are only a limited number of colours that we can use. All the packaging must run on our bottling and labelling line, which has what is know as a “Pharmacode Reader”. This reads a sort of bar code which is made up of the inks used on the packaging to read to ensure that the right labelling is going onto the right product. The Pharmacode Reader can only read strong colours, so this limits the palette of colours that we can call on.

So, with over 100 products, we have had to use the same colour more than once, but you will never find the same colour and the same icon and two products. So you need to look at both the colour and icon. We have also ensured that products that may sit next to each other alphabetically (by generic name) have distinctly different colours.

The packaging design is there to help you, but can never replace your need to read the label and make sure that you have the correct product in your hand.

How can I take my medication if I can’t swallow?

Although swallowing difficulties can affect anyone, almost 60% of people over the age of 65 experience difficulties in swallowing capsules or tablets. If many of these people are not taking their medication then they can become seriously ill and may require hospitalisation. It is important to remember that the most expensive drugs for the NHS are those not being taken as they have no chance of improving the patients’ condition! This is a terrible drain on resources which could so easily have been prevented if a liquid medicine had been prescribed

Here at Rosemont we make a range of liquid alternatives for people who suffer with Dysphagia or just have difficulty in swallowing tablets and capsules. So if you are a patient, or are caring for a patient, don’t be afraid to tell your GP that you can’t swallow the tablets they have prescribed. You won’t get better if you don’t take your medicines and in so doing you could cost the NHS a great deal of money through unnecessary additional treatment. Ask your GP if there is a liquid version of your tablets or capsules available to take. Then you can carry on with your life, and on the road to recovery.

What makes our specials such high quality?

This is something we are often asked by customers.

Here at Rosemont we never crush tablets and suspend the powder, or manipulate a tablet or capsule in any way. We make all of our specials from quality control tested raw materials to a validated method of manufacture and tested to validated quality control methodology.

It takes us 9 to 12 month to develop a formulation for a special. We set up stability testing to ICH (International Conference on Harmonization) standards and customers know that if we say it has a 12 month shelf life then it is stable for that length of time.

Ninety four percent of our manufacturing output is licensed products and all our specials are made to the same standards and testing. So customers can always rely on the high quality of our specials.

We provide a Certificate of Analysis (not just a Certificate of Conformity), so customers know that the end product has been fully tested to ensure the product is safe to release.

We build in quality at every stage of the process so that’s why our customers can rely on our specials with complete confidence.