Page 8 - Index

MANAGING MENTAL HEALTH PATIENTS WITH SWALLOWING DIFFICULTIES
Patient acceptance of prescribed
medication is an important component
of compliance.
Discussions with patients who experience discomfort when swallowing
tablets, to identify an alternative formulation that they are willing to take,
is an important step23
.
Altering solid dose forms
Crushing tablets and opening capsules can change the pharmacokinetic
or bioavailability profile of a medicine which can impact efficacy and
safety31,32. Altering modified release medication may also result in
initial overdose, followed by under-dosing and may make the
medicine taste unpleasant19. Guidance from the NHS on medications
commonly used in the treatment of mental health suggests that even
where crushing is acknowledged, solubility can be poor and dispersing
in water may take over two minutes33
.
Liquid Medicines
Licensed liquid medicines can provide a more appropriate formulation
for patients with swallowing difficulties19. They are easy to swallow,
and the dosage can readily be modified for individual patients23. Many
commonly used solid medications are available as licensed liquid
medicines33 and liquid formulations of antipsychotics in particular have
been acknowledged to have been a success in treating patients with
mental health problems23. Liquid medications are often associated with
a higher acquisition price than solid dose forms but a study in the
Journal of Medical Economics suggests that improved compliance
potentially offsets those extra costs34. As an example, preventing
one day’s admission to a psychiatric hospital would fund liquid
chlorpromazine instead of a solid dose form for 3 patients for a year34
.
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