Antiplatelet formulations suggested for adults with swallowing difficulties

Karoline Brennan, Senior Medicines Information Pharmacist, North West Medicines Information CentrePublished

A range of antiplatelets are suitable for use in adults with swallowing difficulties.

Licensed medicines in suitable formulations

There are no suitable licensed formulations of clopidogrel, modified-release dipyridamole or prasugrel.

Ticagrelor (Brilique) orodispersible tablets

May be suitable for some patients. The tablet should be placed on the tongue where it will rapidly disperse in saliva and can be swallowed, with or without additional water.
Note: ticagrelor orodispersible tablets must be swallowed to be effective. The drug is not absorbed sublingually.

Ticagrelor (Brilique) film-coated tablets

Licensed to be crushed to a fine powder and given with water. See the SPC for details.

Dispersible aspirin tablets

Can be considered as monotherapy for patients post stroke/TIA who are unable to take clopidogrel or modified-release dipyridamole.

Dipyridamole 50mg/5ml and 200mg/5ml oral suspensions

Available as licensed products. Neither requires fridge storage; 50mg/5ml has an expiry of one month once opened, 200mg/5ml has an expiry of 60 days once opened. They are only licensed for use in patients with prosthetic heart valves in combination with oral anticoagulation.
Note: Evidence only supports use of modified-release, not immediate-release, dipyridamole preparations for prevention of vascular events.

Licensed medicines used in an unlicensed manner

Clopidogrel tablets

Can be crushed and/or dispersed in water or crushed and given with soft food.

Ticagrelor film-coated tablets

Can be crushed and given with soft food.

Dipyridamole modified-release capsules

Can be opened and the modified-release granules mixed with water, juice or soft food. The granules must not be crushed or chewed.

Dipyridamole immediate-release tablets

Can be crushed and mixed with water or given with soft food.
Note: Evidence only supports use of modified-release, not immediate-release, dipyridamole preparations for prevention of vascular events.

Special-order medicines

The following preparations are listed in Part VIIIB of the Drug Tariff.

Clopidogrel

Available as 75mg/5ml oral solution and 75mg/5ml oral suspension