How can people who need thickened fluids take medicines?

This Medicines Q&A discusses options available for oral administration of medicines in adults who need thickened fluids.

  • People with dysphagia who need thickened fluids must have their medicines in a form they can swallow safely; they are at risk of aspiration if they take thin liquid medicines or take solid medicines with water.
  • People with dysphagia must be assessed and reviewed by an appropriately trained health professional (a speech and language therapist) who will recommend the appropriate fluid consistency and food texture for that individual.
  • Fluid thickness and texture are measured according to the International Dysphagia Diet Standardisation Initiative (IDDSI) framework. Thickening agents can be used to modify liquids to the appropriate IDDSI Level for the patient.
  • This Medicines Q&A outlines options available for oral administration of medicines for people who need thickened fluids, describing advantages and disadvantages of each and points to consider. The most appropriate option must be made on an individual patient basis.

 

  • Options described are:
  1. Whole tablets or capsules, crushed tablets or opened capsules taken with a spoonful of food (e.g. yoghurt, apple sauce) at the appropriate IDDSI Level for the patient. This is likely to be the best option for most patients.
  2. Whole tablets or capsules, crushed tablets or opened capsules taken with a spoonful of thickened fluid at the appropriate IDDSI Level for the patient.
  3. Liquid medicine mixed with a thickening agent.

 

  • Not all tablets and capsules are suitable to be crushed or opened and it is important to check beforehand with a pharmacy professional or appropriate reference source. · If administering medicines with food, consider drug-food interactions and medicines to be given on an empty stomach.
  • Thickening agents can be starch-based or gum-based. Not all thickening agents are suitable to be mixed with all liquid medicines. Macrogol laxatives (e.g. Movicol) can NOT be thickened with starch-based thickening agents.
  • Crushing tablets, opening capsules and mixing liquid medicines with thickening agent, unless specifically included in the product Summary of Product Characteristics, is unlicensed.
  • Take into account the patient or carer’s ability to administer medicines and consider any risks to the carer from exposure to medicines such as cytotoxics or hormones.
  • Patients and carers should be provided with verbal and written instructions on how to safely administer their medicines.

 

This Medicines Q&A complements two others:

Thickening agents: what to consider when choosing a product?

Thickening agents and thickened fluids: do they interact with medicines? 

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