What are the therapeutic options for patients unable to take solid oral dosage forms?

Karoline Brennan, Senior Medicines Information Pharmacist, North West Medicines Information CentreSource UKMiPublished

Describes a step-wise approach to choosing medicines options for patients with swallowing difficulties (dysphagia). Includes information on crushing tablets.

This updated Medicines Q&A reviews the therapeutic options for patients with swallowing difficulties or feeding tubes, and gives advice on choosing the most appropriate preparation for a patient.

It includes information on the off-label use of licensed medicines (e.g. crushing tablets and opening capsules) and the use of unlicensed special order medicines (‘Specials’).

  • Some adults are unable to take medicines in solid oral dosage forms for reasons such as swallowing difficulties. The choice of medicine for these patients should be made on an individual basis taking into account the patient’s clinical needs, method of feeding, the practicalities of administration, product quality and cost.
  • A stepped approach to choosing a suitable medicine is suggested:
  1. If possible, use a licensed medicine in a suitable formulation to meet the patient’s needs (e.g. a dispersible tablet or licensed liquid medicine). Consider switching to a different agent in the same class, or to a different route of administration to allow a licensed medicine to be used.
  2. Consider using a licensed medicine in an unlicensed manner, for example by crushing/dispersing tablets or opening capsules. Not all medicines are suitable for use in this manner and it important to check beforehand with a pharmacy professional or appropriate reference source. Take into account the patient/carer’s ability to administer medicines in this way and consider any risks to the carer from exposure to medicines such as cytotoxics or hormones.
  3. In situations where the patient’s needs cannot be met by licensed medicines, consider using a special-order product (‘Special’).
  • Licensed medicines should be used where possible. They are manufactured to specific standards and have been assessed for efficacy, safety and quality.
  • Special-order products are unlicensed and are not required to meet the same standards as licensed preparations. Prescribers assume greater liability when using them and should document why they are required.
  • Special-order products listed in Part VIIIB of the Drug Tariff have a defined price to the NHS. The cost of ‘Specials’ not listed in the Drug Tariff is unregulated.
  • An appendix to this Medicines Q&A lists some therapeutic options for adult patients unable to take solid oral dosage forms. Another appendix provides practical advice on administration of medicines for these patients.