Combining Liquid Oral Drugs with Thickener: Compatibility and Changes in Viscosity

Modified medication use in dysphagia: the effect of thickener on drug bioavailability—a systematic review

“…The disintegration time for non-immersed tablets was used as the control. The disintegration time was defined as the time at which the contents of the tablets were released Tablets were grouped into naked tablets, film-coated tablets, orally disintegrating tablets and enteric and sugar-coated tablets The disintegration time of all orally disintegrating tablets was longer when immersed in thickener than that of non-immersed tablets (but it was less than 2 min for the majority of tablets) The disintegration time for several other tablets was shorter or unchanged 0 [ 20 ] Bravo-Jose et al 2022 Combining Liquid Oral Drugs with Thickener: Compatibility and Changes in Viscosity Single centre prospective study 45 medicines The solubility of 45 medicines in the thickened fluid were assessed The amount of thickener added to drugs to achieve various different thickness consistencies was also evaluated 3 drugs (almagate, ibuprofen and macrogol) were physically incompatible with thickener Viscosity measurements indicated that different amounts of thickener needed to be added to different drugs 0 [ 21 ] Sugiura et al 2020 Effect of disintegrants on prolongation of tablet disintegration Induced by Immersion in Xanthan Gum-containing thickening solution – Contribution of disintegrant interactions with disintegration fluids Single centre prospective study n/a Tested 7 different disintegrants (excipients often found in tablets and most crucial for tablet disintegration) Compared disintegration time of control with tablets immersed in 0.9%w/v XTG for 1 min Also compared various tablet properties (and whether these were affected by thickener) Disintegration time is significantly prolonged after immersion in the XTG solution. The extent of prolongation differs according to the disintegrants contained in the model tablets 0 [ 22 ] Huupponen et al 1984 Effect of Guar Gum, a Fibre Preparation, on Digoxin and Penicillin Absorption in Man Double-blind study N = 10 Volunteers received either digoxin or penicillin, medication was taken with either guar gum or a placebo preparation (wheat germ) mixed with 200mls of water Serum and urine concentrations of digoxin were measured by radioimmunoassay Serum penicillin concentrations were measured microbiologically according to Reeves et al (1978) Mean peak digoxin concentration was lower after guar gum than after placebo granules (0.05 < p < 0.1) but similar amounts of digoxin were recovered by 24 h in urine samples A significantly lower mean peak penicillin c...…”

“…They found that some drugs were incompatible with thickener and observed the formation of clumps that did not dissolve. Specifically, they noted this for almagate, ibuprofen and macrogol [ 20 ].…”

“…Both in-vitro and in-vivo studies seem to show that medications (and their therapeutic effect) may be differently affected by the use of thickener. Two in-vitro studies each reviewing 40 + medications have shown that immersion in thickener differentially effects disintegration rates and that several medicines form clumps that do not dissolve when immersed in thickener [ 19 , 20 ]. The differential effect of medication choice on whether therapeutic impact is likely to be affected by thickener in vivo is also borne out by comparing the studies of Tomita et al [ 16 , 24 , 25 ].…”

The Effect of Food Thickeners on the Bitterness and Dissolution of Amlodipine Besilate Loaded Oral Disintegration Tablets: Assessment of Potential Suitability for Patients with Dysphagia

“…Recently, research has been undertaken to determine the most effective viscosity when mixing food thickener with pharmacological medicines [9]. The tolerability and product properties of a gum-containing thickener in patients with dysphagia were also examined in a previous study [10].…”