Oesophageal transit of six commonly used tablets and capsules.

Hey, Henrik; Jørgensen, F; Sørensen, K; Hasselbalch, Hans Carl; Wamberg, T

doi:10.1136/bmj.285.6356.1717

Cited by 180 publications

(92 citation statements)

References 10 publications

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“…When tablets and capsules are swallowed in the supine posture with small volumes of water they frequently lodge in the oesophagus (Channer & Virjee 1982Hey et al, 1982). There are two potential consequences of the delayed oesophageal transit of drugs.…”

Section: Introductionmentioning

confidence: 99%

The effect of posture at the time of administration on the central depressant effects of the new hypnotic zopiclone.

Channer¹,

Dent²,

Roberts³

1984

Brit J Clinical Pharma

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1 Nine healthy volunteers swallowed 7.5 mg zopiclone in the standing and lying positions on different occasions. Plasma concentrations of zopiclone and psychometric tests, including simple and complex reaction time, and critical flicker fusion threshold, were performed at regular intervals after drug administration. 2 The results show that when the drug was swallowed in the supine position, there was a significant delay in the onset of the impairment of psychomotor function, with prolongation in time to peak impairment by 30-40 min (P < 0.02). The overall impairment in psychomotor performance was found to be significantly less after administration of the drug in the supine position (P < 0.005). 3 Pharmacokinetic analysis revealed a prolongation in lag time of > 20 min before absorption began (P < 0.002) after supine drug administration, with a significantly lower rate constant of absorption (P < 0.02). Area under the plasma concentration-time curve extrapolated to infinity and rate constant of elimination were not significantly different between the two modes of administration. 4 We conclude that to obtain a rapid and complete effect from the hypnotic zopiclone, the tablet should be swallowed in the standing position.

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Section: Introductionmentioning

confidence: 99%

The effect of posture at the time of administration on the central depressant effects of the new hypnotic zopiclone.

Channer¹,

Dent²,

Roberts³

1984

Brit J Clinical Pharma

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“…19 The authors showed that this tablet, similar in size and shape to aspirin, can remain in the esophagus for up to 90 minutes after ingestion, if the individual remained supine during the whole period. When swallowing small round tablets, the transit of these tablets can be transiently held up at the upper esophageal sphincter, the aortic arch, and distal esophagus immediately proximal to the lower esophageal sphincter.…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…The esophageal transit of capsules seems not to be affected by the volume of water, but in the supine position, the smaller capsule may be slower to transit than the larger. 19 Twenty-six percent of patients in one survey of general practitioners said they had problems in swallowing tablets. 21 A prominent complaint was the size of the tablet, followed by the surface, form and taste of the tablet.…”

Section: Predisposing Factorsmentioning

confidence: 99%

Drug-Induced Dysphagia

Alshehri

2003

Ann Saudi Med

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AM Al-Shehri, Drug-Induced Dysphagia. 2003; 23(5): 249-253 Dysphagia is related to the impairment of food passage from the mouth to the stomach. It describes disability or problems in swallowing a wet or dry bolus properly. Dysphagia can be accompanied by a pain sensation in the chest, mostly caused by impaction of the food bolus in the esophagus. Dysphagia should not be confused with the globus sensation (globus hystericus), a feeling of having a lump in the throat, which is unrelated to swallowing and occurs without impaired transport.Structural lesions of the cervical spine such as diffuse idiopathic skeletal hyperostosis are rare causes of dysphagia. Dysphagia following anterior cervical fusion as well as globus and dysphonia due to dysfunction of the vertebral joints are more likely. Symptoms during swallowing of fluids indicate a neurogenic origin. Discoordinated swallowing, nasal reflux, dysphonia or general weakness may also occur.1 Chronic aspiration with respiratory compromise is the main consequence in a variety of neurological disorders as well as in cases of postsurgical dysphagia. Relaxation of the upper esophageal sphincter indicates coordinated muscle movement between the pharynx and esophagus. Dysfunction of the pharyngoesophageal segment may lead to cricopharyngeal achalasia. A dyskinetic sphincter commonly represents an extrapharyngeal cause, i.e., disease associated with gastroesophageal reflux.2 Disorders of the esophageal phase of deglutition can produce retrosternal pain, heartburn, regurgitation and vomiting, as well as laryngeal and respiratory signs. Esophageal motility disorders include lower achalasia, tumors, peptic strictures, inflammatory diseases, drug-induced ulcers, rings and webs.3 Motility disorders present with aperistaltic, spontaneous contractions, diffuse esophagospasm, or a hypermotile esophagus. Gastroesophageal reflux with esophagitis must always be excluded, especially in patients with a globus sensation. 2The diagnosis of dysphagia is based upon a careful history, clinical examination, endoscopy, dynamic imaging (videofluoroscopy, cinematography, videosonography) and electrophysiologic procedures (including pharyngoesophageal manometry, electromyography and pH determinations). 1,4 The multiple features of the appearance of the symptoms of dysphagia and globus make a multidisciplinary approach necessary to establish a diagnosis and begin effective treatment. The evaluation of a patient with symptoms of dysphagia involves two principal aspects: determining the functional level of swallowing ability and the etiology of the swallowing disorder. In long-term care facilities, patients generally present with dysphagia symptoms related to established chronic medical conditions. Whether new symptoms of swallowing dysfunction are caused by an emerging medical problem or by progression of a previously identified disease process is a secondary issue in the long-term care environment; the crucial questions relate to quality of life, requirements for daily nutrition and care, an...

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“…Compared to healthy subjects, patients with dysphagia reportedly experience more difficulty swallowing tablets and require an increased volume of water for tablet ingestion, a longer ingestion time, and an increase in the number of swallowing attempts [2][3][4]. In order to improve compliance with taking medication, investigations into the dosage forms and physical properties of tablets that can be easy to ingest have been conducted in the past [5,6]. The larger the tablets, the harder they are to ingest; conversely, if they are too small, they can be difficult to handle.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of Swallowing Tablets during the Recovery Period following Surgery for Tongue Cancer

Yoshizumi¹,

Mikushi²

2016

Otolaryngol

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Objective: Medicinal tablets are sometimes difficult to swallow, even for healthy individuals. Accordingly, it is likely more difficult for patients to swallow tablets after oral surgery for tongue tumors. In this study, we aimed to investigate the dynamics of swallowing tablets in the recovery period following surgery for tongue tumors. Methods:Two experiments were conducted (Experiment 1 and Experiment 2). In Experiment 1, 20 tongue cancer patients swallowed simulated tablets and underwent videofluoroscopic (VF) examination of swallowing before and after surgery. The ability or inability to pass the tablet to the esophagus and the number of swallowing attempts required to ingest the tablet were evaluated. In Experiment 2, 48 similar subjects swallowed thickened barium and simulated tablets and underwent VF examination of swallowing after surgery. The ability or inability to pass the tablet to the esophagus, the number of swallows required to ingest the tablet, the tablet position after the initial and the final swallowing reflexes, and the oral transit time and pharyngeal transit time for swallowing the thickened barium solution and simulated tablets were evaluated.Results: After subtotal glossectomy, more subjects were unable to pass the tablet to the esophagus after surgery rather than before surgery. However, after surgery, patients needed more numbers of swallowing reflex attempts in order to successfully swallow tablets. Also, the tablets remained not only in the mouth, but also in the epiglottic vallecula and pyriform sinus. In the patients who could pass the tablet, the oral transit time of the thickened barium solution was shorter than in the patients who could not. Conclusion:In cases of subtotal glossectomy, tablet intake should be avoided, particularly in the recovery phase, and VF or endoscopic evaluation of swallowing should be performed when tablets are prescribed. After tongue cancer surgery, patients should be recommended to make multiple swallowing attempts when swallowing tablets.

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Oesophageal transit of six commonly used tablets and capsules.

Cited by 180 publications

References 10 publications

The effect of posture at the time of administration on the central depressant effects of the new hypnotic zopiclone.

The effect of posture at the time of administration on the central depressant effects of the new hypnotic zopiclone.

Drug-Induced Dysphagia

Dynamics of Swallowing Tablets during the Recovery Period following Surgery for Tongue Cancer

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