Dysphagia patients need semisolid oral dosage forms prepared by thickening liquids.

Müller, A.; Dolder, Andrea; Jenzer, Helena (2014). Dysphagia patients need semisolid oral dosage forms prepared by thickening liquids. European Journal of Hospital Pharmacy. Science and Practice, 21(1), pp. 128-129. 10.1136/ejhpharm-2013-000436.316

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Background Dysphagic patients are at risk of protein-energy malnutrition and dehydration as well as being incompliant to pharmacotherapy. Causes of dysphagia include neurological conditions (such as stroke, dementia, paraplegia/tetraplegia), otorhinolaryngology (ORL) tumours, etc. If parenteral medicines are not available, an oral dosage form of the right consistency should be prepared. Purpose To present two general formulas for semi-solid dosage forms suitable for dysphagic patients. Materials and methods A suitable texture of oral preparations and food was predefined by an interdisciplinary focus group from the hospital pharmacy, nutrition support team, ORL physicians and logopedic therapists as being a thick puree or like a milk pudding, being able to keep its shape and not needing mastication. Viscosities of a series of thickened test preparations conforming to these requirements were determined using a parallel plate MCR 302 Anton Paar viscometer. Results Viscosities of semi-solid preparations suitable for dysphagic patients range between 1600 and 2300 cP (=mPa.s, at 20°). Two general formulations for thickening liquids leading to this viscosity range can be recommended: Gellan Gum Formula: Gellan Gum (E 418) is a fermented polysaccharide from Pseudomonas Elodea. It is dissolved at 2(m/V)% in an aqueous drug solution of approximately 50°C, filled into a mould and kept at 2–8°C for 1–2 h for gelification. Alginate Formula: Sodium Alginate (E 401) is a polysaccharide from brown algae. A final concentration of 1(m/V)% is dissolved in one half of a calcium-free aqueous drug solution heated to boiling point. This solution I is cooled to 2–8°C for 3–4 h. Solution II consists of calcium lactate 1(m/V)% final concentration dissolved in the second half of the starting drug solution. The gel forms readily by mixing solutions I and II as soon as cross-linking of alginate is induced by calcium. These preparations yield gel-like textures starting from any aqueous drug solution. The thickened masses can be cut into slices corresponding to a needed dose. Conclusions Thickened solutions meeting the need of dysphagic patients can be prepared easily using sodium alginate or gellan gum. In contrast to starch-based preparations, they are not sensitive to amylase, thus will not be affected from an undesirable thinning effect with risk of aspiration.

Item Type:	Journal Article (Original Article)
Division/Institute:	School of Health Professions
Name:	Müller, A.; Dolder, Andrea and Jenzer, Helena
Language:	English
Submitter:	Service Account
Date Deposited:	04 Sep 2019 14:20
Last Modified:	04 Sep 2019 14:20
Publisher DOI:	10.1136/ejhpharm-2013-000436.316
URI:	https://arbor.bfh.ch/id/eprint/5809