title: Pharmaceutical and safety considerations of tablet crushing in patients undergoing enteral intubation.
abstract: Medication in patients undergoing enteral intubation addresses various challenging issues considering safety and treatment efficiency. Ideally, other routes of administration (i.e. intravenous or intramuscular routes) or especially dedicated formulations should be used. However, in absence of liquid dosage form, tablets or pills must be crushed and suspended in a vehicle before administration. The administration of oral dosage forms by enteral tube is usually performed by the nursing staff facing (i) pharmaceutical relevance of crushing, (ii) loss and concomitant aero-contamination of drug substance, (iii) drug-nutriment interactions and (iv) enteral feeding tube clogging. In the present study, different combinations of either open or confined crushing and suspending protocols were compared by taking into account the crushing yield, the stability and granulometry of the solid oral form suspension and finally the extend of aerosol contamination during crushing and suspending. All protocols exhibited comparable crushing efficiency and suspending properties, but significantly higher aerosolisation of tablet particles was observed in both open crushing and suspending protocol. Therefore, both confined crushing and suspending protocol constitutes an efficient, time saving and safe alternative to the absence of available liquid dosage form for intubated patients.
authors.affiliation: Laboratoire de Pharmacie Galénique Industrielle, EA 4169 Fonctions Physiologiques et Pathologiques de Barrière Cutanée, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, F-69373 Lyon Cedex 08, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Salmon
authors.forename: Elisa
authors.initials: E
authors.lastname: Pont
authors.forename: Hélène
authors.initials: H
authors.lastname: Chevallard
authors.forename: Elhadji
authors.initials: E
authors.lastname: Diouf
authors.forename: Mamadou-Lamine
authors.initials: ML
authors.lastname: Tall
authors.forename: Christine
authors.initials: C
authors.lastname: Pivot
authors.forename: Fabrice
authors.initials: F
authors.lastname: Pirot
mesh_terms: D000284:Administration, Oral; D004355:Drug Stability; D004867:Equipment Design; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods / Q000592:standards; D008508:Medication Errors / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D013535:Suspensions; D013607:Tablets / Q000008:administration & dosage / Q000009:adverse effects / Q000737:chemistry
chemical_list: D013535:Suspensions; D013607:Tablets