title: Oral drug therapy in elderly with dysphagia: between a rock and a hard place!
abstract: Demographic indicators forecast that by 2050, the elderly will account for about one-third of the global population. Geriatric patients require a large number of medicines, and in most cases, these products are administered as solid oral solid dosage forms, as they are by far the most common formulations on the market. However, this population tends to suffer difficulties with swallowing. Caregivers in hospital geriatric units routinely compound in solid oral dosage forms for dysphagic patients by crushing the tablets or opening the capsules to facilitate administration. The manipulation of a tablet or a capsule, if not clearly indicated in the product labeling, is an off-label use of the medicine, and must be supported by documented scientific evidence and requires the patient's informed consent. Compounding of marketed products has been recognized as being responsible for an increased number of adverse events and medical errors. Since extemporaneous compounding is the rule and not the exception in geriatrics departments, the seriousness and scope of issues caused by this daily practice are probably underestimated. In this article, the potential problems associated with the manipulation of authorized solid oral dosage forms are discussed.
authors.affiliation: School of Advanced Studies; School of Pharmacy.
authors.forename: Serena
authors.initials: S
authors.lastname: Logrippo
authors.affiliation: School of Law, University of Camerino, Camerino.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Italian National Research Centers on Ageing (INRCA), Ancona, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Sestili
authors.affiliation: School of Pharmacy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cespi
authors.affiliation: Italian National Research Centers on Ageing (INRCA), Ancona, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Ferrara
authors.affiliation: School of Pharmacy.
authors.forename: Giovanni F
authors.initials: GF
authors.lastname: Palmieri
authors.affiliation: Italian National Research Centers on Ageing (INRCA), Ancona, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Ganzetti
authors.affiliation: School of Pharmacy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Bonacucina
authors.affiliation: School of Pharmacy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Blasi
mesh_terms: D000284:Administration, Oral; D000368:Aged; D003680:Deglutition Disorders / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D013607:Tablets
chemical_list: D013607:Tablets
keywords: compounding; dysphagia; gastrointestinal tract toxicity; geriatric medicine; modified-release formulations