Patient’s association launches care home charter for swallowing and medicines

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In Jan 2017 the UK Patient’s Association launched a charter to improve the care of residents in care homes who have swallowing difficulties. In response to a survey results which identified sub-optimal practices with respect to covert administration and medicines administration for care home residents with dysphagia, the Patient’s Association convened an advisory group to address the problem.  Consisting of representatives from care homes, primary care organisations, the nursing, medical and pharmacy professions and leading academics in the field, nine point charters for both patients and healthcare professionals were developed.  With recommendations that medicines and formulation choice be regularly reviewed, that residents are placed at the centre of any decision making and assessment for dysphagia is regularly undertaken it is hoped that residents in care homes will receive better quality care.  Detailed guidance on the charter and how to implement it into care homes is due in August.

Mixing medicines with thickeners can significantly reduce their effectiveness

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Recent research published in the international journal Dysphagia has shown that if Mitiglinide tablets, a treatment for type 2 diabetes are mixed with a thickener before being administered to healthy volunteers, Mitinglinide’s ability to reduce blood sugar levels was seriously affected.  In practice this would mean that if the drug was routinely administered with a thickening agent then the patient’s diabetes control would be poor.  The trial was in five patients who received the tablets on their own and then in a thickening agent and therefore acting as their own controls.  The results showed that the thickener not only delayed absorption of the drug but also resulted in reduced effectiveness. 30 minutes after ingestion the blood glucose level in patients when they had used the thickener was 160mg/dl on average compared to 110mg/dl when it was not used and this difference was shown to be statistically significant.  The authors recommend that if medicines are to be mixed with thickeners then it would be wise to carefully assess and monitor the patient.  The paper’s full title: Tomita T, Goto H, Sumiya K, Yoshida T, Tanaka K,, Kudo K, Kohda Y.Effect of Food Thickener on the Inhibitory Effect of Mitiglinide Tablets on Post-prandial Elevation of Blood Glucose Levels. Dysphagia. 2017 Jun; 32(3): 449-503. doi: 10.1007/s00455-017-9787-1.

Liquid medicines licensed for administration via enteral tubes

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The following liquid medicines manufactured by Rosemont Pharmaceuticals have recently received UK licenses for administration via nasogastric (NG) or percutaneous endoscopic gastronomy (PEG) tube:

  • Furosemide Oral Solution 20mg/5mL, 40mg/5mL and 50mg/5mL
  • Ramipril Oral Solution 2.5mg/5mL
  • Metoclopramide Hydrochloride Oral Solution 5mg/5mL
  • Clonazepam Oral Solution 0.5mg/mL, 2mg/mL
  • Gabapentin Oral Solution 50mg/mL

All of the above medicines can now be safely administered through an enteral tube in the knowledge that no medicine is lost on the tube and that the tube is unlikely to block if the individualised flushing guidance is followed. Interestingly for many of the medicines the amount of water required for flushing has been identified to be similar to the dose being administered and therefore significantly less than that recommended in practice.  The manufacturer recommends that the flushing guidance for each liquid medicine, which is provided in the information leaflet, be adhered to, to ensure that the administration fulfils the licensing requirements.

More information can be found at:  https://www.rosemontpharma.com/news/furosemide-ramipril-metoclopramide-clonazepam-and-gabapentin-approved-enteral-tube

Rosemont Pharmaceuticals have also announced that they have 75 medicines recorded as Halal approved – please see the individual medicines profiles for further information.