The Role of the Pharmacist in Selecting the Best Choice of Medication Formulation in Dysphagic Patients

Abstract

Usually, the administration of drugs by feeding tube in dysphagic patients involves handling of marketing licenses outside their term, due to the lack of suitable formulations. This circumstance has put health professionals in the dilemma of choosing the formulation whose manipulation possibly does not alter the effectiveness of the drug. In this regard, a practical guide providing indications on the prescription, handling, and administration of drugs through enteral feeding tube could be of paramount utility. For this purpose, we have considered the 1047 solid oral pharmaceutical forms included in the formulary of San Paolo Hospital (Savona, Italy). From our analysis, it emerges that 95% of medicinal products are worryingly used off-label and 40% have to be managed by the hospital pharmacists without having suitable indications by either the manufacturers or by literature studies. To fill this gap, we have compiled a detailed table containing missing indications derived from pharmacist expertise and evidence-based practices, with the aim that the sharing of our procedures will contribute to make uniform pharmacological therapies from one hospital to another. This study will allow doctors to have easy access to information on drugs that can be prescribed and nurses to become familiar only with the pharmaceutical forms that can be administered.

Keywords: compounding pharmacist; dysphagic patients; hospital pharmacy; off-label prescriptions; patient safety; solid oral formulations.

Figure 1

Letter addressed to the pharmaceutical companies whose products appear on the hospital formulary.

Figure 2

Solid oral dosage forms included in the Savona hospital formulary.

Figure 3

(a) Obstruction of a tube. (b) Obstruction of a PEG with breakage of the terminal bumper.

Figure 4

Feasibility of drug administration via enteral feeding tube of the solid oral dosage forms included in the Savona hospital formulary.

Figure 5

The weight of pharmacist skill in the administration of a therapy by feeder tube. The different colors are indicative of the sources behind the decisions on the feasibility of using a solid pharmaceutical form administered by tube.