Oral drug therapy in elderly with dysphagia

Demographic indicators forecast that by 2050, the elderly will account for one-third of the global population. Geriatric patients require a large number of medicines, and in most cases, these products are present on the market as solid oral dosage forms. However, this population tends to suffer difficulties with swallowing, defined as dysphagia. In this contest, caregivers in hospital geriatric units routinely compound solid oral dosage forms by crushing tablets or opening capsules to facilitate their administration. This practice requires a manipulation of original formulation making necessary to consider different issues: decrease of drug efficacy, increase in toxicity, problems of instability, lowering of palatability, cross-contamination and loss of drugs. The present work deals with the possibility to improve dysphagic patient compliance under therapy with a cholesterol-lowering drug, pravastatin sodium salt, a widely prescribed molecule traded on the market just as immediate-release tablets. Chemical-analytical and microbiological stability of an aqueous solution of pravastatin starting from tablets has been investigated with the aim to administer the solution orally by using syringe directly in feeding tube. Then, to optimize the compounding process of commercial tablets of water-soluble molecules in a semisolid preparation, a hydrogel for oral admistration has been formulated. The objective was to obtain a product having a suitable consistency and a release kinetic comparable to that of immediate-release tablet. Therefore, patient might switch pharmacological therapy from original solid form to the gelified formulation assuring compliance to treatment. This work demonstrates the possibility to reformulate pravastatin tablets as liquid pharmaceutical formulation or gel with the aim of improving life quality and safety in drug administration.