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Dec 6, 2023
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There are many different extended releases and ODT formulations on the market for many different therapies.
You are to first, discuss a complete summary of the differences of the many different releases available on the market in liquid, tablet, capsule and ODT form. Second,
what are some therapeutic differences you should know when switching your patients from one release to a different release of these same med? Third, explain what are Ghost tablets (discuss in full the different types), which formulations they are found in, which therapeutic drug class are they most found in and any pertinent counseling points you should alert your patients when prescribing these meds.
There are several formulations and releases available for oral medications. Time release or sustained release indicates a gradual release of the active ingredient over a time (Chittaranjan, 20125). Extended release are typically once daily doses (Chittaranjan, 2015). Delayed release, such as enteric coated pills, don’t start to dissolve and absorb until further into the small intestine (Chittaranjan, 2015). Factors that can affect the release of medications include GI tract function and permeability as well as metabolism and patient specific factors such as enzyme availability (Alqahtani, et al., 2021). These factors can be overcome by salt formation which changes the pH solubility of the drug (Alqatani, et al., 2021). Prodrugs can also be used to improve solubility and therapeutic index (Alqatani, et al., 2021).
There are multiple considerations when switching formulations from oral, liquid, or ODT. Absorption can be affected by food in different formulations, such as liquid (U.K Medicines Information, 2021). The use of excipients in the various formulations as well as patient preferences regarding taking some of them. Peanut oil, aspartame, gluten, and lactose are common excipients (U.K. Medicines Information, 2021). Patient also refuse to take formulations that contain animal or insect derived substances which may also be used as excipients (U.K. Medicines Information, 2021). The site of action can also vary between formulations and patients with bowel disorders or that use an enteral feeding tube may be affected by those changes (U.K. Medicines Information, 2021).
Ghost pills are the shells or insoluble part of the pill that are passed in feces (Tungaraza, et al., 2013). They occur most commonly in controlled or extended-release forms. Two common medications that produce ghost pills are oxycontin and venlafaxine XL (Tungaraza, et al., 2013). Several other psychiatric medications and some cardiac medications also produce ghost pills (Tungaraza, et al., 2013).
Chittaranjan, A. (2015, August 26). Sustained-Release, Extended-Release, and Other Time-release Formulations in Neuropsychiatry. The Journal of Clinical Psychiatry. Sustained-Release, Extended-
Release, and Other Time-Release Formulations in Neuropsychiatry | Psychiatrist.com
Tungaraza, T., Talapan-Manikoth, P., & Jenkins, R. (2013, April). Curse of ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Thearpeutic Advances in Drug Safety. 4
(2), 63-71. Curse of the ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry - PMC (nih.gov)
U.K. Medicines Information. (2021, July 19). Switching between liquid and tablet/capsule formulations-
Which medicines require extra care? U.K. Medicines Information. Switching between liquid and tablet/capsule formulations - Which medicines require extra care? (panmerseyapc.nhs.uk)
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Alqatani, M., Kazi, M., Alednaidy, M., & Ahmad, M. (2021, February 19). Advances in Oral Drug Delivery. Frontier Pharmacology.
Frontiers | Advances in Oral Drug Delivery (frontiersin.org)
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