Everyone knows the common sense that taking medicine depends on drinking water. But some [busy people] swallow pills in order to save trouble, There are also some [fierce warriors] who do this to show their swallowing skills. In their view, You can take the pills in one swallow, As to whether the tablets were taken to the place where they should work, They don’t think so much. In fact, Dry swallow the pills, It is the easiest way to stick the tablets to the esophageal wall. Some drugs with irritation to esophageal mucosa (such as potassium chloride, bisphosphate, etc.) remain in esophagus for a long time, It may cause retrosternal pain, burning and other discomfort, and in severe cases it may also cause esophagitis, esophageal ulcer and esophageal erosion. This is not a joke, but it has actually occurred clinically. Therefore, don’t try to save trouble or swallow tablets dry for bravado!
What else should we pay attention to for different drug dosage forms? Next, I will choose several commonly used dosage forms to give you a brief introduction.
Tablet
Tablets are tablets made by mixing drugs and adjuvants evenly and pressing them. Tablets are mainly oral ordinary tablets, but also include buccal tablets, sublingual tablets, oral patches, chewable tablets, dispersible tablets, effervescent tablets, vaginal tablets, sustained-release or controlled-release tablets and enteric-coated tablets. Generally speaking, tablets are composed of two categories of substances: one is drugs that play a therapeutic role (i.e. Main drugs); The other is substances that have no therapeutic effect (i.e. Excipients). The functions of excipients mainly include filling, adhesion, disintegration and lubrication, and sometimes coloring and flavor correction.
Tablets are divided into oral tablets, oral tablets and external tablets.
Oral tablet
Oral tablets are divided into the following types:
I. Ordinary tablets. Refers to tablets made by mixing and pressing drugs and excipients. The quick-release tablets mentioned in this book refer to such ordinary tablets.
2. Coated tablets. Refers to tablets coated with film outside the tablet heart. The purpose of coating is to increase the stability of drugs in the tablets. Cover up the bad smell of drugs, Improve the appearance of tablets, etc. Coated tablets can be divided into: 1. Sugar-coated tablets. It refers to tablets made mainly by wrapping sugar as coating material. 2. Film-coated tablets. It refers to tablets wrapped with a film of polymer material. 3. Enteric-coated tablets. It refers to a layer wrapped with a layer that is insoluble in gastric juice. Tablets of protective clothing that dissolve only in intestinal fluid, The aim is to prevent the drug from being damaged in gastric juice and avoid the irritation of the drug to the stomach. Therefore, when taking enteric-coated tablets, the tablets cannot be broken, chewed or ground into powder, which will destroy the protective coat and lead to premature release of the drug. On the one hand, it may cause gastric mucosa irritation and cause or aggravate gastric ulcer. On the other hand, gastric juice may also inactivate the drug and cannot exert the curative effect of the drug.
3. Chewable tablets. Refers to tablets swallowed after chewing in the mouth. This kind of tablet is more suitable for young children. Sugar and suitable spices will be added to chewable tablets for young children to improve the taste.
4. Effervescent tablets. Refers to tablets containing effervescent disintegrating agents. Effervescent tablets can produce gas (usually carbon dioxide) when exposed to water, which can dissolve the tablets quickly, such as vitamin C effervescent tablets. If you take effervescent tablets orally carelessly, you will quickly release a large amount of gas in the oral cavity and gastrointestinal tract, irritating mucosa and even causing accidents. The correct approach is to dissolve it in warm water and take it orally after it is completely dissolved.
5. Dispersible tablets. Refers to tablets that can be rapidly dissolved in warm water and can form suspension when drugs are dispersed in water. This tablet is suitable for infants (when the drug taste is not bitter) and the elderly, and can be quickly absorbed.
6. Sustained/controlled release tablets. Refers to tablets that make the drug release slowly or at a controlled speed through a special process and prolong the action time. Compared with ordinary rapid release tablets, Sustained/controlled release tablets can reduce the number of times of administration, It is more suitable for patients with chronic diseases such as hypertension, hyperlipidemia and diabetes to take for a long time. For example, the hypoglycemic drug gliclazide sustained-release tablets, the antihypertensive drug nifedipine controlled-release tablets, etc. In general, Both sustained and controlled release tablets need to be swallowed as a whole, It cannot be broken, chewed or ground into powder. Otherwise, the dosage form will be destroyed. Losing the meaning of slow release or controlled release of drugs, It is more likely to cause sudden and large release of drugs in dosage forms, So as to increase the toxic and side effects of the drugs. For drugs that can be broken with special instructions, they must also be broken along the notches carved in advance on the tablets, and cannot be broken at will. Patients taking such dosage forms sometimes find a strange phenomenon, and even find complete tablets in the excreted stool! Is there something wrong with the quality of the drug? In fact, in order to achieve the purpose of slow release of drugs, some of these tablets will build a complete house (drug shell) for the drugs during the preparation process. When the drugs are released and absorbed, the house will be discharged with the stool, so there is no need to worry that the drugs will not work. The tablets you see in the stool are just drug shells.
Oral tablet
Oral tablets are divided into the following two types:
1. Buccal tablets. Refers to tablets that slowly dissolve in the buccal membrane and play a therapeutic role. Buccal tablets are mostly used for oral and throat discomfort. Can produce local anti-inflammatory and bactericidal effects, For example, Benyi Buccal Tablets (generic name: Diquinine Brevibacterium Chloride Buccal Tablets) and so on. When this tablet is contained in the mouth, do not chew it up, and the longer it is taken, the better. After taking it, try not to drink water or eat for half an hour, and maintain a relatively high concentration of drugs in the throat, which can better play a role in sterilization.
2. Sublingual tablets. Refers to tablets placed under the tongue. Its content method is different from buccal tablets. Buccal tablets can be contained anywhere in the mouth, The sublingual tablet must be contained under the tongue, Because the capillaries under the tongue are very rich, drugs are absorbed very quickly. For example, nitroglycerin sublingual tablets used to relieve angina pectoris need to be taken sublingual to make it take effect quickly to save lives. Never swallow sublingual tablets, which not only take effect slowly, but also often fail to achieve therapeutic effect or even fail.
Tablets for external use
Refers to vaginal tablets and compression tablets specially used for preparing external solutions. The former is directly used in vagina. For example, metronidazole vaginal effervescent tablets are used to treat bacterial vaginitis. External solution tablets refer to the dissolution of tablets by adding a certain amount of water. After making a solution with a certain concentration for external use, Never take it orally, Such as potassium permanganate tablets for sterilization, You need to add 500 ml of water to one tablet to make a solution. Then for external use. Potassium permanganate is used for disinfection of skin infection. Clean small areas of ulceration or abscess, And hemorrhoids hip bath, It can kill various bacteria, fungi and other pathogenic microorganisms. Potassium permanganate itself has strong corrosivity and burn property. Clinically, it can occasionally encounter patients who seek medical treatment due to taking potassium permanganate external tablets by mistake. The local concentration of potassium permanganate external tablets is very high after being taken by mistake. It can cause damage to human body, even if it is small, it may cause damage to esophagus, gastric mucosa and intestinal tract, resulting in ulcer or hemorrhage. Remind everyone to be careful not to think that the word [tablet] is edible.
Capsules
Capsule refers to a dosage form made by putting drugs into capsules according to dosage. Capsules generally use gelatin as the main raw material. Sometimes methyl cellulose, calcium alginate, denatured gelatin and other polymer materials are also used to change its solubility or achieve enteric-coated purposes. Capsules can cover up the bad smell of drugs, are easy to swallow, can also improve the stability and bioavailability of drugs, and can release drugs regularly and locally.
Capsules are mainly divided into hard capsules and soft capsules (capsules).
Hard capsule
Refers to making a certain amount of drugs and appropriate auxiliary materials into uniform powder or particles, It is made by filling it in hollow hard capsules. Hard capsules are very widely used. As mentioned earlier, Capsules generally use gelatin as the main raw material, Pigskin or cowhide used for qualified medicinal gelatin should be leather hides or fresh or frozen hides that have not been tanned with chromium salt or contaminated by harmful metals. In 2012, Some enterprises in Hebei use quicklime to treat leather waste and boil it into industrial gelatin with chromium exceeding the standard. Selling some pharmaceutical factories to pretend to be medicinal capsules for patients to eat into their stomachs triggered a sensational [poison capsule incident], in which a number of pharmaceutical factories were investigated and dealt with and a series of drugs were recalled. This has led to people’s worries about the type of capsules taken, triggering such issues as [can capsules be taken apart? Although the capsule shell itself has no drug effect, it plays an important role, including: 1. Covering up the bad smell of drugs, such as traditional Chinese medicine capsules; 2. Avoid drug burns to esophagus, such as minocycline capsules; 3. Avoid the stimulation of drugs to the stomach or protect drugs from gastric acid damage, such as enteric-coated capsules; 4. That release speed of the drug is control, the action time of the drug is prolonged, Such as slow/controlled capsules. If the capsules are taken apart, It may reduce the efficacy of the drug or enhance the adverse stimulation of the drug. In addition, it is not conducive to the accurate grasp of the dosage of drugs. Therefore, it is usually not appropriate to take the capsules apart. If it is really necessary to take the capsules apart, Should consult doctors or pharmacists and other professionals first. However, after the [poison capsule incident], the relevant national regulatory authorities have been very strict in the supervision of capsules, and now the capsule drugs produced by regular pharmaceutical factories can still be taken with confidence.
Soft capsules
It is to dissolve a certain amount of drugs in appropriate auxiliary materials, and then seal them in spherical or olive-shaped soft capsules by pressing method (or dropping method). Capsules made by sealing oil drugs in soft capsules are also called gel pills. It is made by pressing method, often with pressure seams in the middle. Made by dropping method, it is round and seamless. Soft capsules can be swallowed as a whole or cut open to squeeze out drugs, such as vitamin D3 soft capsules.
Granules, Suspensions, Dry Suspensions
Granule
Refers to a granular preparation made by mixing drugs with suitable auxiliary materials. Generally, it can be divided into soluble granules, suspension granules and effervescent granules. Its main characteristics are that it can be swallowed directly or poured into water for drinking. It is convenient to use and carry, and has fast dissolution and absorption speed. Its main disadvantages are easy deliquescence and high requirements on packaging methods and materials.
Suspension
Refers to the distribution of insoluble solid drugs in the form of particles in liquid preparations, Such as ibuprofen suspension. This is like a bottle of fruit orange beverage, fruit particles are not dissolved in the beverage, so the suspension is not clear, put for a long time will produce precipitation. Therefore, before each use of the suspension, should be fully shaken like shake fruit orange beverage, in order to avoid uneven distribution of drugs and affect the efficacy.
Dry suspension
Refers to making insoluble drugs and suitable auxiliary materials into powder, A liquid preparation that can be dispersed into a suspension for oral administration by shaking with water. Simply put, It is the suspension that has not been added with water. Because the suspension of liquid dosage form has poor stability, Easily precipitated or degraded, Dry suspensions do not have this problem. In fact, many bagged antibiotics (e.g., Amoxicillin/potassium clavulanate dry suspension or azithromycin dry suspension) is a dry suspension dosage form. The drug is made into powder and packaged. It is convenient to take and store. When eating, Just brew with water. Some dry suspensions will be packaged in bottles. You need to brew the whole bottle before you use it. Then take a certain volume according to the dosage, The rest of the solution is stored in the refrigerator. The prepared solution cannot be simply stored at normal temperature. That is easy to deteriorate. Shake it well before the next use. In order to ensure the accurate dosage, it is best to take the medicine with the dosage tube every time you take it. It should be noted that you must not swallow the dry suspension directly, because the dry suspension is usually a fine powder, which is easy to choke into the trachea and cause asphyxia.
Author: Ji Lianmei
This article is taken from the book “Ji Lianmei Talk: Chinese Should Use Drugs This Way”, which is reprinted by the author’s authorized clove garden.