Atkin, Jayne, Devaney, Christopher, Yoshimatsu, Yuki and Smithard, David G (2024) Modified medication use in dysphagia: the effect of thickener on drug bioavailability—a systematic review. European Geriatric Medicine, 15. pp. 19-31. ISSN 1878-7649 (Print), 1878-7657 (Online) (doi:10.1007/s41999-023-00896-6)

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Abstract

Introduction
Dysphagia is associated with long-term conditions including strokes, dementia, Parkinson’s disease and frailty. Dysphagia affects 30–40% of the population aged over 65 years-old. Adults with dysphagia often experience long-term conditions requiring multiple medications (often > 5) to manage these. The thickening of liquids is a common compensatory strategy in dysphagia management. Studies suggest that immersion in thickened liquids affects medicines’ solubility in vitro. Clinicians and pharmacists are unaware of the pharmacokinetic/therapeutic effects of thickened liquids on oral medicines. We conducted a systematic review of existing literature on thickeners’ effects on drug bioavailability.
Methodology
We performed a literature search of MEDLINE & EMBASE. Search terms included: dysphagia/thickened diet (EMBASE only)/ bioavailability or absorption of medicines or pharmacokinetics; excluded: NG feeds/animal studies. Studies included: all genders, countries, > 18 years, community and hospital settings. PRISMA guidance was followed.
Results
Five hundred seventy results were found, and 23 articles identified following the reference list review. Following an abstract and full-text review, 18 were included. Most articles evaluated thickeners on dissolution profiles in-vitro, with a few investigating in-vivo. Most studies were single-centre prospective studies identifying that thickeners generally affect dissolution rates of medications. Few studies assessed bioavailability or used clinical outcomes.
Conclusion
Dysphagia and polypharmacy are common in older adults, but little is known about the effects of altering liquid viscosity on the therapeutic effect of most medications. Further larger-scale studies are required to evaluate the therapeutic impact of thickener, on a bigger range of medications, factoring in other variables such as type of thickener, viscosity of thickener and duration of immersion.

Item Type:	Article
Uncontrolled Keywords:	dysphagia; swallowing; thickener; modified diets; thickened-liquids; bioavailability
Subjects:	R Medicine > R Medicine (General) R Medicine > RS Pharmacy and materia medica R Medicine > RZ Other systems of medicine
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Exercise Activity and Rehabilitation
Last Modified:	12 Mar 2024 12:12
URI:	http://gala.gre.ac.uk/id/eprint/46238

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