Many products today are designed to be 'plug-and-play'. Reading the instructions closely may enable the consumer to get the best out of their purchase, but in most cases a little bit of logic renders the accompanying booklet redundant. If there's a problem, intuitive improvisation can usually overcome the difficulty.
So if medication is in the form of a tablet or capsule, all the patient has to do is swallow the requisite number at the specified intervals. And if the patient has difficulty in swallowing, the obvious solution would seem to be to crush the tablet or empty the capsule's contents and mix them with food or liquid, rather than ask for an alternative dosage form.
Drug delivery technology is one of the fastest developing areas in the pharmaceutical sector. Tailoring a dosage form to get the active ingredient to the site in the body where it can do most good while causing the least harm is a complex and highly skilled science. But it all comes to nothing if the structure of the tablet or capsule is tampered with.
Who knows how many adverse drug reactions - both reported and unreported - have been caused by defective administration rather than a reaction to the compound itself?
If the original dosage form is unsuitable, most drugs are available in other formulations, including oral liquid, suppository, transdermal patch or inhaler. Even a different size or shape of tablet can be helpful. A timely study commissioned by Colorcon and conducted by Glasgow-based Bio-Images Research showed that film-coated oval tablets are easier to take than any other commonly manufactured solid dosage forms.
Researchers used sophisticated nuclear medicine cameras to study medication passage from the mouth to the lower GI tract, and found that oval film-coated tablets demonstrated the fewest instances of slow transit in the esophagus, fewer incidences of lodging in the esophagus, and the least likelihood of causing swallowing problems.
Patients cannot be expected to be aware of complex and sophisticated drug delivery technologies such as the Egalet development or Cambridge Consultants' revolutionary inhaler, but those prescribing the medication should ensure that compliance encompasses not only 'how much' and 'how often' but also, quite simply, 'how'.