How Much Water Should I Drink While Taking Pills

Pharm Pract (Granada). 2009 Jul-Sep; 7(3): 170–174.

The amount of liquid patients utilise to have tablets or capsules

Received 2009 Mar 12; Accustomed 2009 Aug five.

Abstract

The right use of pharmaceutical drugs supports therapy success and reduces the number of adverse side effects. 1 relevant aspect of use concerns the amount of liquid consumed when taking compact and shaped medicines.

Objective:

The aim of this study was to investigate the volume of liquid used by patients when administering their medication.

Methods:

Every patient who bought tablets or capsules from the study leader in a pharmacy in Jena (Frg), and wanted to accept their medicine immediately, received a glass containing 150ml of water. The book of water consumed by the patients was measured subsequently they took their medication.

Results:

21 out of the 136 participants (15.4%) used only upwardly to 60ml of liquid to take their tablets or capsules. Significant influences of demographic aspects, such as historic period or gender, on the book of used liquid were not found. However, an increase in tablet or sheathing size led to a significant increment in the volume of swallowed liquid.

Conclusion:

Patients demand to be ameliorate informed about drinking a sufficient amount of liquid when taking tablets or capsules orally. Therefore, it is of import that every package insert of compact and shaped medicines contains this information. In addition, medical and pharmaceutical experts should also provide this advice to their patients.

Keywords: Tablets, Capsules, Counseling, Drug Labeling, Deutschland

INTRODUCTION

The right utilize of medicines is very important to clinch high success in treatments and to avoid agin drug reactions. In this context, patients should show a loftier rate of compliance when administering their medications: use the correct amount of medicine at the right time and over the appropriate duration.1,2 In improver to compliance, further considerations should as well be taken into business relationship:

Can the patient use the medicine without assistance, such as inhalers or injectors?
Can the patient measure the correct dose?
Do the patients sympathise the dosage instructions or other required information for safe employ?
Is the patient able to separate the tablet correctly?3-half dozen

Another aspect, which is not so frequently reported, concerns the amount of liquid used to eat orally administered, compact and shaped pharmaceuticals, such equally tablets and capsules. For example, Gallo et al. reported that successful esophagus passages of tablets are significantly influenced past the torso position of the patient and the volume of liquid consumed. Taking a 12.5 mm barium sulphate tablet in a supine position resulted in an overall rate of successful esophagus passage in only 17.0% of the 20 test participants. Notwithstanding, a 45° upright position of the upper torso increased the success rate to 66.5% and a vertical position to 69.7%. A quick tablet transport from the mouth to the stomach in a supine position was achieved according to the consumed liquid as follows: no liquid=9.1%, 15ml=38.7%, 30ml=55.viii%, 60ml=lxx.0% and 100ml=81.six%. Capsules or tablets which stick to the esophagus cannot be hands removed or dislodged by drinking farther liquid or eating. Therefore, the authors of the above study recommended that when taking orally administered tablets people should drink a minimum of 60ml of liquid and position the upper body at a minimum of 45° to accomplish a high passage charge per unit of tablets or capsules.vii Other authors have published similar findings.viii

These recommendations are extremely important considering tablets or capsules that remain in the esophagus inhibit the quick effects of the medicine. Furthermore, in that location are many known active substances which severely impairment the esophagus if they release in this organ. Bisphosphonates, tetracyclines and NSAIDs are some examples.9

However, data relating to the amount of liquid needed for successful esophagus passage was given in only 20.5% of the investigated 68 parcel inserts available on the German medicine market in 2000. Recommendations that tablets and capsules should be taken in an upright position were missing in all cases.10 Unpublished research, recently completed by our research group, institute slightly better results. Of 271 randomly selected package inserts from the German medicine market in the year 2005, 31.6% contained information regarding the amount of liquid that should be consumed when taking the medication. All the same, again, not a single package insert designed for orally taken, compact and shaped medicines provided communication that the product should be taken in an upright upper body position.

Therefore, the following study was initiated to investigate:

how much liquid patients usually beverage when they take medications such equally capsules or tablets
which variables influence the book of consumed liquid, for example gender and age.

METHODS

The survey was carried out between Feb and December 2005 in a chemist's in Jena (Germany). All patients who were sold, by the written report leader (pharmacist), shaped and orally administered medicines and who requested to take their medication immediately were included in this report. Each participant was given a glass containing 150ml of h2o to swallow their medicine. Later on the utilize of the prescribed or OTC medicines, the pharmacist measured, equally a predefined parameter, the volume of water consumed using a measuring cylinder. In addition, each participant was observed regarding how he or she swallowed their medicine.

Furthermore, the identification code, a unique seven-digit number given to each medicine available on the High german market, of each administered medicine was collected. These codes allowed for the following data to be gathered which furthered the investigation

pharmaceutical course
weight of the tablets and capsules
volume of the tablets and capsules (without consideration of curves and notches), calculated by using the:
- - length, breadth and height for ellipsoidal tablets
- - diameter and pinnacle for round tablets
- - length and diameter for capsules

The data were collected from the Gelbe Liste [yellowish list]11, the medicines' summary of products characteristics and directly from the pharmaceutical companies.

All nerveless data were coded and inserted into a table using the SPSS statistical program via double information input checking. Averages of the consumed volume of water and if breaks were taken when swallowing the medicine were calculated for the total number of participants and different groups. Significant influences of demographic data and medicine forms on the book of consumed liquid were checked using showtime the Kruskal-Wallis test equally a global test and in a 2d step, the U-examination after Isle of mann and Whitney. In the case that pregnant influences occurred, the Spearman correlation coefficient was conducted.

RESULTS

136 patients with an average age of 55 years were included in this study, co-ordinate to the criteria stated in the method section (minimum: 15 years of historic period, maximum: 83 years of historic period). At the time of the survey, 14.7% of the participants (n=20) were between the ages of 15 and 29, 36.0% were between the ages of xxx and 59 (n=49) and the remaining 49.iii% were 60 years old and over (north=67). Ii thirds of the participants were female (65.four%), and the majority of participants lived in Jena (81.0%).

55.1% of the patients (n=75) were recruited during colder seasons – February to April and October to December. The remaining group participated between May and September 2005. Nearly of the administered medicines were antibiotics (58.1%, n=79). 25.seven% were different types of analgesics (north=35), and the remaining were medicines such every bit antihypertensives, antiviral drugs or proton pump inhibitors.

The patients took their medicines with an average of 115 ml of h2o, which was 76.6% of the provided corporeality of liquid. However, before the pharmacist was able to provide a glass of water, i participant swallowed his tablet without whatsoever liquid. According to the consumed corporeality of h2o, the participants tin can be classified into three groups:

0 to 60 ml: n=21 participants (15.iv%),
61 to 100 ml: n=28 participants (20.6%)
101 to 150 ml: n=87 participants (64.0%).

14 of the 21 people who used 0 to 60ml of water were female and almost half were threescore years of age or older (northward=eleven). However, considering the larger percentages of women and elderly people that participated in this written report, neither patient group was afflicted more than the other by insufficient liquid use when taking tablets or capsules.

Almost one-half of the 136 participants (due north=70) drank the unabridged provided liquid (minimum consumed book: 145ml). In add-on, nearly half of the people swallowed their medicines with water without taking a pause (42.2%), while the others stopped repeatedly. Table 1 shows the volume of water used by all participants, itemized by age group and participants' gender. Information technology also illustrates less of a departure between the groups, as stated higher up. Even when not significant, young men swallowed their medicine, on average, with the highest book of water and young women with the lowest.

Tabular array i

Volume of h2o used to eat compact, shaped and orally practical medicines, such every bit tablets or capsules, itemized by age, group and gender (northward=136 participants)

		Volume of water (average) used to take medicines itemized regarding age
		to 29 years	30 to 59 years	60 years and over	total
Book of water (boilerplate) used to accept medicines itemized regarding gender	female	107 ml (n=14)	118 ml (n=31)	115 ml (north=44)	115 ml (n=89)
	male person	150 ml (n = six)	109 ml (n=xviii)	109 ml (northward=23)	114 ml (northward=47)
	full	120 ml (n=20)	115 ml (n=49)	113 ml (n=67)	115 ml (n=136)

In the common cold season, slightly more than h2o was consumed (average: 119 ml; n=75) than in warmer months (average: 109 ml; n=61). All the same, the differences were not significant.

In 135 cases of the 136 participants, information relating to the pharmaceutical form were bachelor. Participants taking uncoated tablets (northward=36) swallowed on average of 107.7 ml h2o. They drank on boilerplate of 118.seven ml liquid when using coated tablets (n=81) and 114.8 ml when swallowing capsules (n=18). Significant influences caused by the pharmaceutical grade were not found.

The required medicine dimensions were available in 132 cases to summate the volume of the tablets or capsules. Significant influences of the medicines' book on the swallowed volume of water was plant (Spearman's correlation coefficient: 0.188; p=0.031) (Effigy i). Participants whose medicine had a volume of up to 500 mm³ (north=67) used on average of 107.7 ml water. Most of the uncoated tablets (n=22) and half of the capsules (north=9) were in this low volume grouping, which helps to explicate why people who took these medicines used less liquid to swallow their medicines.

An external file that holds a picture, illustration, etc. Object name is pharmpract-07-170-g001.jpg

Relationship betwixt the volume of medicines and the book of water used to swallow shaped and orally applied medicines, such as tablets or capsules (n = 132 participants)

Tablets or capsules with a book of 500 mm3 to 1000 mm3 (n=47) were swallowed on boilerplate with 120.0 ml of liquid. The medicines with a volume of over thou mm3 (n=18) were swallowed on average with 128.9 ml of liquid.

Insignificant influence was found apropos the medicines' weight on the swallowed volume of water (Spearman's correlation coefficient: 0.160, p=0.067). People who took medicines up to 500 mg per tablet or capsule swallowed these with the everyman amount of liquid (average: 108.seven ml). 122.0ml (boilerplate) of liquid was used when tablet or capsule weights were over 500 up to 1000 mg. Heavier tablets or capsules were taken also with an average of 122.0 ml of liquid.

Give-and-take

About every sixth person in this study swallowed tablets or capsules with too piffling liquid. These patients are at a higher risk of oesophagus diseases when taking sure medicines orally, such as bisphosphonates or NSAIDs.7,9 Furthermore, the percentage of people who drinkable too little liquid could fifty-fifty be higher because, in their regular surroundings, patients would not necessarily receive a pre-measured liquid book of 150 ml, as in this study.

On the other hand, people could drink more than h2o when taking their medication because they would have an unlimited amount in their own homes. Furthermore, the participants of this study could be behaving more exemplary when taking their medicine in front of a chemist, as compared to how they would behave privately.

Considering that the tablet size of 12.5 mm (diameter) used in the study of Gallo et al.7, which was larger than the boilerplate of 9.vii mm (min: 7 mm; max: 16 mm; due north=20) of circular tablets investigated in this survey, a lower book of liquid could be considered sufficient for smaller tablets. However, oblong tablets, which were used oft in this written report and were oftentimes twice to iii times larger in size than the tablet in the Gallo et al. written report, could require college volumes of liquid to successfully swallow. In addition, not merely the shape of the medicine, circular or oblong, but besides its coatings could influence the corporeality of liquid required to hands eat tablets and capsules.

One reason that some people eat oral, compact and shaped medicines with likewise little liquid is considering they are unaware of the possible problems associated with this behavior. Another explanation is that they drink bereft amount of liquids as a consequence of an existing disease, such as incontinence. Meaning influences by historic period, gender or other demographic aspects on the volume of used liquid were not found.

All the same, the volume of swallowed liquid was significantly influenced by the size of the medicine. This influence was college, in comparison, to the weight of the tablets or capsules. One possible explanation for these findings could be that people visually estimate the size of the medicine which and then influences the amount of liquid they consumed: when the size of the tablet or capsule increases, the corporeality of swallowed liquid also slightly increases.

Regardless of the variables that influence the amount of liquid a person drinks when taking their medicines, patients need to be better informed most the importance of taking tablets and capsules with a sufficient amount of liquid. This could be accomplished by including in every package insert the precise data nearly the book of required liquid for administration for these forms of medications. The weaknesses of German package inserts in this aspect, as described above, could also exist a European wide problem because many medicines accept approval for unlike markets of the European Union member states. This means that the package inserts provide identical information in different languages, thus affecting a wider range of people.

In addition, no European guideline or directive recommends including details concerning the book of liquid required for using orally taken, meaty and shaped medicines in bundle inserts. The QRD template, available in the dissimilar languages of the European Matrimony member states12, would exist an appropriate location to include this information.

Furthermore, medical and pharmaceutical experts should as well inform their patients of this recommendation when they sell or fill prescriptions for tablets or capsules. This should particularly be done for medications that are known to harm the esophagus when their agile substances are released in this organ. Nurses and other care givers should also be aware of this recommendation. If they requite their patients a glass with a minimum 100ml liquid to take such medicines, it should help the patient avoid adverse drug reactions and increase therapeutic success.

CONCLUSIONS

A high percentage of patients swallow compact and shaped medicines, such as capsules and tablets, with too little liquid. It is recommended that every package insert of these medicine types should provide information about the precise required volume of liquid recommended to assure positive effects. In addition, medical and pharmaceutical experts, besides as whatever other caregivers, should provide this advice to their patients, or provide their patients with a sufficient amount of liquid to ensure the successful passage of tablets and capsules through the esophagus.

Footnotes

Conflict OF INTEREST

There is no conflict of interest.

References

1. Sale J, Gignac M, Hawker G. How "bad" does the pain have to be? A qualitative study examining adherence to pain medication in older adults with osteoarthritis. Arthritis Care Res. 2006;55:272–278. [PubMed] [Google Scholar]

2. Gibbs S, Waters WE, George CF. The benefits of prescription information leaflets (one) Br J Clin Pharmacol. 1989;27:723–739. [PMC costless article] [PubMed] [Google Scholar]

three. Fuchs J, Hippius Thou. Inappropriate dosage instructions in package inserts. Patient Educ Couns. 2007;67:157–168. [PubMed] [Google Scholar]

4. Kelloway JS, Kochevar JW, Sveum RJ, Hahn MA. Evaluation of the Autohaler Actuator: The effect of written patient instructions on correct use. J Asthma. 1993;xxx:373–379. [PubMed] [Google Scholar]

5. Quinzler R, Gasse C, Schneider A, Kaufmann-Kolle P, Szecsenyi J, Haefeli WE. The frequency of inappropriate tablet splitting in primary care. Eur J Clin Pharmacol. 2006;65:1065–1073. [PubMed] [Google Scholar]

half dozen. Fuchs J, Finke A, Hippius M. Wie genau lassen sich Tabletten teilen? Internist Praxis. 2008;48:147–159. [Google Scholar]

7. Gallo SH, McClave SA, Makk LJK, Looney SW. Standardization of clinical criteria required for apply of the 12.v millimeter barium tablet in evaluating esophageal lumenal patency. Gastrointest Endosc. 1996;two:181–184. [PubMed] [Google Scholar]

viii. Osmanoglou Eastward, Van Der Voort IR, Fach K, Kosch O, Bach D, Hartmann V, Strenzke A, Weitschies W, Wiedenmann B, Trahms L, Mönnikes H. Oesophageal transport of solid dosage forms depends on body position, swallowing volume and pharyngeal propulsion velocity. Neurogastroenterol Motil. 2004;16:547–556. [PubMed] [Google Scholar]

9. Jaspersen D. Drug-induced oesophageal disorders: pathogenesis, incidence, prevention and direction. Drug Saf. 2000;22:237–249. [PubMed] [Google Scholar]

ten. Fuchs J, Hippius Yard, Schaefer M. Analysis of German language package inserts. Int J Clin Pharmacol Ther. 2006;44:8–13. [PubMed] [Google Scholar]

Manufactures from Chemist's Exercise are provided here courtesy of Centro de Investigaciones y Publicaciones Farmaceuticas