Rx Update: August 2004
Joan Murhammer, R.Ph., Mary Ross, R.Ph., M.B.A., Kevin Bebout,
R.Ph.
Peer Review Status: Internally Reviewed
There are a number of medications that are now available as orally disintegrating tablets (ODTs). ODTs are tablets that are designed to dissolve rapidly when placed on the tongue leaving an easy-to-swallow residue that is dispersed into the saliva and must then be swallowed to undergo absorption in the gut. ODTs are not absorbed sublingually. The disintegration times are generally less than one minute and may be within seconds. Orally disintegrating tablets do not have a faster therapeutic onset and are generally bioequivalent to the standard tablet dosage form of the active drug.
For patients, the main benefit of ODTs is the convenience of taking the product since they can be swallowed without water. The disadvantages of ODTs are that they generally cost more than the conventional tablets and are more difficult to handle without breaking into small pieces because they are lightweight and generally in tightly sealed moisture-resistant blister cards. They are not an alternative to oral tablets or liquids in patients with a gastrointestinal obstruction or other conditions that affect drug absorption in the gut since they are absorbed after the tablet residue is swallowed with saliva and they are not absorbed in the mouth. ODTs may be an alternative in patients with a decreased ability to swallow, for patients who may "cheek" the dose, to an oral liquid medication that is not palatable, or for patients with limited access to water. Most of the ODTs contain aspartame as a sweetener; therefore, they should not be used in patients with phenylketonuria.
Examples of medications that are commercially available as orally disintegrating tablets include:
High - Alert Medications - Pyxis Alert
In order to ensure the safe use of high-alert (high risk) medications, UIHC has developed additional safety steps for managing high-alert medications. A hospital wide policy (V.44) has been developed which outlines the procedures to follow when handling these medications. For several medications, a double check is required before the medication can be administered to a patient; some medications also require a double check of infusion pump settings. The double check may be provided by another nurse, respiratory therapist, pharmacist or physician. The following medications/medication classes are considered to be high-alert medications and require a double-check before administration at UIHC:
Verbal orders for these medications are not permitted except in emergent situations when a delay in medication administration would result in patient harm. Accessing high-alert medications stored in the Pyxis Medstations will automatically generate a message stating "High Alert Medication - Double Check Required." High-alert medications that are dispensed from Pharmacy which are individually labeled for a patient will be labeled "High Alert Medication: Requires Double Check."