It’s no choke

A recent survey commissioned by Hermes Pharma has highlighted some key issues surrounding swallowing difficulties with tablets and capsules. Hermes discusses the opportunities of capturing market share with user-friendly dosage forms

Over 55% of people suffer from swallowing difficulties when taking tablets and/or capsules, according to a recent market study commissioned by Hermes Pharma. The study surveyed 2,000 people in the US and Germany and was conducted by market research expert Spiegel Institut Mannheim. The findings also pointed out that swallowing difficulties are likely to have a negative impact on compliance and identified the weaknesses of conventional tablets and capsules in comparison to alternative solid dosage forms.

The oral route has long been considered a simple and cost-efficient way of delivery, with most products being traditionally formulated as solid tablets or capsules. However, consumer habits and demands are changing. Today’s patients have grown accustomed to having freedom of choice and the benefits of convenience. They also enjoy instant access to a wealth of information, leading them to request specific products and treatments and becoming more involved in therapy decisions than ever before.

Hermes maintains that pharmaceutical products will need to appeal to a wider range of preferences, from treatment needs through to lifestyle requirements in order to deliver medical and commercial success in the future.

Widespread difficulty swallowing tablets/capsules

Over half of the people surveyed (50% in the US and more than 60% in Germany) reported difficulties when swallowing tablets/capsules. The overwhelming majority of these people did not report any similar problems with foodstuffs or fluids, indicating that this trend is specifically linked to tablets/capsules. A variety of reasons were cited for these problems, but the most frequent were due to tablets/capsules being too big, becoming stuck in the throat and having an unpleasant taste/odour.

To overcome these difficulties, a worrying number of people had turned to breaking tablets before swallowing (32% overall) or crushing them up and dissolving them in water (17%), both of which can affect API release profile, bioavailability and medical efficacy. The same issue would affect the 9% of participants who reported having chewed tablets/capsules before swallowing them. Perhaps most worryingly of all, 8% of people had resorted to not taking their medication at all in the face of swallowing difficulties (figure 1).

Swallowing not just a problem for the elderly

Around 44% of participants 65 years or older reported swallowing difficulties when taking tablets/capsules. Interestingly, an even greater number (70%) of younger people aged 16-34 also reported this problem. Tablet size was an issue across all age groups: Older people tended to highlight factors associated with tablet size as being the most important cause of swallowing difficulties, whereas younger people also cited disliking the taste and odor of tablets/capsules.

The study also looked in more detail at relevant product characteristics when selecting medications/food supplements. 64% of the participants reported that products should be easy and comfortable to swallow. Next frequently reported characteristic was a pleasant flavor/odour (41% of people), with the ‘ease of integration into everyday routines’ cited by 38%. A third of the participants mentioned that the packaging should be easy to open (figure 2).

User-friendly dosage forms for a better experience

When respondents were asked to evaluate tablets/capsules and alternative dosage forms based on their experience, they consistently scored tablets/capsules lower than all other dosage forms for characteristics such as ease of swallowing, sensation in the mouth, package opening and ease of intake.

Instant drinks scored particularly high across most criteria in the US. They were felt to be easy to ingest, do not require much time for intake and are easy to swallow. Orally disintegrating granules (ODG) scored highly in regard to ‘opening the packaging’ and ‘integration into everyday routine.’ In Germany, lozenges received the best evaluation as participants deemed them to be easy to ingest and integrate into their daily routines. ODGs scored highly when it came to integration into daily routines.

Key take-aways of the study

Conventional tablets and capsules exhibit a range of drawbacks and may no longer be the best solution for large segments of the population. By offering products that are easy to swallow, convenient to take and taste well, companies can improve patient experience, increase compliance, and boost the effectiveness of treatment. Dosage forms such as effervescent tablets, orally disintegrating granules, lozenges, instant drinks and chewable tablets are truly user-friendly. They allow healthcare companies to expand existing product lines, prolong product lifecycles, revitalize brands and at the same time grow revenues