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  • I have a clinical question I need help with.

    Because I work in a pharmacy I'm bombarded with all sort of questions from family and friends, but this has flummoxed me.
    A bit of a backstory for my 'patient'. She's had stomach surgery two years ago (gastro bypass) and struggles to eat meals and swallow medicine. She is asking if she can mix her meds with her hot food to trick the brain into thinking it's dinner i.e. mixed with warm honey, soup
    .

    She's on Fluoxetine 20mg/5ml oral (5ml TDS) and Amitriptyline 25mg/5ml oral (5ml BD)

    I can't find anywhere that she shouldn't mix it with food, but neither can I see if this is OK. Her doctor told her to talk to a pharmacist but the pharmacist told her to talk to her GP!

    Can anyone help me help her?

  • #2
    I would ring the npa they usually have information on this
    ​​type of query

    Comment


    • #3
      As long as she doesn't stir them into scalding hot tea/coffee, I would not worry. Both would get mixed with stomach contents any way. Put tablet/capsule on back of tongue, a gulp of a drink and a spoonful of food.
      johnep

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      • #4
        I am a little confused, why can't she just take the liquids normally or with non hot food? why does it have to be with hot food? Since when does the body assume only hot meals are food?

        Anyway, she should be fine taking them with hot meals. When we say people can take certain medicines with food, we're obviously also considering the food being hot, so she should be fine. I don't understand why a pharmacist would refer the patient to GP for this, this is our domain, the GP won't have a clue. Some pharmacist seem to just have a default "see your GP" for every little query and it's frankly very disappointing.

        Comment


        • #5
          Thanks everyone. I've discussed it with her and have come up with her taking it with cold/warm food instead of hot. It's to fool the brain (not the body) into thinking it's not medicine as the medicine makes her gag.

          Comment


          • #6
            The key here is what is to stop her taking the medication and then wolfing down a massive meal/soup very shortly afterwards? Nothing. It will all be mixed up as far as the stomach is concerned over the course of time.

            Unless there is absolute evidence to the contrary then this should be ok.

            Comment


            • #7
              A lot of drugs won't do well over 30 degrees Celsius and will do even worse over 40 degrees.

              I think the idea of cold food is the best option but even then avoid highly acidic or basic foods.

              I do however agree with other posters in that if she can drink soup and some foods she should be able to take the liquid or even tablets . . . .

              If it's a psychosomatic issue it should be dealt with as such. Throwing money at the issue by switching everything to expensive liquids and specials doesn't help anyone in the long run. I always had an issue with supplying three bottles of flucloxacillin to teenagers because "they don't like tablets" and the GP just wanted an easy life with no consideration for the £70+ price difference.
              I remember when a blog was an individual boot.

              Comment


              • #8
                Thanks, yes, it's a mental thing and she is seeing doctors etc for her issues. Thanks again, everyone.

                Comment


                • #9
                  Originally posted by Jen_here View Post
                  Because I work in a pharmacy I'm bombarded with all sort of questions from family and friends, but this has flummoxed me.
                  A bit of a backstory for my 'patient'. She's had stomach surgery two years ago (gastro bypass) and struggles to eat meals and swallow medicine. She is asking if she can mix her meds with her hot food to trick the brain into thinking it's dinner i.e. mixed with warm honey, soup
                  .

                  She's on Fluoxetine 20mg/5ml oral (5ml TDS) and Amitriptyline 25mg/5ml oral (5ml BD)

                  I can't find anywhere that she shouldn't mix it with food, but neither can I see if this is OK. Her doctor told her to talk to a pharmacist but the pharmacist told her to talk to her GP!

                  Can anyone help me help her?
                  Contact the pharmacists at your local CCG and they will be able to look into this in more detail and if not, will pass it onto the local medicines information service.

                  Hope this helps.

                  Comment


                  • #10
                    Originally posted by Nimrec View Post
                    A lot of drugs won't do well over 30 degrees Celsius and will do even worse over 40 degrees.

                    I think the idea of cold food is the best option but even then avoid highly acidic or basic foods.

                    I do however agree with other posters in that if she can drink soup and some foods she should be able to take the liquid or even tablets . . . .

                    If it's a psychosomatic issue it should be dealt with as such. Throwing money at the issue by switching everything to expensive liquids and specials doesn't help anyone in the long run. I always had an issue with supplying three bottles of flucloxacillin to teenagers because "they don't like tablets" and the GP just wanted an easy life with no consideration for the £70+ price difference.
                    Considering normal body temperature is 37 degrees I don't see the issue.

                    Comment


                    • #11
                      Originally posted by Energize View Post

                      Considering normal body temperature is 37 degrees I don't see the issue.
                      Exactly why the drug is designed to breakdown/release over 30 degrees. Perfect for release in the body. Not so great for deposition/release in your porridge.
                      I remember when a blog was an individual boot.

                      Comment


                      • #12
                        Just wondering about MDS and liquids.
                        Is that system that could pack liquids into MDS still around?
                        I
                        47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
                        2018 AD : Modern Man : I shopped, I clicked, I collected.
                        How times change.

                        If you find you have read something that has upset or offended you an anyway please unread it at once.

                        Comment


                        • #13
                          Had a look on t'internet and found this Closure of Protomed Limited

                          30 November 2018

                          Dear Customer,
                          In line with our communication to you on 23 October 2018, Protomed Limited ceased trading today.
                          The business stopped taking new orders for Biodose consumables at 12pm. The Biodose software system will remain available to customers until 14 December 2018 as previously communicated, after which time it will be switched off.
                          We can also confirm that an agreement was successfully concluded today to transfer all remaining stock of trays, pods and seals to Dose Care, along with the intellectual property rights that will enable Dose Care to continue to manufacture the trays, pods and seals going forward.
                          Dose Care can be contacted on 0330 094 8053 or at hello@dosecare.co.uk

                          Comment


                          • #14
                            Originally posted by Nimrec View Post

                            Exactly why the drug is designed to breakdown/release over 30 degrees. Perfect for release in the body. Not so great for deposition/release in your porridge.
                            The chemistry is not really altered, whether the drug is in 37 degree hydrochloric acid or in porridge the bioavailability is largely the same, it is ubiquitous for patients to take medication with food and the cases where pharmacokinetics are altered to a clinically significant extent are the exception rather than the rule.

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