Avtor/Urednik		Gašperlin, Mirjana
Naslov		Zakaj tablet ne smemo deliti ali drobiti?
Prevedeni naslov		Why should tablets not be crushed or split?
Tip		članek
Vir		In: [Zbornik predavanj] Ljubljana : Medicinski razgledi
Vol. in št.		Letnik 57, št. supl. 2
Leto izdaje		2018
Obseg		str. 11-19
Jezik		slv
Abstrakt		Peroralno jemanje je najbolj razširjen, priročen, varen in naraven način jemanja zdravil. Največ se uporabljajo trdne enoenotne farmacevtske oblike, kot so tablete in kapsule, ki so dobro sprejete tako pri bolnikih kot zdravstvenem osebju. Kadar za predpisano zdravljenje registrirano zdravilo ni dostopno, v praksi še vedno izvajamo posege, kot so drobljenje tablet, odpiranje trdnih kapsul, deljenje tablet in mešanje zdravil s hrano, predvsem zaradi prilagajanja odmerka in olajšanja požiranja (npr. pri bolnikih, ki imajo težave s požiranjem, pri hospitaliziranih bolnikih, ki se hranijo enteralno s sondo, bolnikih z nevrološkimi boleznimi, pri otrocih, starostnikih, itd.). Vsi ti posegi pomenijo uporabo, neskladno z navodili (angl. off-label use), ki prinaša tudi določena tveganja, saj proizvajalec ne zagotavlja več varnosti, učinkovitosti in kakovosti zdravila. Poudariti pa je treba, da določenih tablet nikakor ne smemo drobiti ali deliti. To so predvsem tablete s prirejenim sproščanjem, ker bi se tako spremenila hitrost ali mesto absorpcije zdravilne učinkovine, tablete s takojšnjim sproščenjem, ki so obložene zaradi povečanja stabilnosti učinkovine, gastrorezistentne tablete, ki so namenjene zaščiti učinkovin pred kislim okoljem želodca ali želodca pred učinkovino in tablete z učinkovinami, ki povzročajo tveganje za zdravstveno osebje (citostatiki). V članku je podana tudi definicija prirejenega sproščanja. To je krovni izraz, ki vključuje farmacevtske oblike s podaljšanim, zakasnelim in pulzirajočim sproščanjem. Opisane so tehnološke značilnosti posameznih vrst prirejenega sproščanja.Oral route is the most popular, convenient and safe way of drug administration with tablets as the most common type of solid single-unit dosage forms in contemporary use being preferred by both patients and health care professionals. However, when the licenced medicine is not available, modifications such as crushing tablets or opening hard gelatine capsules, splitting tablets and co-administration or mixing medicines with food or drink may be necessary to adjust dose or to facilitate administration (patients with difficulty swallowing the intact dosage form, hospitalized patients with enteral feeding tubes, patients with neurological diseases, geriatric and paediatric populations). There are a number of safety and efficacy concerns around these manipulations which means if not specified in the product information leaflet and summary of the product characteristics, an off-label use of the medicine. In these circumstances, safety, efficacy and quality is not guaranteed by the manufacturers. However, there are certain medicines that should not be crushed. These are predominantly modified release dosage forms due to the risk of bioavailability modification (by crushing either place or kinetics of the absorption could be changed), immediate release dosage forms with coating to enhance stability, gastro-resistant tablets which are formulated because some drugs can be irritant to the stomach or are degraded by stomach acid, so by such coating the drug%s release can be delayed until it reaches the small intestine, and tablets with potentially hazardous drugs which if crushed may cause occupational health or safety risk (cytostatic drugs). The definition of modified release which includes prolonged, delayed and pulsatile release is given together with some general technological characteristics of particular kinds of modified release.
Deskriptorji		Farmacevtske oblike
Proste vsebinske oznake		drobljenje tablet deljenje tablet prirejeno sproščanje podaljšano sproščanje gastrorezistentne tablete starostniki