Palatability of crushed over-the-counter medications

Context: Dysphagia is a common concern, especially in the last several days of life. Medications are often crushed for ease of administration for individuals with swallowing difficulty.

Objectives: To assess palatability of commonly used crushed over-the-counter (OTC) medications. A secondary objective is to evaluate pharmacist knowledge and opinions of crushing medications.

Methods: Pharmacist participants sampled crushed OTC medications and completed pre- and post-sampling surveys about crushing medications. Participants were excluded for current smoking or tobacco use, pregnancy, allergy to any study medication or applesauce, or potential drug-drug interaction with study medications. Eight OTC medications were crushed and mixed in applesauce: naproxen, fexofenadine, phenazopyridine, multivitamin, loperamide, famotidine, sennosides, and sennosides-docusate. Participants were blinded to medication samples and control (plain applesauce). Samples were rated from 1 (least palatable) to 5 (most palatable). Investigators recorded participants' comments, behaviors, and facial expressions during sampling.

Results: Nineteen volunteers completed the study. The majority of participants rated 3 samples as not palatable (score of 2 or less): fexofenadine, 16 (84%); loperamide, 13 (68%); sennosides-docusate, 16 (84%). All participants rated famotidine and sennosides palatable. The percentage of participants who would consider palatability in recommendations for crushing medications increased from 47% pre-study to 79% post-study.

Conclusion: Palatability should be considered when recommending crushed medications. Survey responses indicate pharmacists' opinions of crushed medications changed after this palatability experiment. Clinicians should evaluate the appropriateness of all medications when dysphagia is a concern and deprescribe medications when appropriate to reduce burden for patients and caregivers.

Keywords: dysphagia; hospice; medication administration; medication crushing; pharmacist.