From Mr M. Hadley, MRPharmS
SIR,—Pharmacia & Upjohn recently sent out a medical information product
update drawing attention to an error in its patient information leaflet which
directs that Salazopyrin EN should be taken on an empty stomach. It says now
that its only advice is to take the tablets swallowed with a glass of water,
not crushed or chewed.
This advice follows our inquires with its medical information department, when
we pointed out the differing advice given in the patient information leaflet,
the summary of product characteristics and the British National Formulary. The
BNF advises the tablets to be taken with or after food.
Surely the correct advice is that originally given in the patient information
leaflet and not as stated in the BNF? The reason for taking enteric-coated products
on an empty stomach is to ensure that they pass rapidly through to the duodenum
and disintegrate in the lower pH existing there.
The advice being given to take enteric-coated tablets with food is surely due
to muddled thinking. You either take a product with food to lessen stomach irritation
or you enteric coat it so that it passes through the stomach. It makes little
sense to do both.
It is time that pharmaceutical chemists researched this subject and gave unequivocal
advice. There are probably a number of cases where optimum benefit from medicines
is not obtained because of the timing of administration.
One example is enteric-coated prednisolone. Work done with enteric-coated prednisolone
tablets at Guy’s hospital showed that absorption could be delayed for up
to 12 hours if taken with food. This could have serious consequences in an acute
asthma attack.
Mike Hadley
Hadley Healthcare Solutions,
Malvern