What’s the Buzz

Whether you are being admitted to the hospital or treated in an outpatient clinic, a team of healthcare professionals, consisting of physicians, pharmacists, and nurses, work together to prescribe and administer medication. We have science to thank for the vast number of medication therapies to treat various diseases and conditions in this modern medicine world. You may not realize that many of the same medications are available in various dosage forms, including oral liquid forms or solid dosage forms such as capsules and tablets. Each drug form has advantages and disadvantages regarding effectiveness, convenience, safety, and cost.

Choosing a specific form and route of a drug depends on different factors. In other words, let’s say we have two drugs, drug A1 and drug A2 and both have the same active pharmaceutical ingredient but different dosage forms. Because both drugs A1 and A2 have the same active ingredient, they are designed to treat one or more medical conditions. Regarding different dosage forms, drug A1 is a regular oral tablet, and drug A2 is an orally disintegrating tablet (ODT). The advantage of ODT over the regular tablet is that the ODT drug dissolves under the tongue and gets absorbed into the bloodstream, thus, affecting the body more quickly. This is just one example of the different effects provided by different dosage forms.

Another factor to consider is drug metabolism, or how a drug is broken down. Digestive enzymes break down many oral medications in the stomach even before reaching the bloodstream. As a result, a different dosage form and route of administration, such as injection or rectal suppository, must be utilized. An example is insulin for diabetic individuals; if insulin is taken by mouth, it would be destroyed by the stomach enzyme, rendered ineffective long before it reaches the bloodstream.

A medical professional may choose a particular dosage form to target a specific area or body organ without the systemic or side effects of oral or injectable medications. For instance, skin treatments such as topical creams, ointments, lotions, patches, or other dosage forms such as nasal sprays, eye drops, and suppositories to deliver medication to the affected area without causing systemic (body-wide) side effects. Liquid forms of medicine typically contain the same active ingredient as solid forms, and they are the more optimal option for children and adults with difficulty swallowing tablets. 

In the following paragraphs, we will look at some different forms of oral drugs (medications taken by mouth) and discuss the pros and cons of each. 

Different Forms of Oral Medication

Oral medications start working once they reach the digestive tract and are absorbed into the bloodstream. Other medication forms, such as topical treatments and injections, bypass the digestive tract and enter the bloodstream directly.

Tablets

This solid dosage form is the most common form of oral medication. The active pharmaceutical ingredient is bound into a solid form (pill) with one or more inactive substances. Tablets or pills are available in different shapes and sizes. 

Some of the advantages of administering medication in pill form include:

• Affordability (they are mass-produced and generally inexpensive)
• Stable dosage form (they have a long shelf-life)
• Accurate dosing (you don’t need to measure the dose, but keep in mind, sometimes, you will have to split the scored tablet into smaller doses based on the prescribed dosage)
• Ease of use (you can swallow a pill with a glass of water)
• Light and compact (they are easy to travel with)
• The convenience of combination products (some pills contain more than one active substance)
• Bitter medicines can be coated to make them more palatable

The disadvantages of tablets include:

• Aftertaste (may leave a bad taste in the mouth after swallowing)
• Slower acting (may take longer to work)
• More likely to irritate the gastrointestinal tract causing nausea, vomiting, and diarrhea

There are different types of oral tablets, such as:

Enteric Coated Tablets

These are coated with special polymers that prevent them from dissolving in stomach acid and allow them to be absorbed in the small intestine. Examples include certain antibiotics and proton pump inhibitors to treat gastroesophageal reflux disease.

Sublingual Tablets 

A sublingual tablet is placed under the tongue, where it dissolves and is absorbed into the blood via the oral mucosa. Examples include sublingual nitroglycerine used to treat angina chest pain.

This method of administration is useful when you want the drug to work quickly. In addition, it is suitable for people who cannot swallow tablets. It’s also useful for medications that are not well absorbed in the stomach or if their effectiveness is decreased by digestion. 

The disadvantages of sublingual tablets are that eating, drinking, and smoking can affect how well they work. Also, they can irritate the mouth.

Chewable Tablets 

This form of medicine is chewed and then swallowed. It is often considered the best form of oral medication for children and elderly people. Advantages of chewable tablets include:

• Quick action
• Come in various flavors 
• You don’t need water to swallow them, so you can take them anytime.

Disadvantages include:

• It may not taste pleasant to some people
• It may need special storage and careful handling
• Can interfere with dental appliances

Orally Disintegrating Tablets 

These pills dissolve on the tongue, become liquified, are swallowed subconsciously, and then the tiny pieces of the drug travel to the stomach and intestines, where the absorption occurs. Pros of this method of administering medication include ease of use and quick onset of action. Cons are that they may be more expensive and not as stable as other solid dosage forms. 

Effervescent Tablets

These are dissolved in water and then drunk. Pros are ease of use, better absorption, and a reasonably quick action onset. Cons: They are relatively more expensive, depending on the type of drug. You should pay attention to what type of liquid this tablet can be dissolved in, as water and juice are acceptable depending on the type of medication.

Lozenges

Also called troches, pastilles, or cough drops, lozenges are medicated tablets that dissolve slowly in the mouth and lubricate or soothe irritated tissues in patients with sore throats. They offer local pain relief and ease of use for children and adults who have difficulty swallowing pills.

Capsules

This solid form contains the medicine in a soft or hard gelatin shell. The shell breaks down in the digestive tract and releases the active substance. 

Advantages include a possibly palatable taste for some and relatively fast action. Disadvantages of a capsule are that it is more expensive to manufacture, less stable with unfavorable storage conditions, and has a shorter shelf life. These products may contain animal products.

Spansules

These are a type of advanced drug delivery system. Spansules deliver the drug at a steady rate over a fixed period of several hours. For example, a doctor may prescribe Dexedrine Spansules to treat ADHD symptoms.

Softgels

These are similar to capsules except that the active substances are in the form of liquids contained in a gelatin shell.

Liquid Form

Liquid medications are in solution form, making them easy to swallow. In addition to the tasty flavor, they are ideal for the pediatric population. The dosing is more flexible than a pill, as it comes in various concentrations such as milligram/milliliter (mg/mL). Also, they are absorbed faster compared to a solid dosage form.

However, you need to measure the dose of a liquid medicine precisely with a medicine-measuring spoon or syringe. Liquids are also less stable and generally have a shorter shelf life. Some liquid medications may need to be refrigerated, which can be inconvenient with transport and travel.

Granules and Powders

These often come in pre-measured packets and are taken by mixing in water or soft foods like applesauce, pudding, or yogurt. 

The benefits of powder medication are ease of swallowing after being mixed, and the apple sauce or pudding may mask the unpleasant taste. Powders and granules are generally stable, have a long shelf life, and are easily transported. Also, it’s possible to give larger doses of medication that would be uncomfortable to swallow in compressed tablet form. 

The disadvantages of powders and granules are that not all drugs can be manufactured in this form. Also, the taste and consistency of the final product after mixing might not be appealing to some people. 

Wrapping Up

In most cases, over-the-counter and prescription medications are available in multiple forms. If you prefer one over the other, talk to your healthcare provider about alternative forms of the medication you are being prescribed. Also, if you have questions about why one specific dosage form is chosen for you by your healthcare provider, discuss your concerns and preference with them.