When we take a pill, we swallow it with a little water and forget about it, knowing that it will take effect quickly. Instead the medicine start one long journey pass first stomachthan ingut; so it comes absorbed into the blood, to come where necessary. However, this journey can be complicated by the attitude taken when taking the pill: according to research from the American Johns Hopkins Universitythe “wrong” attitude can increase the time spent in the stomach by up to an hour, increasing theintestinal absorption of the active principles. The authors investigated what happens to the pills when they enter the stomach because, explains the study’s coordinator, the Johns Hopkins fluid dynamics expert Rajat Mittal«Medicines by mouth are easier to take than medicines that are injected, but they are absorbed into the intestine after passing through the stomach: that is why their effect is not immediate and elements related to stomach disorders can affect the speed of action.
This may not be a problem if you take vitamins or supplements, but it becomes critical if we need to eliminate pain with an analgesic or maintain stable concentrations of an active ingredient in the bloodstream. So Mittal built it StomachSima computerized model of the stomach, reconstructed from high-resolution images of a volunteer’s organ, and simulated the biomechanics and the movements of a pill that arrives in the stomach holding four different positions. That’s what the results show swallowing it while leaning to the right or lying on the right side doubles the speed at which it enters the small intestine compared to sitting down; leaning to the left or lying on that side instead slows the absorption of the drug by a factor of five compared to the sitting position, which, due to gravity and anatomy, promotes transit through the stomach. The data confirm previous studies on gastric emptying of food, according to which lying on the right side accelerates it, so to absorb a drug taken by mouth faster, it is good to throw it down while standing, sitting or to the right leans, for example, when you go to bed. Mittal admits that «A computer simulation is a simplified model and the amount of fluids, gases and food in the stomach can also affect absorption; however, it is better to pay attention to posture when taking oral therapy, especially in elderly or bedridden people”.
Mistakes should not be made
The elderly are also the category of patients most likely to make mistakes when taking pills, as they often modify them to make them easier to take, a study by the Italian Society of Gerontology and Geriatrics found. “Four out of ten change the pills, but also with the pill cutter, the safest way to divide them and make them easier to swallow is one in three misdistributed and the dose obtained is at least 15 percent higher or lower compared to what is prescribed,” he says Francesco Landi, chairman Mrs. «Sometimes the elderly mix all prescribed medicines in a mix, which can cause risks of interaction between different active ingredients and even symptoms of respiratory tract irritation from inhalation of dust, in addition, it also happens that the elderly or their caregivers chop or distribute their own medicines and those of others, for example those of husband and wife, always use the same tools: not cleaning the knife or pestle, however, can lead to allergic reactions or further interactions due to residual medicine residue».
Do not break the capsules
Trituration should always be avoided in the case of modified-release gastro-resistant sublingual tablets: modifying gastro-resistant tablets or capsules involves destroying or removing the coating, which is designed to keep the drug intact until it passes through the stomach and reaches the intestines. “The lining serves to protect the stomach from injury or to prevent a decrease in effect or inactivation of the active ingredient by the gastric juices,” notes Landi. “Trituration and oral administration of these modified drugs may reduce their benefits or increase the risk of adverse gastrointestinal effects; if you cannot take the pills, before changing them, it is good to ask your doctor about alternative formulations that exist today for many active ingredients».