Ghost pill: knowledge and awareness of this phenomenon among health care professionals
Keywords:
Slow release, Ghost pill, PharmacokineticAbstract
Background: Slow release (SR) drug formulations associated with the passage of intact tablet like object in faeces sometimes known as the “ghost pill” have been in the market for many years. Anecdotal evidence suggests that few health care professionals are aware of this phenomenon. Our study aims were to find out what proportion of health care professionals was aware of the ghost pill phenomena and what drug formulations and specific drugs were associated with it.
Methods: A survey was conducted among health care professionals at three hospital sights in the West Midlands, UK. The subjects included doctors, nursing staff, pharmacists, and other allied professionals involved in patient care.
Results: A total of 321 health care professionals were included in the final analysis. Very few, 12.8% (41) have heard of the ghost pill phenomenon and a further 14 (4.4%) have come across of a patient who has experienced it. Only 13 (4%) correctly associated the phenomenon with SR drug formulations.
Conclusion: Our survey has shown that the ghost pill phenomenon, a normal outcome of a novel way of delivering orally taken SR drugs, is not well-known among health care professionals. Lack of awareness of it has implications to trainers, medical and nonmedical prescribers and nursing staff working with patients who are taking these medications. Lack of awareness among health care staff, may result in relevant information not being shared with patients at the time of prescribing or when patients enquires of it.
References
Buxton ILO, Benet LZ. Pharmacokinetics: the dynamics of drug absorption, distribution, metabolism and elimination. In: Brunton LL, editor, Chabner BA, Knollmann BC, Associate editors. Goodman & Gilman’s the Pharmacological Basis of Therapeutics. 12th Edition. New York: McGraw Hill Medical; 2011: 17-40.
Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Ther. 2001;23(8):1296-310.
Kardas P. Comparison of patient compliance with once-daily and twice-daily antibiotic regimens in respiratory tract infections: results of a randomized trial. J Antimicrob Chemother. 2007;59(3):531-6.
Douroumis D. Orally disintegrating dosage forms and taste-masking technologies; 2010. Expert Opin Drug Deliv. 2011;8(5):665-75.
Smart JD, Keegan G. Buccal drug delivery systems. In: Wen H, Park K, editors. Oral Controlled Release Formulation Design and Drug Delivery. Theory to Practice. New Jersey: Wiley; 2010: 169-83.
Siegel RA, Rathbone MJ. Overview of controlled release mechanisms. In: Siepmann J, Siegel RA, Rathbone MJ, editors. Fundamentals and Applications of Controlled Release Drug Delivery. 1st Edition. New York: Springer; 2012: 19-46.
Tungaraza TE, Talapan-Manikoth P, Jenkins R. Curse of the ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry. Ther Adv Drug Saf. 2013;4:63-71.
Anderson DT, Fritz KL, Muto JJ. Oxycontin: the concept of a “ghost pill” and the postmortem tissue distribution of oxycodone in 36 cases. J Anal Toxicol. 2002;26(7):448-59.
Malik S. Minister sends labs on a wild goose chase after pill pops out intact, 2012. Available from: http://www.tribune.com.pk/story/403679/look-but-dont-see-minister-sends-labs-on-a-wild-goose-chase-after-pill-pops-out-intact/[Last accessed on 2013 Jun 02].
Laboratorios LICONSA. Venlanic XL packge leaflet. Guadalajara: Laboratorios LICONSA, S.A; 2011.
GlaxoSmithKline. Wellbutrin XL package leaflet. London: GlaxoSmithKline; 2008.
Janssen-Cilag. Lyrinel XL package leaflet. Latina: Janssen-Cilag; 2012.
Alphapharma. Adefin XL package leaflet. Millers Point: Alphapharma; 2009.
Fleischhacker WW, Oehl MA, Hummer M. Factors influencing compliance in schizophrenia patients. J Clin Psychiatry. 2003;64 Suppl 16:10-3.
Verma RK, Garg S. Current status of drug delivery technologies and future directions. Pharm Technol Online. 2001;25(2):1-14. Available from: http://www.pharmanet.com.br/pdf/drugdelivery.pdf. [Last accessed on 2013 Jul 20].
Tang ESK, Chan LW, Heng PWS. Coating of multiparticulates for sustained release. Am J Drug Deliv. 2005;3(1):17-28.
Wilding IR. Coupe AJ, Davis SS. The role of gamma scintigraphy in oral drug delivery. Adv Drug Deliv Rev. 1991;7:87-117.
Lingam M, Ashok T, Venkateswarlu V, Madhusudan Rao Y. Design and evaluation of a novel matrix type multiple units as biphasic gastroretentive drug delivery systems. AAPS Pharm Sci Tech. 2008;9(4):1253-61.
Gabor F, Fillafer C, Neutsch L, Ratzinger G, Wirth M. Improving oral delivery. Handb Exp Pharmacol. 2010;(197):345-98.
Stanos SP, Bruckenthal P, Barkin RL. Strategies to reduce the tampering and subsequent abuse of long-acting opioids: potential risks and benefits of formulations with physical or pharmacologic deterrents to tampering. Mayo Clin Proc. 2012;87(7):683-94.
Raffa RB, Pergolizzi JV Jr. Opioid formulations designed to resist/deter abuse. Drugs. 2010;70(13):1657-75.
Davar N, Ghosh S. Oral controlled release based products for life cycle management. In: Wen H, Park K, editors. Oral Controlled Release Formulation Design and Drug Delivery. Theory to Practice. New Jersey: Wiley; 2010: 305-3119.
Spencer TJ, Biederman J, Ciccone PE, Madras BK, Dougherty DD, Bonab AA, et al. PET study examining pharmacokinetics, detection and likeability, and dopamine transporter receptor occupancy of short- and long-acting oral methylphenidate. Am J Psychiatry. 2006;163(3):387-95.
Zhang H, Surian JM. Biopharmaceutic consideration and assessment for oral controlled relase formulations. In: Wen H, Park K, editors. Oral Controlled Release Formulation Design and Drug Delivery. Theory to Practice. New Jersey: Wiley; 2010: 33-45.
Simpson SE. Pharmacobezoars described and demystified. Clin Toxicol (Phila). 2011;49(2):72-89.
Sansom L. Oral extended release products. Aust Prescr. 1999;22(4):88-90.
Conley R, Gupta SK, Sathyan G. Clinical spectrum of the osmotic-controlled release oral delivery system (OROS), an advanced oral delivery form. Curr Med Res Opin. 2006;22(10):1879-92.
Shamblin SL. Controlled release using bilayer osmotic tablet technology: reducing theory to practice. In: Wen H, Park K, editors. Oral Controlled Release Formulation Design and Drug Delivery. Theory to Practice. New Jersey: Wiley; 2010: 129-53.
