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Question
I look after my wife who is an MS sufferer of over twenty five years. She has several medicines to take each day. Over the last half year or so she has got into the habit of holding the tablets in her mouth for several minutes (maybe five or more - typically with tea) before swallowing them.
Is this just another unfortunate symptom of her changing cognition, and harmless? Or could it be harmful?
I don't want to be trying to dissuade her from doing it unless it is important since I am already having to struggle to persuade her to do enough exercise, drink enough water, eat more healthily , try to stay positive (!), etc. ...

Her daily tablets are:
2 x 400mg    Tegretol
1 x 60mg    Trospium chloride MR (Regurin XL)
1 x 100mcg    Levothyroxine
1 x 150mg    Venlafaxine slow release (Venlalic XL)
1        Elleste Duet Conti
1 x 100mg    Modafinil

Many thanks if you can advise. M.

Answer
Martin

Retaining tablets may be an indication of swallowing difficulties either caused by her condition or a loss of sensation in her mouth. If she is able to take food by mouth (albeit pureed), then her swallowing is not itself impared, though she may have problems with solid dose forms and may want / try to chew them, which isn't necessarily advisible. Also consider if she has a very dry mouth and limited saliva production. This is a very common side effect from the Trospium, so your wife may need regular sips of water to allow her to swallow more easily.

Retaining the tablets could potentially cause irrition to the mouth if they are beginning to dissolve, and any chewing of the slow release / MR products will mean that the controlled release effect is lost and there may be greater fluctuation in dose and effect over time.

If necessary, the Tegretol is available as a liquid formulation but the 400mg strength is again slow release, so some dose adjustment may be necessary and spreading the daily dose into several smaller doses through the day. Although levothyroxine is available as an (unlincensed) liquid product, given the small size of the tablets, it is perhaps just as easy to crush the tablet and either administer it in a volume of water, or mix it with food (soft desserts are ideal). As your wife is at home, you will not encounter the resistance some care institutions (or home carers) have about covert administration, but something perhaps to be aware of if that situation arises.

Likewise, Modafinil could be crushed if necessary and Venlafaxine slow release capsules can usually be openend and the pellets sprinkled onto food. The pellets themselves should not be crushed though. If you needed to use this method, the doctor would need to change the prescription as again, the venlafaxine tablets cannot be crushed.

Unfortunately, there is no direct alternative formulation or closely related product to the Trospium, though a Hyoscine patch may be worth trying as it has similar effects (and side effects), so could give similar benefit. Again it will cause mouth dryness, and may also affect vision and focussing. That perhaps needs more discussion with your doctor or specialist.

If it helps, I am sure you are doing a really excellent job under such demanding circumstances. As I know from my own parents, development of a chronic, progressive and debilitating disease places untold pressure on the other partner and despite every effort, the condition ultimately wins and more specialist care is needed. Do not feel bad when that time comes, your own actions will have delayed that for a long time and it is never a sign of your own failure!

I hope this helps!!

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Nigel Simmons

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I am happy to answer general questions on medicines and hospital care. If possible, please use approved / chemical names rather than brands which are not internationally recognised. Like all health professionals I am bound by a duty of care which prevents me giving detailed information about medication or treatment of people other than the questioner. I will endeavour to help wherever possible or point towards more appropriate advice. If however your question crosses too far into patient confidentiality, I hope you will understand why I cannot answer your question. Consider.. would you want me to discuss your care with a friend or relative without your knowledge?

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