Chipped tablets

[BillB]

Hi folks! New to here, but not new to forums, or Crohn's or UC.

I've been taking Lialda 4 x 1.2G pills for over 10 years now. They used to work, but I'm not sure they are doing anything anymore since I'm now also on Remicade infusions. But that's for another discussion - and, besides, my GI doc says to keep taking them.

I get my 90 day supply of Lialda via Express Scripts mail delivery and inevitably, there will be 1 or 2 tablets in each bottle where the outer shell has chipped, exposing the pill's payload, if you will, as seen by this pic.



It is my understanding the thick shell for these pills is there to ensure our stomach acids and other digestive processes going on in our guts do not dissolve this outer shell prematurely until the pills get down to the UC/Crohn's affected area. For that reason (and the uncertainty of what mesalamine would do to my stomach lining), I always throw those chipped pills away. I estimate since I started taking these pills, I have probably thrown in the trash, close to a full 90 day supply.

These pills are not cheap and while I am fortunate to have good insurance, I wonder if this chipped pill issue is widespread, if everyone else is throwing them away too, and if that waste is artificially and unnecessarily raising the cost of this medicine for everyone?

I am sure the pill manufacturers are not complaining. They get to sell more pills.

I contacted Express Scripts and suggested they stuff the free space in the bottles with cotton to help minimize bouncing around and chipping during transport. I got some canned/scripted reply that really didn't apply, and needless to say, no cotton and I am still getting chipped pills.

So just wondering if you get chipped pills too, and what do you do with them? Do you still take them or do you toss them?

 

[hawkeye]

When I was talking 5ASA I would get the odd chipped tablet, butbtgey were few and far between. I just used them anyway. They were 500 gram tablets and I was taking 2 tablets 3 times per day if you do here the chipped tablets, I would space them out.

 

[BillB]

Thanks. I've been throwing mine away. I'm assuming the exposed inner pill would cause them to dissolve prematurely in the stomach. And the occasional one chipped pill probably [hopefully!] would do no harm to the stomach lining. But I suspect by dissolving early, it would not help in fighting Crohn's either. That's why I toss them.

I wonder how widespread this chipping problem is? Since you are the first and only reply after nearly 2 weeks, It would seem not very.

Thanks again.

 

[D Bergy]

You could get some confectioners Shellac and Put some over the chipped part. Probably similar to whats on there anyway.

Dan

 

[BillB]

That seems a bit extreme for my particular scenario. Out of a 90 day supply (360 tablets in 4 bottles), there may be 8 tablets chipped. If I had to pay totally out-of-pocket, or if there were many more chipped, I might be so inclined.

But your post got me to thinking about the coating that is on there and you are right, it likely is indeed shellac or something similar. But I was surprised to learn there is a whole nother science to pill coatings and specifically when it comes to pills for Crohn's and UC. Apparently, the coating is often applied in several distinct layers, with each layer designed to target specific areas in the GI tract.

See this GI Society article. Depending on the specific ailment and the affected area in the GI track being targeted, the coating on the particular form of the 5-ASA medication requires...

...specific coatings to reach precise affected locations in the GI tract for direct application to the intestinal mucosa. Otherwise, they are absorbed by the body overall, potentially resulting in an increased incidence of adverse drug reactions.

...are coated with one, two, or three layers of ethylcellulose. After passing safely through the stomach, the one-layer granules release in the upper small intestine, the two-layer granules release later in the small intestine, and the triple-covered granules in the colon.

So I learned something new there. That's always good for the "little gray cells".

Also in that article is a concern about generic alternatives. The primary medication in generic pills may be equivalent, but not the coatings which for some patients, may affect the effectiveness of the pill. My bottles do say Lialda and manufactured by Shire so that is the current patent holder. But according to this, that patent expires this coming June. So something to watch out for. Those of us taking Liada may need to get our doctors to write the scripts to prohibit generic versions.

 

[hawkeye]

It may have something to do with the mail order prescriptions and shipping. Mine were always pick up from the pharmacy and early on the Salofalk was in blister packs in boxes.

 

[BillB]

I am sure the chips occur during shipping. That's why I made a suggestion to Express Scripts, my mail pharmacy, to stuff cotton in the jars to minimize jostling about during transport. But I am sure my message only got to someone who is not allow to take any initiative and had to follow some pre-written checklist of canned replies.

Oh well.