An algorithm for analyzing the feasibility and selecting the method for modifying solid oral dosage forms for individuals with swallowing difficulties

Aim : To develop and evaluate an algorithm to assess the feasibility of and select modification methods for solid oral dosage forms in individuals with swallowing difficulties Methods : This methodological study comprised three steps: development of an algorithm; conducting a narrative literature review to identify general and method-specific contraindications to modification; and application of the algorithm by four independent researchers to select the modification method for solid oral dosage forms from Brazil’s National List of Essential Medicines. Results : Of the 423 solid oral dosage forms analyzed, 85.3% contained sufficient information for algorithm application, whereas 14.7% required drug therapy adjustment. A total of 145 general contraindications to modification were identified, indicating a substantial risk of inappropriate use in individuals with swallowing difficulties. The most common general contraindications to modification were drugs with bitter or unpleasant taste (46.8%) and those that irritate the oral or esophageal mucosa (23.5%). When selecting a tablet modification method, dispersion was more commonly chosen than crushing (42.2% vs. 21.3%). Among eligible oral dosage forms considered for modification, 54.5% contained hazardous drugs, underscoring occupational risks associated with modification practices. Conclusion : The algorithm identified both general and specific contraindications and supported the selection of suitable modification methods, while also indicating when drug therapy adjustment may be necessary. Further studies are required to evaluate the algorithm’s impact on medication safety and to optimize nursing workload.