Ghost-Pill
Introduction
A patient who is taking Glucophage XR 500 mg came to the pharmacy concerned that she had seen some tablet-like structures in her stool.
- She asked if she was still getting the full dose of medication if the tablet was not dissolving.
Facts
With some controlled-release formulations, it is expected that the empty intact shell that housed the medicine ("ghost-pill" or "ghost-tablet"), or other insoluble formulation parts will appear in the stools.
- This is because controlled-release formulations (tablets, capsules and their parts) are designed to either disintegrate slowly to release the medicine over a predetermined period or remain intact.
Examples of Medicines
Some examples of medicine that can appear in the stool include:
- Adefin XL (nifedipine)
- Cardura XL (doxazosin)
- Concerta (methylphenidate)
- Duride (isosorbide mononitrate)
- Effexor-XR (venlafaxine)
- Glucophage XR (metformin)
- Invega (paliperidone)
- Nuelin SR (theophylline)
- OxyContin (oxycodone)
- Pristiq (desvenlafaxine)
- Span-K (potassium chloride)
- Urocit-K (potassium citrate)
Patient Counselling
When prescribing these controlled-release medicines, it is important to reassure patients that the active medicine will be released, even if remnants of the medicine can appear in their stools.
- However, if the patient reports a lack of efficacy from their medication, further investigations may be warranted.
External Links
- 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, 2013
- Ghost pill: knowledge and awareness of this phenomenon among health care professionals, 2014
- Ghosts of Medicines Passed, 2016
- Ghost tablet in faeces, 2017
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