Can orodispersible films contribute to the improvement of treatment adherence in the older population?

The gradual decline of body functions in elderly people results in a higher incidence of dysphagia, trembling hands and reduced hand-eye coordination. Moreover, the altered gastrointestinal motility and hepatic or renal function modify the drug pharmacokinetics, requiring dose and regimen adjustments. In this context, conventional oral dosage forms show a high risk of practical therapeutic problems (e.g., difficult handling and swallowability) and errors that can result in a poor adherence and/or reduced patient or caregiver quality of life. Orodispersible dosage forms (ODXs) permit to overcome these disadvantages. Two main ODXs currently available are Orodispersible tablets (ODTs) and films (ODFs), which have been recently commercialized. ODFs are sheets designed to be placed in the mouth and to disintegrate quickly, giving a fine suspension or solution of drug substance in the saliva that can be easily swallowed also by patients with fear of choking or suffering from dysphagia. Constituted of plasticized water-soluble polymers, ODFs are predominantly produced by solvent casting technique. From a manufacturing point of view, the main advantage of ODF is the possibility to obtain different strengths from the same intermediate laminate by changing the cutting size. The main disadvantage lies in the reduced formulation space, which limits their use to only potent drug substances (< 100 mg) and makes the task masking difficult. Beside such technological limitations, the ODFs seem a very promising dosage form to be used in elderly population since they permit an accurate dosage, an easy handling, a good swallowability, other than a reduced risk of excipient overload.