Pentasa - Can you open the capsules?

Just wondering if anyone could direct me to any studies about the effectiveness of Pentasae when you open up the gelatin capsules that it comes in. [I submitted this same question for Budesonide today.]

My 10 year old son was taking this anti-inflammatory for crohns.

We had a difference of opinion with his pediatric GI specialist. The Pentasa capsule was way to big for our son to swallow, so we opened up the capsule and he swallowed the little granules that were inside the capsule.

His GI specialist thought that that would undermine the effectiveness of the drug, but he didn't seem to know exactly why.

Our pharmacist thought opening the capsule would be fine - he said that the capsule dissolves in about five minutes anyway after you swallow it and that the little granules have a special coating that only dissolves when the granules hit the right spot in the digestive system.

Would appreciate any information anyone might have on this.

Thanks.

Have you tried sourcing info directly from the drug manufacturers website? That is what I would try first. I use a variant of 5-ASA called Salofalk, and I went to their website (Dr Falk) to deal with side effects. Salofalk isn't in capsule form, so I can't provide you any pertinent first hand info on it. My understanding (and bear in mind that this is anecdotal info from a layman's perspective) of how this type of drug works is that they are very potent anti-inflammatories coated so they pass thru most of the intestinal system before breaking down and being absorbed in the crucial targeted areas. If you do anything to speed up the rate in which they breakdown, then it might not reach the area being targeted. Perhaps this is what made your GI hesitate? A gel coating doesn't seem appropriate... making me wonder if Pentasa works in the same fashion... I wouldn't expect a gel coated pill to pass the stomach. But, that's a strictly uneducated assumption on my part. The pharmacist may be right... that the granules themselves are coated to make the journey. The drug manufacturer may have a Q & A section, or a link for such questions. Its probably your only source for the absolute correct answer to your question. I wish you the best, and welcome to the forum. Hope you get your answers..

I'm also under the assumption that the pills are coated to pass thru until it hits the part of the intestines it needs to... kinda like wearing a coat in cold weather, so you make it inside the house before you freeze.

Thanks. I've gone to the manufacturer web site and did not see anything addressing opening the capsules.

I'm also a little disappointed because I don't think my son's GI has done any research on the effects of opening the capsules. In fact, I've found that our doctors sometimes have no idea what the delivery system is for the medications they prescribe. They know the dosage levels but don't know whether the pill comes in a tablet or a capsule or in another form.

Instead of researching this issue for us, I sense that my son's GI is simply taking the easy offiicial position of directing him to take the capsule unopened. My feeling is that, in at least some of the cases, the pharmacueticals don't seem sensitive to the size of the "horse pills" that they make and aren't sensitive to the fact that some of their customers are children.

The pharmacist told me that the outside gel capsules are simply a way to package the medicine in exact dosage amounts and to make it easy to take (if you can swallow that size pill), but that the gel capsule basically dissolves in about five minutes in our stomach and has little or no role in exactly where in your digestive system the medication is released.

I tried putting a couple of hte capsules in a glass of water and, in about five minutes, the outside gel capsule was dissolving.

I believe the pharmacist is correct in this case. The capsule is just to hold the contents.

Enteric coated tablets or capsules are formulated to deliver the substance past the stomach into the intestines. As long as the capsule is not this type it is doing nothing but holding in the medicine until it gets to the stomach.

Taking it out of the capsule just makes it five minutes faster in dissolving.

Dan Bergman

doesn't it say something about never chewing the pills, i would think because of that you couldn't

Yeah, the capsule is time released so that it disintegrates by the time it reaches the ileum and upper colon where it is most effective. Opening the capsule and swallowing the granules will activate the medicine far earlier than it needs to, which will keep it from reaching the proper location farther down in the digestive system. See if you can get the Pentasa in tablet form. I had some 500mg Pentasa in tablet form a while ago. It'd probably be easier to swallow and you'd be able to cut them in half if they are still a bear to swallow.

That's how it was explained to me and I do know that Pentasa is a time released capsule.

I live in Lebanon and take Pentasa also. Here it doesn't come in a capsule but in tablet form (made in Denmark). On the leaflet, they also mention that you can split the tablet in 2 to make swallowing it easier..

I will definitely look into this.

Thanks1

How do you know the outside capsule is time-released?

I just put two of the capsules into a cup of lukewarm water and, within five minutes, both capsules very decomposing and had holes in them where some of the inside granules were already leaking out.

First, let's distinguish between what a 'capsule' is and what a 'granule' is. A capsule is the blue pill, the outside part. The granules are the little white beads found inside the capsule.

The capsule itself is not time released.

Don't believe me? Put the whole capsule in water. Within several minutes, it will start to dissolve. How will the capsule ever get past the acids in the stomach if it dissolves so fast? Answer: it won't. Within several minutes, the pill will be punctured by the stomach acids and the medicine will be floating around in the stomach, anyway.

Now, try opening the capsule and putting the GRANULES in the water. The granules will not dissolve, even if it is left in the water for over 12+ hours.

The granules are the ones that cannot be bitten down or chewed. The granules have the enteric time-released coating. The granules were designed to get past the stomach acids. The pill itself, which can be destroyed by my pinky, is just a nice decoration.

If someone has trouble swallowing these pills, I advise them to open it and take the granules with something like pudding or yogurt. It's worked for me, and yes, you do have your bad days even when you take Pentasa.

AndrewEsq said:

Don't believe me? Put the whole capsule in water. Within several minutes, it will start to dissolve. How will the capsule ever get past the acids in the stomach if it dissolves so fast?

Click to expand...

The stomach is of a low pH (1-5) whereas water is pH neutral (7).

By using time release capsules you can delay the release of the tablet in liquid by not reacting to the low pH of stomach acid, but to the higher pH found in the intestines.

From Google Answers

...For example, aspirin is normally has a
special coating termed an enteric coating, which is resistant to
stomach acid and dissolves in the high pH of the intestines. The
purpose of this coating is to prevent dissolution of the tablet in the
stomach, where the stomach acid may degrade the active ingredient, or
where the time of passage may compromise its effectiveness, in favor
of dissolution in the small intestine, where the active principle is
better absorbed.

Click to expand...

Im not saying that this happens with Pentasa, but to say that the capsule is not important just because it dissolves in water is incorrect.

The website does state they use time-delayed capsules, so I would suspect you do need to have them as a whole. I hope that helps

Pentasa can be opened up and placed into applesauce or something similar for little kids ( per our GI and the pharmacist).
It is most effective if swallowed whole in the capsule.

Yes, Pentasa also comes in sachet form: http://www.bing.com/search?q=Pentasa+sachet&qs=n&form=QBRE&pq=pentasa+sachet&sc=0-0&sp=-1&sk=

Yeah, it's just the granules, I have the sachet form (I had the capsule form before)

I know of no capsules of crohn's medication that are time released to be honest, even entocort capsules are not time released. I don't think medical companies want capsules getting stuck in intestines of people with strictures because it didn't dissolve, the only thing that is time released is the granule.

I know of 2 different types of granules too, they make the tiny little balls and they make the tiny little cylinder type now too, not sure if there's any difference.

I would also be careful of taking supplements with special coatings, even normal capsules that have no time release have been known to not release their content and stay whole, that was one of the complaints in a crohn's disease study with antibiotics, some of the capsules did not dissolve. The last thing you want is surgery because some capsule is stuck.

I know this post is older but my doctor told me it was fine to open the capsule to take the Pentasa. I was putting it in baby food but now all I do is empty 2 capsules into my mouth and chug some juice. I cannot and will not attempt to swallow those huge ars capsules.
Yes I'm a Big baby with pills : )

My son takes Pentasa and he generally cannot handle big pills, but he can take the Pentasa fine because the capsules are so soft and smooth, they slide right down (unlike some of the giant, rock hard vitamin tablets).

I was on Apriso but couldn't swallow those huge capsules. I called my GI and it sounded like he had no idea there's such a concept as not being able to swallow pills. (In fact, he asked me, "Could you swallow your food?")
He changed me to Lialda, a tablet which was slightly smaller. I couldn't swallow them either, but my pharmacist told me I could cut them in half. By then, I couldn't swallow the halves either so I basically ground them, and they tasted horrible.
I had a flare recently so my GI changed me to Pentasa. It's almost the same size as the original Apriso, but so far I'm able to swallow them. I always tried swallowing the pills with applesauce, and then it stopped working. What I do now, is practice swallowing spoons of applesauce without anything in them, because I believe my problem with swallowing is that I tend to overchew my food (even soup or applesauce). I had to train myself to swallow a spoon of applesauce straight without chewing it. Once I did that and put a pill in, it went down fine.
Maybe you can try that with your son.

There's a number of studies that showed that some capsules of medication never open no matter what. Really, most of those capsules used are horrible, I always try to avoid capsules as much as possible.

ebaby said:

I was on Apriso but couldn't swallow those huge capsules. I called my GI and it sounded like he had no idea there's such a concept as not being able to swallow pills. (In fact, he asked me, "Could you swallow your food?")
He changed me to Lialda, a tablet which was slightly smaller. I couldn't swallow them either, but my pharmacist told me I could cut them in half. By then, I couldn't swallow the halves either so I basically ground them, and they tasted horrible.
I had a flare recently so my GI changed me to Pentasa. It's almost the same size as the original Apriso, but so far I'm able to swallow them. I always tried swallowing the pills with applesauce, and then it stopped working. What I do now, is practice swallowing spoons of applesauce without anything in them, because I believe my problem with swallowing is that I tend to overchew my food (even soup or applesauce). I had to train myself to swallow a spoon of applesauce straight without chewing it. Once I did that and put a pill in, it went down fine.
Maybe you can try that with your son.

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The rules change depending on the preparation of 5ASA you are taking. Lialda is one preparation that should never be crushed, broken or chewed because in doing so you render it ineffective. It is designed to be released in the colon only so once the enteric coating is compromised it will do one of two things in the stomach, either the coating is there to protect the stomach from the tablets contents or it is there to protect the contents from the acidic environment of the stomach.

Your pharmacist should have known that. A good rule of thumb of any medication is if it has a hard smooth coating and it isn't scored then you can't break or crush them.

Dusty.

Thanks Dusty; wish I would have known that before.
Do you think that's what could have contributed to the flare I had then, when I was taking the crushed Lialda?
By now I'm fine, the Pentasa is working great!

I don't think you could rule it out ebaby, the tablets wouldn't have reached the targeted area intact so to a large degree they would have been ineffective due to insufficient dose.

Dusty. xxx