Not all capsules are meant to be swallowed


There are some asthma medications that come as powder-filled capsules. The powder inside though is meant to be breathed into the lungs using a special device called an inhaler.

The powder is ineffective if the capsule is swallowed intact. Both Foradil (formoterol fumarate) and Spiriva (tiotropium bromide) are examples of inhalation powders in a capsule that looks like those that can be swallowed. The capsules are further packaged in blister cards. Foradil is used for the treatment of asthma and also for a lung condition called "chronic obstructive pulmonary disease" or COPD. Spiriva is used only for the treatment of COPD.

Foradil comes with an inhaler called the "Aerolizer" and Spiriva comes with an inhaler called the "Handihaler." For each dose, the capsule should be removed from the blister card and placed into the accompanying inhaler as shown in the instructions that come with the product. Each time the inhaler is activated it punches a hole into the capsule, releasing the dry powder from the capsule, which is inhaled by mouth into the lungs.

ISMP and FDA have received numerous reports of patients who have mistakenly swallowed the Foradil and Spiriva capsules. We have even heard of nurses accidentally giving the capsules to hospitalized patients to swallow. Yet swallowing these capsules renders the medication ineffective and therefore does not provide treatment for asthma or COPD.

To prevent similar errors, keep in mind that capsules that come with an inhaler have powder inside that is meant to be inhaled. If a device is given to you with your medication, ask the pharmacist to explain how to use the device. And finally, make sure you read the drug information pamphlet that comes with your medication.

You can learn more about whichever product you are taking and view printed instructions and a video, by going to the associated website. The Spiriva website link is here and the one for Foradil is here.

Created on August 9, 2009

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