arznei-telegramm 2002; 33: 108


Intestinal perforation caused by a blister wrapped tablet: An almost blind diabetic patient with moderately impaired mental capacity was admitted to the hospital with the diagnosis of an acute abdomen. Laparoscopy revealed a perforation of the terminal ileum, caused by an omeprazole tablet still in its blister wrapping and partially penetrating the intestinal wall. His wife had cut the package into individual blister wrapped tablets before she put them into his pill box. The patient swallowed the tablet together with its wrapping (Network report 12.465). In a number of drugs separating the blister along the prepared perforation line or cutting the blister wrapping may create sharp edges. These indigestible foreign bodies are especially dangerous for patients with impaired vision or cognitive functioning and patients on sedative medication: Reports of severe complications in the esophagus or gastrointestinal tract following the accidental intake of drugs with blister wrappings are especially common for this group of patients (FULFORD, S., TOOLEY, A.H.: Lancet 1996; 347: 128-9; LURTON, A. et al.: N. Engl. J. Med. 1996, 335: 754, GUPTA, N.M. et al.: Asian Cardiovasc. Thorac. Ann. 2002; 10: 87-8). A database research revealed eleven reports regarding this subject. An additional warning, such as, "Do not hand out tablet while still in the blister wrapping to vision-impaired or disoriented patients, nor to children" might provide some protection.

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