digestion

[adam_uk]

i have a question, i have had sore tonsils recently, and i feel the propecia pill is getting stick for a bit on the way down when i swallow, do u think this will hinder the propecias effectiveness? thanks...

 

[Bryan]

I always suggest that people chew their Propecia/Proscar tablets a bit before swallowing. That would make your (possible) problem a moot point.

 

[adam_uk]

indeed, wow

so what your saying is along as it goes down some how it will be absorbed, either in the throat/tongue or in the stomach?

 

[Nathaniel]

Unless it's a time release formula, it won't hurt to chew the pills because you will absorb better. If by chance it dissolves in the mouth it will get washed down with the saliva you swallow (just make sure you don't spit right after).

 

[medmax84]

i have a question, i have had sore tonsils recently, and i feel the propecia pill is getting stick for a bit on the way down when i swallow, do u think this will hinder the propecias effectiveness? thanks...

What you describe is consistent with pill esophagitis. You should really be taking your propecia tab with a full 8-oz glass of water. I get the best results when I take mine with a full glass of water after eating a meal. I have an easy-to-upset stomach and esophagus, so I can feel your pain.

 

[medmax84]

I always suggest that people chew their Propecia/Proscar tablets a bit before swallowing. That would make your (possible) problem a moot point.

True, but I think swallowing the full tab (or the portion in its entirety) minimizes the risk of aspiration into the upper respiratory system.

 

[medmax84]

indeed, wow

so what your saying is along as it goes down some how it will be absorbed, either in the throat/tongue or in the stomach?

Any mucus membrane can absorb nutrients. However, the greatest absorption typically takes place in the small intestine. This is why it is best to swallow the tab in its entirety as the mucosa of the mouth and esophagus are not as efficient.

I suggest placing the pill directly on your tongue, pushing the tongue lightly against the roof of your mouth to hold it in place then take several gulps of water to wash the pill down. It is suggested to take propecia with 8 ounces of water. I sincerely believe this will fix your problem.

 

[Bryan]

I always suggest that people chew their Propecia/Proscar tablets a bit before swallowing. That would make your (possible) problem a moot point.

True, but I think swallowing the full tab (or the portion in its entirety) minimizes the risk of aspiration into the upper respiratory system.

Perhaps, but as you said yourself, you should just take it with water or other beverage as you chew it up. That's the way I take all _my_ drugs and supplements. I think people need to get away from this pointless tradition of swallowing these things whole, unless there's a really good reason to do so (like a time-release formulation).

 

[Bryan]

Any mucus membrane can absorb nutrients. However, the greatest absorption typically takes place in the small intestine. This is why it is best to swallow the tab in its entirety as the mucosa of the mouth and esophagus are not as efficient.

I don't follow the logic of that statement. Any part of a nutrient or drug that DOESN'T get absorbed by the mucosa of the mouth and esophagus will go on to be swallowed and absorbed in the usual fashion in the small intestine. For that reason, I fail to see why it would be "best to swallow the tab in it entirety".

 

[bubka]

Bryan (yes, I have mentioned this many times before) put a drop of water on a propecia / proscar pill, the thing falls apart. There is no chance in hell that it will make it even past the stomach without being fully dissipated.

 

[medmax84]

Any mucus membrane can absorb nutrients. However, the greatest absorption typically takes place in the small intestine. This is why it is best to swallow the tab in its entirety as the mucosa of the mouth and esophagus are not as efficient.

I don't follow the logic of that statement. Any part of a nutrient or drug that DOESN'T get absorbed by the mucosa of the mouth and esophagus will go on to be swallowed and absorbed in the usual fashion in the small intestine. For that reason, I fail to see why it would be "best to swallow the tab in it entirety".

The capillary beds are shared throughout the entire GI tract which feed into the portal system. That is true. The difference may be negligible.

However, the lining of the intestine is designed for absorption. Admittedly, it would be more of an argument if finasteride was a prodrug. I don't believe that it is.

I am less-than-inclined to persuade people to chew a tab that is supposed to be swallowed whole if the rationale for doing so isn't compelling. There is no reason why someone wouldn't be able to swallow a 1 or 1.25 mg tab with a full glass of water. As I've said, taking it with food, while not stressed is always recommended. It promotes slow absorption, but it ALSO means that you are past the cephalic and gastric phase of digestion which means you are salivating and producing mucus in your mouth, producing gastric acid (HCl) in your stomach, and have active motility through the pyloric sphincter into and through small bowel. These function to maximize the mechanical and chemical breakdown of the tablet and also assure that it won't get "stuck in your throat."

 

[medmax84]

actually, if it is fat soluble it may partially bypass the portal system and travel through lacteals (lymph vessels)... just a thought. Gotta get to class. In that case, dietary fat would also increase absorption/bioavailability.

 

[Bryan]

I don't follow the logic of that statement. Any part of a nutrient or drug that DOESN'T get absorbed by the mucosa of the mouth and esophagus will go on to be swallowed and absorbed in the usual fashion in the small intestine. For that reason, I fail to see why it would be "best to swallow the tab in it entirety".

The capillary beds are shared throughout the entire GI tract which feed into the portal system. That is true. The difference may be negligible.

However, the lining of the intestine is designed for absorption.

I don't want to seem like I'm beating a dead horse here, but I just don't see any relevance at all in the fact that the intestine is "designed for absorption". Like I said before, any part of a drug that doesn't get absorbed PRIOR to hitting the intestine will be absorbed in the normal fashion when it DOES hit the intestine afterwards.

All this reminds me of a discussion I had several years ago with Dr. Stephen Harris, MD, a well-known medical researcher and gerentologist who posts frequently on medical newsgroups and forums. What he and I were arguing about was the advisability of using those so-called "sublingual" vitamin B-12 supplements. Those are supposed to bypass the need for intrinsic factor in the stomach by having the B-12 be absorbed directly into the bloodstream through the tissues in the mouth. But Dr. Harris scoffed at that idea, pointing out (like you) that the intestine is "designed for absorption", so he said just go ahead and swallow any B-12 supplement.

But I did see a more recent study which compared blood levels of B-12 in volunteers, some of whom used those "sublingual" supplements, and some of whom swallowed ordinary B-12 tablets. The blood levels of the vitamin in the two groups were virtually IDENTICAL, indicating (just like I said) that even if the "sublingual" route doesn't really work as advertised, it nevertheless _will_ get absorbed in the usual way (via intrinsic factor in the stomach) when it inevitably gets swallowed afterwards.

It's highly misleading to hint or imply that chewing something up is possibly going to adversely affect its absorption, just because the intestine is "designed for absorption".

I am less-than-inclined to persuade people to chew a tab that is supposed to be swallowed whole if the rationale for doing so isn't compelling. There is no reason why someone wouldn't be able to swallow a 1 or 1.25 mg tab with a full glass of water.

But I don't think there's any reason that tablets are "supposed" to be swallowed whole, except for pointless and arbitrary customs and traditions! Since you're relatively new here, you probably haven't seen a couple of things I've posted about here a few times in the past. The first one is a study I read about many years ago in a newspaper in which a California doctor found that ALL nutritional supplements were absorbed more completely when the tablets/capsules were chewed-up first, prior to swallowing. He recommended that everybody do that, even if some of them may not taste very good.

The second thing that I've mentioned several times on all these sites is a true story about my mother (all the other guys are now groaning: "Oh no! Bryan's going to repeat that pill-swallowing story about his mother again!!" ): Several years ago she had been taking a prescription medication (I believe it was a blood-pressure pill, if I'm remembering correctly), and she noticed one day that one of the pills had passed all the way through her, intact!! :shock: So horrified was she at the sight of this intact pill in the toilet, she actually got my father to come in and verify it, which he did (I questioned both of them about it later, at some length). She immediately called the pharmacist and told him about it, and she says the pharmacist was also horrified by it, and claimed that he had never heard of such a thing happening.

I think you can see now why I've had a very bad feeling for a long time about what I consider to be the pointless and unnecessary tradition of swallowing pills and capsules whole. Unless there is a compelling reason to swallow them whole (like if it's a "time-release" formula), I believe that ALL tablets and capsules, drugs and nutritional supplements alike, should be chewed-up prior to swallowing. I've been doing that myself for about the last 35 years, amd I always recommend it to other people. Why take any chances at all that the things you're using aren't being fully and completely absorbed, just because of some stupid societal tradition of swallowing tablets whole?? :roll: :nono:

 

[medmax84]

I don't follow the logic of that statement. Any part of a nutrient or drug that DOESN'T get absorbed by the mucosa of the mouth and esophagus will go on to be swallowed and absorbed in the usual fashion in the small intestine. For that reason, I fail to see why it would be "best to swallow the tab in it entirety".

The capillary beds are shared throughout the entire GI tract which feed into the portal system. That is true. The difference may be negligible.

However, the lining of the intestine is designed for absorption.

I don't want to seem like I'm beating a dead horse here, but I just don't see any relevance at all in the fact that the intestine is "designed for absorption". Like I said before, any part of a drug that doesn't get absorbed PRIOR to hitting the intestine will be absorbed in the normal fashion when it DOES hit the intestine afterwards.

All this reminds me of a discussion I had several years ago with Dr. Stephen Harris, MD, a well-known medical researcher and gerentologist who posts frequently on medical newsgroups and forums. What he and I were arguing about was the advisability of using those so-called "sublingual" vitamin B-12 supplements. Those are supposed to bypass the need for intrinsic factor in the stomach by having the B-12 be absorbed directly into the bloodstream through the tissues in the mouth. But Dr. Harris scoffed at that idea, pointing out (like you) that the intestine is "designed for absorption", so he said just go ahead and swallow any B-12 supplement.

But I did see a more recent study which compared blood levels of B-12 in volunteers, some of whom used those "sublingual" supplements, and some of whom swallowed ordinary B-12 tablets. The blood levels of the vitamin in the two groups were virtually IDENTICAL, indicating (just like I said) that even if the "sublingual" route doesn't really work as advertised, it nevertheless _will_ get absorbed in the usual way (via intrinsic factor in the stomach) when it inevitably gets swallowed afterwards.

It's highly misleading to hint or imply that chewing something up is possibly going to adversely affect its absorption, just because the intestine is "designed for absorption".

I am less-than-inclined to persuade people to chew a tab that is supposed to be swallowed whole if the rationale for doing so isn't compelling. There is no reason why someone wouldn't be able to swallow a 1 or 1.25 mg tab with a full glass of water.

But I don't think there's any reason that tablets are "supposed" to be swallowed whole, except for pointless and arbitrary customs and traditions! Since you're relatively new here, you probably haven't seen a couple of things I've posted about here a few times in the past. The first one is a study I read about many years ago in a newspaper in which a California doctor found that ALL nutritional supplements were absorbed more completely when the tablets/capsules were chewed-up first, prior to swallowing. He recommended that everybody do that, even if some of them may not taste very good.

The second thing that I've mentioned several times on all these sites is a true story about my mother (all the other guys are now groaning: "Oh no! Bryan's going to repeat that pill-swallowing story about his mother again!!" ): Several years ago she had been taking a prescription medication (I believe it was a blood-pressure pill, if I'm remembering correctly), and she noticed one day that one of the pills had passed all the way through her, intact!! :shock: So horrified was she at the sight of this intact pill in the toilet, she actually got my father to come in and verify it, which he did (I questioned both of them about it later, at some length). She immediately called the pharmacist and told him about it, and she says the pharmacist was also horrified by it, and claimed that he had never heard of such a thing happening.

I think you can see now why I've had a very bad feeling for a long time about what I consider to be the pointless and unnecessary tradition of swallowing pills and capsules whole. Unless there is a compelling reason to swallow them whole (like if it's a "time-release" formula), I believe that ALL tablets and capsules, drugs and nutritional supplements alike, should be chewed-up prior to swallowing. I've been doing that myself for about the last 35 years, amd I always recommend it to other people. Why take any chances at all that the things you're using aren't being fully and completely absorbed, just because of some stupid societal tradition of swallowing tablets whole?? :roll: :nono:

I can't disprove any of your argument. I just want to point out that intrinsic factor is excreted in the stomach but B12 is actually absorbed further down the GI tract in the small intestine (either the duodenum or ileum... shoot i should know this...)

At any rate, the finasteride molecule appears to be steroid or cholesterol-like in appearance. I am not a chemist, so I cannot say for certain, but there is a possibility that it is BEST absorbed with dietary fat in the small intestine. I am unsure of the role that it would play in its absorption or whether being absorbed in the oral mucosa would be difficult because of this.

I think sublingual capillary beds have a first pass through the liver, but they MAY not be. Keep in mind finasteride is metabolized exclusively by the liver (which is why I don't take pills on days I plan to drink). The dosage for any per oral medication is calculated based on a first-pass effect. Again, I don't know if finasteride participates in packaging into chylomicrons or if it is pulled into lacteals... if that is the case then it bypasses the first pass. It's just too much speculation for me to be comfortable with recommending chewing as I am not sure that the only reasoning behind swallowing the pill whole is dogma.

To summarize the important points:

finasteride is metabolized by liver enzymes (P450?). Dosages are calculated based on the "first-pass effect" if they are metabolized by the liver, because if the drug is absorbed into the portal system via intestinal capillary beds it will FIRST travel to the liver before it gets to its target sites of where 5AR is located via systemic circulation. IF the lingual mucosa bypasses the liver, then this could be a problem because you will skip that first pass effect and it will be as though you took a significantly higher dose (perhaps not dnagerous in the case of finasteride). I am going to look up whether the oral mucosa is part of the portal system. I suspect that it is, at least in part.


Was the pill that passed through the woman you discussed in a capsule or was it just a coated tablet?

I'm a little incoherent in this post... I'm mostly thinking out loud.

 

[treadstone]

Finpecia tablets are like, smaller than a fruity/cocoa pebble. What would be the purpose in chewing that? Unless propecia tablets are significantly larger...

 

[Bryan]

I can't disprove any of your argument. I just want to point out that intrinsic factor is excreted in the stomach but B12 is actually absorbed further down the GI tract in the small intestine (either the duodenum or ileum... shoot i should know this...)

Yes. Intrinsic factor is secreted somewhere in the stomach, and then binds with B12 somewhere along the line. Then the complex is absorbed in the small intestine.

At any rate, the finasteride molecule appears to be steroid or cholesterol-like in appearance.

It's an "azasteroid", a steroid with a certain specific chemical structure.

I am not a chemist, so I cannot say for certain, but there is a possibility that it is BEST absorbed with dietary fat in the small intestine. I am unsure of the role that it would play in its absorption or whether being absorbed in the oral mucosa would be difficult because of this.

I think sublingual capillary beds have a first pass through the liver, but they MAY not be. Keep in mind finasteride is metabolized exclusively by the liver (which is why I don't take pills on days I plan to drink). The dosage for any per oral medication is calculated based on a first-pass effect.

I don't think the doses for finasteride (either Proscar or Propecia) were "calculated" per se, I'm sure those decisions were simply based on the results of empirical trials done with varying doses of finasteride.

Again, I don't know if finasteride participates in packaging into chylomicrons or if it is pulled into lacteals... if that is the case then it bypasses the first pass. It's just too much speculation for me to be comfortable with recommending chewing as I am not sure that the only reasoning behind swallowing the pill whole is dogma.

I realize now that I _may_ have inadvertently misled you into thinking something I didn't really mean to imply: I'm not recommending that everybody chew-up their drugs and supplements for the specific purpose of enhancing their absorption through the oral tissues. I'm just recommending doing that to enhance their absorption through the NORMAL mechanism of digestion, and minimize the possibility of having them pass all the way through completely unabsorbed, as it did with my mother.

Was the pill that passed through the woman you discussed in a capsule or was it just a coated tablet?

It was a tablet. Don't know if it was "coated".

 

[medmax84]

I don't know why people would take oral B12 anyway. Can't you get monthly B12 shots and just bypass that whole problem? I guess some people are wary of needles/have to pay a copay everytime they go to the Doctor... oops just answered my own question. :crazy:

Is it alarming to you how little is known about the long-term action of this drug in the body? It's alarming to me that the impetus for money was so great that they created a DHT reducer without fully understanding the systemic role of DHT in adults. They released the drug after a 2-year trial, correct? Seems a little irresponsible to me. They got lucky that the picture continued to improve after 5.

Anyway, I have no way of knowing whether your advice is good or bad about chewing the tabs. I'd be willing to bet it makes a negligible difference either way (chewing or swallowing whole). The arguments for and against appear sound.

To further the discussion (I think you have shared some valuable information), I do know that some drugs are slightly caustic to the mucosa in the mouth and esophagus, and that the coating on pill tabs and capsules are designed to protect from this effect in addition to their role of preventing disintegration until further down the GI. If he is having trouble with mild esophagitis secondary to swallowing his pill with an inadequate amount of water (I haven't read that finasteride itself is caustic) chewing the tab is probably well-tolerated but my personal recommendation is to attempt swallowing it with more water.

I WOULD NOT suggest chewing all tabs unless you know that they are 1. NOT time-released (you mentioned this, too, Bryan) and 2. NOT caustic to the upper GI.

Good discussion, Bryan. Hope you didn't get frustrated with me for voicing opposition. I actually think between the two of us, we can offer some great medical (BUT UNOFFICIAL - GO TO YOUR Doctor) advice on these boards. Thanks for humoring some of my speculation.

PS I can't believe that happened to your mother. That would be ridiculously irritating to me. Maybe it was just a freak occurence and the pill got engulfed by a bolus of food at some point...?

 

[Bryan]

PS I can't believe that happened to your mother. That would be ridiculously irritating to me. Maybe it was just a freak occurence and the pill got engulfed by a bolus of food at some point...?

I wish I knew exactly how that happened, too, and how rare (or common) it really is. Who knows how many other times it may have happened to her before that she didn't notice, and how many times it may happen to other people? But in any event, I consider that to have been a very lucky, very serendipitous observation on her part. And adding in the findings of that California doctor makes it even more obvious to me that there's a simple and obvious way to help the problem: just chew-up all your supplements and drugs, unless there's a specific and compelling reason not to do so.

 

[adam_uk]

i wish to know what actualy happends to my Propecia tablet when i swallow it? I have tested a few pills and they seem to break down as soon as they touch fluide? how long does it take to reach my stomach?If i spit after taking the pill is there a chance some of the pill will come out of me? Can a pill get stuck in my throat? is this possible or am i just thinking it, when it could just be my tonsals?

thanks for reading my posts chaps! unk:

 

[Nathaniel]

i wish to know what actualy happends to my Propecia tablet when i swallow it? I have tested a few pills and they seem to break down as soon as they touch fluide?

Once you swallow it, it will get digested and absorbed just like anything else you eat. If you use proscar (i.e. the coating is gone in some areas of the fragmented pill) as soon as it comes in contact with the saliva in your mouth it pretty much dissolves. Not so for propecia or finpecia since they still have the coating when putting it in your mouth.

If i spit after taking the pill is there a chance some of the pill will come out of me?

Yes specially if you are dealing with fragmented finasteride (proscar or chewed propecia) and if you do it immediately after swallowing. Some finasteride mixed with saliva will be wasted. So spitting or brushing your teeth right after is probably not a good idea.

Can a pill get stuck in my throat? is this possible or am i just thinking it, when it could just be my tonsals?

It depends on your technique. With finasteride, pills are so small and with proscar the fragments are even smaller. You shouldn't have a problem if you take it with water. You won't choke to death, you'll feel a bitter sensation in your throat if it rubs hard against it (I have this happen when I didn't drink enough water).