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Abstract Introduction Dysphagia is associated with long-term conditions including strokes, dementia, Parkinson’s disease and frailty. Dysphagia affects 30-40% of the population aged over 65-years-old. Adults with dysphagia are likely to experience long-term conditions requiring multiple medications (often >5) to manage this. The thickening of liquids is a common compensatory strategy in dysphagia management. Studies suggest that immersion in thickened liquids affects medicines’ solubility in vitro. Clinicians and pharmacists are unaware of the pharmacokinetic/therapeutic effects of thickened liquids on oral medicines. We conducted a systematic review of existing literature on thickeners’ effects on drug bioavailability. Methodology We performed a literature search of MEDLINE and EMBASE. Search terms included: dysphagia/thickened diet (EMBASE only)/ bioavailability or absorption of medicines or pharmacokinetics; excluded: NG feeds/animal studies. Studies included: all genders, countries, >18 years, community and hospital settings. PRISMA guidance was followed. Results 526 results were found and 15 articles identified following reference list review. Following abstract review, 508 were rejected. 33 received a full text review, 18 were rejected, and the remaining 15 included. Most articles evaluated the effect of thickeners on dissolution profiles of medications in-vitro. Few studies assessed bioavailability or used clinical outcome measures. Often these were small studies on limited numbers of medications. Conclusion Despite dysphagia and polypharmacy being common in older adults, little is known about the effects of altering liquid viscosity on the pharmacokinetics and therapeutic effect of most medications. Small single-centre studies suggest that immersion in thickener may negatively affect drug pharmacokinetics and therapeutic outcomes.
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