Ghost Pills: A Case Report
Authors: Desiree M. Salanio, Rachel Taylor, Joel E.D. Stanton, Edward J. Wild
Journal: Annals of Internal Medicine (2017)

Letters18 April 2017Ghost Pills: A Case ReportDesiree M. Salanio, RN, MA, MSc, Rachel Taylor, RN, MSc, Joel E.D. Stanton, RN, BSc, and Edward J. Wild, MD, PhDDesiree M. Salanio, RN, MA, MScFrom University College London Hospitals NHS Foundation Trust and UCL Huntington's Disease Centre, London, United Kingdom.Search for more papers by this author, Rachel Taylor, RN, MScFrom University College London Hospitals NHS Foundation Trust and UCL Huntington's Disease Centre, London, United Kingdom.Search for more papers by this author, Joel E.D. Stanton, RN, BScFrom University College London Hospitals NHS Foundation Trust and UCL Huntington's Disease Centre, London, United Kingdom.Search for more papers by this author, and Edward J. Wild, MD, PhDFrom University College London Hospitals NHS Foundation Trust and UCL Huntington's Disease Centre, London, United Kingdom.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0376 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Some sustained-release formulations of oral medications are not fully digested.Purpose: To alert clinicians to the concerns of some patients and caregivers about these medications.Case Report: We prescribed sustained-release venlafaxine (Venlalic XL, Ethypharm), 75 mg/d, for depression and anxiety in a 71-year-old man with Huntington disease. His caregiver expressed concern that the patient excreted the pills undigested in his stool. She intrepidly isolated 1 pill and brought it to the clinic. Examination revealed an undigested pill casing resembling a fresh pill with a small hole through which the drug is designed to leach slowly (Figure, left). Unlike a ...References1. Anderson DT, Fritz KL, Muto JJ. Oxycontin: the concept of a “ghost pill” and the postmortem tissue distribution of oxycodone in 36 cases. J Anal Toxicol. 2002;26:448-59. [PMID: 12422999] CrossrefMedlineGoogle Scholar2. Tungaraza TE, Talapan-Manikoth P, Jenkins R. Curse of the ghost pills: the role of oral controlled-release formulations in the passage of empty intact shells in faeces. Two case reports and a literature review relevant to psychiatry. Ther Adv Drug Saf. 2013;4:63-71. [PMID: 25083252] doi:10.1177/2042098612474681 CrossrefMedlineGoogle Scholar3. Tungaraza TE, Talapan-Manikoth P, Eboka YM, Mahmood N, Bains SK, Sihota K. Ghost pill: knowledge and awareness of this phenomenon among health care professionals. Int J Basic Clin Pharmacol. 2014;3:602-7. doi:10.5455/2319-2003.ijbcp20140803 CrossrefGoogle Scholar4. Sun D, Wen H, Externbrink A, Gao Z, Keire D, Krauss G, et al. Ghost-pill-buster: a case study of intact levetiracetam extended-release tablets after dissolution testing. CNS Drugs. 2016;30:455-60. [PMID: 27048352] doi:10.1007/s40263-016-0332-9 CrossrefMedlineGoogle Scholar5. Therapeutic Research Center. Ghosts of tablets passed. 2013. Accessed at www.primetimehealthplan.com/Handlers/FormHandler.ashx?intFormId=783 on 4 November 2016. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University College London Hospitals NHS Foundation Trust and UCL Huntington's Disease Centre, London, United Kingdom.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L16-0376.This article was published at Annals.org on 4 April 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMorphine Sustained Release Tablets Becoming Ghost Pill: A Palliative Conundrum 18 April 2017Volume 166, Issue 8Page: 609KeywordsAnxietyCaregiversDisclosureDrugs ePublished: 4 April 2017 Issue Published: 18 April 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...