Capsule vs. Tablet & 'Salt Forms' Dispensing

The quick answer for tizanidine: Tablets and capsules are bioequivalent when given under fasting conditions, and under fed conditions, they are not.

What I do in retail: Dispense whatever, and keep it consistent. Depends on how much customer copay, pharmacy reimbursement, and/or customer preference.

The long answer from LexiComp:

Dosing: Adult
Spasticity: Oral: Initial: 2 mg up to 3 times daily (at 6- to 8-hour intervals) as needed; may titrate to optimal effect in 2-4 mg increments per dose (with a minimum of 1-4 days between dose increases); maximum: 36 mg daily. Note: Single doses >16 mg have not been studied.

Food: Food alters absorption profile relative to administration under fasting conditions. In addition, bioequivalence between capsules and tablets is altered by food; capsules and tablets are bioequivalent under fasting conditions, but not under nonfasting conditions.

The tablet and capsule dosage forms are not bioequivalent when administered with food. Food increases both the time to peak concentration and the extent of absorption for both the tablet and capsule. However, maximal concentrations of tizanidine achieved when administered with food were increased by 30% for the tablet, but decreased by 20% for the capsule. Under fed conditions, the capsule is approximately 80% bioavailable relative to the tablet. Management: Administer with or without food, but keep consistent.

Absorption: Tablets and capsules are bioequivalent under fasting conditions, but not under nonfasting conditions.
-Tablets administered with food: Peak plasma concentration is increased by ~30%; time to peak increased by 25 minutes; extent of absorption increased by ~30%.
-Capsules administered with food: Peak plasma concentration decreased by 20%; time to peak increased by 2-3 hours; extent of absorption increased by ~10%.
-Capsules opened and sprinkled on applesauce are not bioequivalent to administration of intact capsules under fasting conditions. Peak plasma concentration and AUC are increased by 15% to 20%; time to peak decreased by 15 minutes.

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Capsule vs. Tablet & 'Salt Forms' Dispensing