This design can improve patient compliance and drug effectiveness while decreasing the risk of adverse effects. Crushing a tablet, opening a capsule or chewing either of these can circumvent many of the protective design features intended to control when and where a drug is released in the digestive tract. Depending on the drug, this can result in overdosing, underdosing or direct toxic injury to the lining of the mouth, stomach or intestines.
The Prescrire International review highlighted examples of each of these potentially dangerous circumstances for several commonly used drugs. For some drugs, crushing, chewing or opening a tablet or capsule before swallowing can cause the rapid absorption of a large amount of the drug, potentially resulting in an overdose. Digoxin is approved by the Food and Drug Administration FDA to treat heart failure and to slow the heart rate in patients who develop atrial fibrillation, a common abnormal heart rhythm characterized by an irregular and often rapid heart rate.
According to the authors of the Prescrire International review, crushing digoxin tablets before swallowing may increase the risk of other dangerous abnormal heart rhythms. Likewise, the authors noted that opening capsules containing the oral anticoagulant dabigatran PRADAXA will increase the amount of drug that is absorbed, exposing the patient to a greater risk of serious bleeding.
Sustained-release drugs also should not be crushed or chewed before swallowing because doing so will cause the dangerously rapid absorption of a large dose that was intended to be released slowly over many hours. See text box, below , for stories of patients who have been seriously harmed or killed after ingesting tablets that were chewed or crushed. Here are just a few examples published in the medical literature of patients who have been injured or have died after ingesting a sustained-release drug that was chewed or crushed:.
In contrast to the prior examples, for some drugs, crushing tablets, opening capsules or chewing either of these before ingestion can result in patients receiving an insufficient dose of the active ingredient. This occurs commonly with medications that have an enteric coating, designed to protect the active ingredient from being destroyed as the tablet or capsule passes through the stomach.
The authors of the Prescrire International review referenced a case of a year-old man who had severe heartburn. He was diagnosed with severe gastroesophageal reflux disease. His doctor prescribed the proton pump inhibitor omeprazole twice daily. The omeprazole tablets were crushed before being administered via a tube placed in his stomach. Crushing the tablets likely compromised the integrity of their coating, allowing the stomach acid to inactivate the omeprazole, thus rendering the drug ineffective.
Omeprazole also is available over the counter OTC. Finally, the authors of the Prescrire International review reported that some medications have a coating that is intended to prevent the active ingredients from causing ulcers and tissue injury in the mouth, stomach or intestines.
For example, crushing certain iron supplements available in tablet form can cause ulcers in the mouth due to exposure to the iron.
When taking a prescription drug, you should never crush a tablet, open a capsule or chew either without first asking the prescribing health care provider or dispensing pharmacist whether it is safe to do so.
Carefully adhere to such instructions. If you have difficulty swallowing pills and there aren't alternatives like syrups, crushing pills may be a reasonable option.
However, not every pill can be crushed as it may affect the absorption of the drug and decrease its intended effect. If a pill can be crushed, there is a right way and wrong way of doing this. Here is a primer that can help. Not every pill can be crushed. There are times when doing so can decrease the drug's effectiveness or increase the risk of side effects and overdosing. The types of pills below should not be crushed. Enteric-coated drugs should never be crushed, broken, or chewed.
The pills are coated to reduce stomach irritation. The special coating is gradually dissolved as it passes through the stomach so that the drug begins to be released as it passes into the intestine. Enteric-coated tablets often have "-EN" for enteric or "-EC" enteric-coated tagged at the end of the brand name. Some drugs are also enteric-coated to avoid teeth staining or to prevent stomach acids from destroying the drug. If not swallowed whole, these drugs may be less effective and more likely to cause side effects.
You can often tell that a pill is enteric-coated when it is has a slight sheen. If in doubt, call your pharmacist. Sustained-release drugs are similar to enteric-coated drugs in that they are meant to be absorbed slowly rather than all at once. These products typically have brand names that end with "-CR" controlled-release , "-DA" delayed-action , and "-ER" or "-XR" extended-release , among others.
Sustained-release medications are designed to deliver the drug over a long period of time. Crushing the pill causes the drug to be released all at once. This reduces its effectiveness as the drug concentration will be high at first and then drop quickly so that there is no more left in the body.
The initial high levels can also increase the risk or severity of side effects. You should never crush narcotics , also known as opioids. These drugs have a high potential for drug addiction and are designed to be released at a controlled, steady rate. The rapid release of opioids in the bloodstream can intensify the effects of the drug, including pain relief and feelings of euphoria. This can increase the risk of a drug overdose. It can also increase the risk of addiction as the body becomes accustomed to the rapid burst of the drug and requires more and more to achieve the same effects.
Some of the more commonly prescribed opioids include:. Not all pills can be crushed. These include pills that are enteric-coated or sustained-release. Opioid drugs especially should never be crushed as it increase the risk of addiction and overdose. Please enter your name here. You have entered an incorrect email address! Recent Posts. Udomoh Eshemokha - November 11, 0. How to check blood sugar at home naturally Udomoh Eshemokha - November 11, 0. Udomoh Eshemokha - November 10, 0.
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Contact us: [email protected]. Can Andrew liver salt remove early pregnancy? January 6, Health Benefits of ginger, garlic, turmeric and cloves combo plus Side June 5, But this is not always the case. Occasionally, the exact dose of medication you need is not available commercially, so part of a tablet or capsule may be needed. As long as your doctor and pharmacist are on top of things, they'll know which drugs to prescribe in order to avoid these instances or at least which are OK to break up.
But what about situations where an elderly individual or child has trouble swallowing the exact dose? Or, what about situations where your child can't stand the taste. Usually, in either case, that still means breaking the tablet into smaller pieces or crushing it so it can be mixed with jelly.
How do you know when it's safe to do that? A question sent in by a reader gives us the opportunity to discuss this. The woman wrote: "My elderly mother has a hard time swallowing her medicine. Can I just crush her pills and mix them into her food?
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