Tuesday, June 30, 2015

Certain medicines should never be crushed or chewed

If you or someone you are caring for has trouble swallowing their pills, be sure to check with your health professional before crushing or splitting them.

Certain medicines should never be crushed or chewed

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If you or someone you are caring for has trouble swallowing their pills, be sure to check with your health professional before crushing or splitting them.

It’s not just about bad taste.

In some cases the medicine is coated so it won’t be released in your stomach where it may cause irritation. In other cases medicines special coatings or other properties are used to deliver the medicine to your body slowly, over time. This is more convenient than having to take a drug several times a day, but if these pills are crushed or chewed, the way they are supposed to work will be destroyed and the medicine may go into the body too fast. If that happens, then a large amount of the medicine will be released all at once, which could cause side effects or serious harm.

Many of the long-acting medications have drug names that end with a two-letter suffix. For example, CD (controlled dosing), SR (sustained release), LA (long-acting), XR (extended release). A partial list of drugs with suffixes and product characteristics is on our website.

In one case reported to us an elderly patient was given a prescription for Cardizem CD to treat high blood pressure. This is a specially formulated medication that releases an entire day’s supply of the medication slowly over a 24-hour period. You’re supposed to take it just once a day. However, in this case, the pill was too large for the woman to swallow, so she chewed it. She soon complained of feeling dizzy, weak, listless, and lethargic. Without realizing it, chewing it caused the drug to be released all at once, causing dangerously high blood levels which, according to her doctor, contributed to her death.

Never crush any medicines unless your doctor or pharmacist or another healthcare professional specifically tells you that it’s OK to do so. Also, check our list of medicines that should never be crushed. While the list is accurate as of April, it may not be complete. So always check with a health professional and/or the product labeling.

Take note of any additional labels or warnings on containers of non-prescription and prescription medicines. Look for warnings that advise against crushing, splitting, or chewing the medicine. Examples of the types of medicines that should not be crushed, split, or chewed include products that are "controlled", "sustained", "prolonged", or "extended" release and medicines that are "enteric coated.” When dispensing a medicine that shouldn’t be crushed, your pharmacist should be placing a sticker on the container to warn against it. It looks like this:

If you or someone you are caring for has trouble swallowing their pills, be sure to check with your health professional. In many cases there may be another form of a needed medicine that can be crushed, or a different pill that is smaller. There may also be a liquid forms, patches, or some other dosage form that can be used as an alternative. But don't ever crush or chew medicines before finding out if it's safe!


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President, Institute for Safe Medication Practices
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Check Up covers regional health news and a wide array of healthcare topics from pharmaceutical happenings to patient safety. Read about some of our bloggers here.

Portions of this blog may also be found in the Inquirer's Sunday Health Section.

Michael R. Cohen, R.Ph. President, Institute for Safe Medication Practices
Daniel R. Hoffman, Ph.D. President, Pharmaceutical Business Research Associates
Hooman Noorchashm, M.D., Ph.D. Cardiothoracic surgeon in the Philadelphia area
Amy J. Reed, M.D., Ph.D. Anesthesiologist and Surgical Intensivist in the Philadelphia Area
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