Crushing certain pills to ease swallowing can prove dangerous

One of the most common questions consumers ask in regards to medications is whether or not a certain pill can be chewed or crushed. Queries usually arise when a patient has trouble swallowing pills or when kids complain taste is unpleasant and moms want to mix the medication with jelly or some other food or beverage to make it easier to go down. It is estimated that 60% of elderly people have trouble swallowing medication. So this is a frequent problem for seniors, who happen to take most of the chronic medications. In hospitals, nurses sometimes ask us about crushing medicines so they can mix it for patients with feeding tubes.

Several years ago we heard from the family of an 83 year-old patient who was given Cardizem CD for blood pressure control. This is a specially formulated tablet that releases an entire day’s supply of medication over a 24-hour period, so you take it once daily. However, because the capsule was too large for the woman to swallow, the patient chewed the tablet.

Shortly after therapy began, the patient complained of feeling dizzy, weak, listless, and lethargic. Without realizing it, she was releasing the medication in the tablet all at once and it was being absorbed in her body causing dangerously high blood levels. The patient’s son measured her pulse at only 40 beats per minute on two occasions since blood levels of the drug that are too high can slow the heart. Although her son called the doctor and he did eventually change her medicine to immediate release tablets which she was able to swallow, the doctor accidentally prescribed the long acting form when she returned months later for a check-up. This was dispensed by an unsuspecting pharmacist and once again the patient began chewing the tablet, this time with fatal results according to the son.

The family was unaware that the product’s labeling contains this statement: “Take this medication by mouth with or without food, usually once daily or as directed by your doctor. Swallow the capsules whole. Do not crush or chew the capsules. Doing so can release the entire drug at once and may increase your risk of side effects.”

Some medicines are prepared using special coatings or other properties 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.

Health professionals should be screening patients about to be placed on long acting oral dosage forms and include consideration of capsule or tablet size and past history of swallowing problems. Pharmacists should be adding auxiliary warning labels to the prescription container labeling to reinforce that the pills must always be swallowed whole. But it’s important for consumers to be aware of this potential problem too.

Do some homework before crushing or chewing pills. My advice is never to do this at all unless your doctor or pharmacist or another healthcare professional is specifically aware that it’s OK to do so by reading product labeling or at least checking our list of medicines that should never be crushed. While this list is accurate as of April, 2011, it may not be complete. So always check with a health professional and/or the product labeling.

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). We wrote to all of the drug companies to prepare a list of medications with suffixes like these and what the abbreviation means. Not all of the companies responded, so the list is not complete. Also, other letters may be used to mean gradual release, and some pills that should not be crushed or chewed may not have any letters at the end of their names.

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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