Friday, July 3, 2015

Is it safe to crush pills to make them easier to swallow?

A question sent to us by a reader gives me the opportunity to discuss when it is safe to crush a pill. 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? Or can she chew them?" It depends on what her mother is taking.

Is it safe to crush pills to make them easier to swallow?



Most pills you need to swallow are available commercially in the dosage strengths commonly prescribed for patients. Or, if need be, a liquid or suspension might be available.  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 to us by a reader gives me 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? Or can she chew them?”

It depends on what her mother is taking. Some medicines are specially prepared to deliver the medicine to your body slowly, over time. If these pills are crushed or chewed, or the capsules are opened before swallowing, the medicine may go into the body too fast, which can cause harm.

In one report sent to us, an 83 year-old woman was taking Cardizem CD (diltiazem) for high blood pressure. The capsule was too large to swallow so she chewed it. Soon after she swallowed the medicine she became weak, had a very slow heartbeat, and had to be hospitalized. Cardizem CD is one of a long list of drugs designed to release drug slowly over a 24-hour period. Chewing it breaks down the formulation, causing unintended absorption all at once. This leads to blood levels that are too high, which may be intolerable to some.

In other cases, medications may have special coatings to protect your stomach or delay absorption until the drug gets into your intestines, so it won’t be destroyed by stomach acids.  Breaking these tablets destroys the coating, so again you might absorb the medicine too fast or make it ineffective.  Or you could be inviting undue nausea and vomiting.

Often, you can identify drugs that should never be crushed just by looking at the name. Many gradual-release medicines have names that end with:

CD - controlled dose

SR - sustained release

CR - controlled release

TD - time delayed

ER - extended release

TR - time released

LA - long acting

XL - extended release

SA - sustained action

XR - extended release.

Beware though! Other letters may be used to mean gradual release or may indicate some other property of the drug. In fact, some pills that should not be crushed or chewed may not have any letters at the end of their names. We do have a tool on our website that lists drugs that should never be crushed (or split in two or more pieces). You can find it here.

Call your pharmacist or doctor to learn the best way to handle these situations. Tell them about difficulties with swallowing the pills. As above, there may very well be a liquid form or another medicine that can be crushed safely, or even a different pill that is smaller. One thing is certain: Never crush or chew medicines before finding out if it's safe!

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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
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