Crushing your tablet -a smart hack or a dangerous move?

“The tablet was too big for me to swallow, so I just crushed it into a powder and drank it with water.”

How many of you can relate to this? Are you someone with dysphagia (fear of swallowing)? What tablets are safe to crush and which ones are not? Read till the end to know more.

According to a survey, nearly 40% of adults have difficulty swallowing tablets as a whole.

Can we crush medicines? Why this question matters

We normally chew food before we swallow it. But when it comes to medicines, we have to surpass the chewing part and directly swallow the tablet as a whole. A lot of us have experienced not being able to swallow a whole tablet at one point. Why does this happen?

1. They could have a fear of choking. Anxiety can make the throat tighten.
2. They could have a dry mouth- less lubrication makes swallowing harder
3. They may have some medical conditions, like a stroke, that may affect their ability to swallow.
   

To solve this problem, many of us try to crush the medicine or split it into smaller bits so it is easier to swallow. Some even incorporate it with soft fruits like bananas. This could result in patient noncompliance and thereby reduce the efficacy of the drug.

But, is this a safe option?

Not all pills are created equal.

Tablets or capsules come in different shapes, colors, and sizes. They are designed that way to control how and where the drug works in your body. Any given tablet available in the market contains one or more active ingredients, which are the main component of the drug. In addition to them, the tablets also contain inactive ingredients like coating materials, flavorings, dyes, and binders that hold the capsules together. The final product is designed in such a way that the active ingredients are released at a specific rate and in a specific location within the digestive tract.

Some uncoated immediate-release tablets are designed to disintegrate quickly in the stomach and release the active ingredients into the bloodstream. In such cases, the active ingredient must be able to withstand the stomach acid before they are absorbed.

For some other drugs involving active ingredients that would be broken down by the stomach acid, they have designed tablets and capsules with acid-resistant coatings or enteric coatings. These tablets will dissolve only when they reach the small intestine.

Some drugs are designed in such a way that they release their active ingredients even more slowly, over 12-24 hours. This sustained release concept is more convenient to a patient as the once or twice daily dosing and minimizes the variation in the amount of drug in the blood. This can improve patient compliance and drug effectiveness.

What tablets can you safely crush or split?

1. Immediate release tablets- they are designed to release the active ingredient quickly. Hence, it is safe to crush. These include pain relievers, antihistamines, and blood pressure medications.
2. Chewable tablets- they are designed to be broken down in the mouth, so it is safe to crush them or even mix with food and liquid if the patient cannot swallow them.
3. Uncoated tablets- coated tablets are generally designed that way for a reason. So, it is safe to crush them.
   

Meds that shouldn’t be crushed

1. Extended release tablets- they are designed to release the active ingredient over an extended period. Crushing them makes them lose their efficacy.
2. Enteric-coated tablets- these tablets have coatings that prevent them from being destroyed by the stomach acid. Crushing them removes the enteric coating, and the drug is destroyed by the stomach acid before the active ingredient is released into the bloodstream.
3. Capsules with beads are granules- they are slow-release tablets, so crushing them will result in an overdose of the active ingredient in the blood, making it ineffective.
4. Special medications that are meant to be placed under the tongue cannot be crushed as it interferes with the process.
5. Medications with specific coatings- the film coating is there to reduce side effects, improve absorption, and protect the stomach. Crushing them will make them lose their property.
   

The risks of doing it wrong

1. It could irritate the stomach lining
2. Could result in ulcerations
3. Drug instability
4. Changes in bioavailability
5. Some drugs even pose a higher risk of stroke or heart attack
   

Better alternatives if you cannot swallow

1. You can ask your pharmacist if they have a smaller dose, so it is easier to swallow.
2. If the pill is safe to be crushed, you can mix it with water or even add a little sweetening substance if it is ok to do so.
3. If it has to be swallowed whole, you can try incorporating it in soft liquids like apple sauce. It is better to avoid taking drugs along with hot liquids, as the heat may damage the drug.
4. In worst cases, you can check if the medication is available in the form of an injection.
   

Take-home message

A lot of us find it difficult to swallow tablets. And to cope with that, we try to crush it or split it so it is easier to consume. But not all drugs can be made safe after crushing. The safer move- Always ask the pharmacist before you alter the medicine. You can also check the SMPC of that particular drug.

Stay informed, Stay safe, Stay healthy.