A recent study from the University of Queensland noted that almost half of the respondents were unaware of any potential dangers of crushing tablets of their medications.
Furthermore, they found that people taking more than 4 doses of medication per day were more likely to open capsules and/or crush tablets. Rarely, if ever, was a pharmacist or other healthcare provider, consulted. Instead, the patient sought counsel from family and friends.
As a senior care pharmacist, I find the results of this study both alarmingly and scary. Medications should be never be opened or crushed without consulting a pharmacist first.
The dosage form of a medication (tablet, capsule, liquid, etc.) and the design of tablets/capsules are a major factor in determining how quickly the medication delivers its desired effect and at what spot in our body the medication will dissolve.
Some tablets are designed to release their medication over an extended period of time (8 to 12 hours). Over the counter products of this type are generally labeled as “long-acting”, “sustained-released”, or “extended-release”. Prescription medications, though, do not always contain these buzz words. The pain medications, MS Contin and Oxycontin, are two examples of long-acting preparations.
Crushing or opening long-acting preparations results in a “dumping” or an immediate release of the entire dose of a medication into a person’s system. Worse-case scenario, this results in an overdose of the medication. It can also lead to many unwarranted side effects.
Some medications are irritating to the stomach lining. Aspirin is an example of this type of medication. People that cannot tolerate the stomach irritation of aspirin or are at risk for stomach ulcers, are told to take enteric coated preparations. Enteric coating of tablets allows the tablet to pass through the stomach and into the small intestine to be absorbed. Crushing of this type of tablet negates the effect of the enteric coating resulting in the medication being absorbed in the stomach. The exact place it was designed to avoid!
As we age, swallowing difficulties become more common. A multi-disciplinary health care approach should be utilized to develop a medication strategy when patients are no longer able to swallow their medications as easily as they did in the past.
Each medication in a person’s medication regimen needs to be examined, individually. Some medications may be able to be crushed, some may need to be changed to a liquid preparation, and some may need to be changed to an entirely different medication.
A senior care pharmacist, such as those at Our Personal Pharmacist, is able to work with caregivers and patients to determine the approach that is best for you or your loved one.
A PDF of medications that should not be crushed are listed at www.ismp.org/tools.