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​WHY CRUSHING YOUR PILLS
CAN HARM YOU

Crushing pills: why the 'simpler way' may not be the 'best way'

 

If you find it difficult to swallow pills, fret not – you are not the only one. Some would delay or skip a dose, or even stop taking their medication completely because they have problems swallowing pills. Some might take the easier way out: crush a tablet or open the capsule to make swallowing the medication easier.


However, this 'simpler way' might not be as safe as you think. Ms Ng Xin Hui, pharmacist at SKH, says crushing tablets or opening capsules inappropriately may have serious consequences.


"It can change how your body processes and responds to the medication, prevent it from working properly, or cause serious side effects." She adds that for some medications which require special handling, crushing the tablet or opening the capsule may be harmful to the person handling it. If inhaled, the powder or particles from these medications might be toxic to the body.


The best way to find out if a medication can be crushed is to refer to the label. A 'Swallow whole, do not crush' warning will usually be indicated. You can also check the information leaflet that comes with your medication, if available, under the "Administration" section.

Some medication may also react adversely to certain foods and liquids, so always check with your pharmacist before mixing them. If popping pills is really a challenge, Ms Ng recommends some head posture techniques or asking your pharmacist for an alternative form of the mediation, such as syrup, chewable, or rapidly-dissolving tablets.


Sometimes, simply relaxing works too. "One study showed that those who took a deep breath before taking the pill were able to minimise their gag reflex."

 

While it's not always possible to tell if a tablet can be crushed, those that must be taken whole usually fall into these categories:


Modified-release

Medication that has been modified so it is released slowly and does not have to be taken so frequently. Crushing it can result in the full dose of medication being released too quickly, causing more side effects. Common suffixes in their names include XL, SR, CR, LA, XR, MR.

Examples: Nifedipine LA 60mg tablet, Alfuzosin HCl XL 10mg tablet, Diclofenac SR 75mg tablet


Enteric-coated

Enteric coating is a layer of protection placed around the medication to protect the stomach from the medication which can be irritating, to protect the medication from the acidic environment, or to deliver the drug as a whole to the site of absorption. EN and EC are usually in the medication name.

Examples: Aspirin 100mg tablet, Diclofenac EC 25mg tablet, Omeprazole 20mg capsule (enteric coated pellets within capsule)


Sugar-coated or film-coated

Sugar or film coating improves tolerability and makes it easier to swallow. Crushing it may make it taste unpleasant and hence, patients may choose not to complete the course of medication or follow its specific instructions.

Example: Ibuprofen 200mg tablet


Sublingual or effervescent

Sublingual tablets are placed under the tongue to be diffused into the tissue while effervescent tablets dissolve in water. These medications should not be crushed because it will decrease their effectiveness.

Examples: Acetylcysteine 600mg tablet, Glyceryl trinitrate 500mcg sublingual tablet
 


"Hazardous" medication

As these medications require special handling, crushing of these medications is not recommended.

Examples: Azathioprine 50mg tablet, Methotrexate 2.5mg tablet

 

Difficulty swallowing your pills? 

Try these techniques suggested by the Annals of Family Medicine medical journal.

 

Bottle method for tablets

1. Fill a flexible or soft plastic water bottle with water.

2. Put the tablet on your tongue and close your lips tightly around the opening of the bottle.

3. Take a drink from the bottle, keeping contact between the bottle and your lips by pursing your lips and using a sucking motion. Swallow the water and the pill right away.

4. Do not let air get into the bottle as you swallow. You should feel the bottle squeeze in on itself as you swallow, helping you take the tablet easier.


 

 

Lean-forward technique for capsules

1. Put the capsule on your tongue.

2. Take a medium sip of water, but do not swallow yet.

3. Bend your head forward by tilting your chin slightly toward your chest.

4. Swallow the capsule and the water with your head bent forward.