Consumer medication safety: Crushing oral medications not always a good idea.

Mortar, Pestle... Hold the Crushed Meds.

People crush their tablets or open their capsules and crush the contents for a multitude of reasons; an upset stomach, bad taste, presence of a feeding tube, bariatric surgery or lap band placement, etc, etc.  It is important to be aware however, that unintended consequences ranging from the benign to mildly irritating to extremely dangerous side effects could result if one chooses to crush a medication without first determining the safety impact of doing so.  As with all medical or pharmaceutical questions, one should consult one’s doctor, nurse practitioner or pharmacist for the best advice, and follow up by verifying the information provided by researching the answer at a reputable online or published resource.

During the quarter of the twentieth century, many pharmaceutical manufacturers were able to formulate medications which were previously dosed multiple times a day in a manner that supported once daily dosing.  An example is the drug Theophylline, used for respiratory conditions such as COPD.   Many drugs can be taken once a day because the tablet/capsule is either designed to break down slowly and release the active ingredient through tiny microspheres or beads, or are coated so that they do not release the active ingredient in the stomach, where they might cause undue irritation of the stomach lining or where they could be inactivated by stomach acid.

If either of these types of medications are crushed and swallowed, there is the potential of the following occuring:

1) A larger than intended dose being absorbed by the body over a short amount of time due to the slow release feature of the drug becoming inactivated

2) The enteric coating being inactivated by crushing resulting in the active ingredient being neutralized by stomach acid and losing potency.  Other medications may form unintended chemical entities by binding with stomach acid.

3) The active ingredient could be released into the stomach and irritate the stomach lining, resulting in irritation or ulcers.

A good rule of thumb for consumers is that if a medication trade name has the suffix XL, XR, LA, SR, SA, CD, LA or EC, be sure to find out whether it is acceptable to crush the medication prior to taking it.

Further information can be found at the following locations (note that links will open in a separate browser window):

1) ISMP’s Do Not Crush List

2) To Crush or Not to Crush.  The Hospitalist, April 2009

3) Medications that should not be crushed.  Med-Pass

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