Information For Patients On The Dangers Of Tablet Crushing

Learn more about clinical consequences for crushing tablets or opening capsules.

“Don’t rush to crush”

For patients who have difficulty swallowing, a common solution is to crush tablets or open capsules. Before crushing a tablet or opening a capsule, it is better to consider and research the impact crushing a tablet may have on the drug’s effects. It is sometimes preferable to use a different dosage form, or a different active ingredient.^[1]

The clinical consequences for the patient of crushing tablets or opening capsules can mean that the drug is less effective or more likely to cause side effects. When crushing disrupts a drug’s sustained-release properties, the active ingredient is no longer released and absorbed gradually, resulting in overdose. When a gastro-resistant layer is destroyed by crushing, underdosing is likely.^[1]

The active ingredient released may degrade on contact with light, moisture or the food with which it is mixed for administration.^[1]

The person who crushes the tablets or opens the capsules is exposed to drug particles, which may cause side effects including allergies. In practice, there are many drugs that should never be crushed or opened.^[1]

Why you shouldn’t crush

A third of people find swallowing tablets tricky but grinding them up could do you more harm than good.^[2]

Whether your medication is prescribed by a doctor or bought over the counter (OTC), it always comes with guidance on how you should take it to make sure it’s safe and that it works.

You may be tempted to crush or grind up tablets, especially if you have problems swallowing them, but this isn’t always a good idea.^[2]

Medication is manufactured in a variety of formats, such as tablets, capsules, liquids or patches. These formulations have different purposes, such as slow-release or easy-swallow formulations and are rigorously tested for their safety and efficacy.^[2]

Easy-swallow formulations are usually available for those who have trouble with tablets, but can be pricey or have impractical storage requirements – such as needing to be kept in the fridge.^[2]

It can be tempting to crush some medications instead, but this could mean that the drug is less effective or more likely to cause side effects.^[2]

Here are some of the key reasons to take care before messing with your medications:^[2]

1. Some have a special protective coating

Although many drugs come in standard (or ‘immediate release’) tablets, others are specially coated to control whereabouts in the body the medication is activated and over what period of time.^[2]

• Enteric coatings (may have EN or EC at the end of the drug name). These stop the drug breaking down in the stomach, to protect either the stomach or the drug, or to enable it to be released further along the digestive process.^[2]
• Modified or prolonged release (may have XL, LA, SR or MR at the end of the drug name). These drugs – also known as extended release, slow release or controlled release – are steadily released, which means they don’t have to be taken so frequently.^[2]

It isn’t always possible to tell if a tablet or capsule has a special modification or coating just by looking at it. If you’re unsure, check the patient information leaflet or ask your pharmacist.

2. You could be risking an overdose

Crushing or splitting enteric-coated or modified-release medication risks too much of the drug being released into your bloodstream too soon.^[2]

Not only does this increase the risk of overdose and experiencing side effects, it also means there could be a period of time you won’t be benefiting from it at all.^[2]

‘For example, a long-lasting, slow-release painkiller might only work for eight of the 12 hours intended if you crush it up.^[2]

3. It might make the medication unstable

Some drugs are highly sensitive to environmental factors such as light, heat or moisture, which is why they are manufactured in a certain way.^[2]

4. It could put other people in danger

There are some medications that could represent a risk to whoever it is that crushes up or splits a tablet, especially if they are drugs that can be absorbed through the skin or inhaled.^[2]

What to do instead of crushing

Speak to your pharmacist to see if another version of your meds are available, such as a liquid, a dissolvable or chewable tablet or even a patch (if it’s prescribed, you may need to ask your GP to amend the prescription).^[2]

ROS000051-002 DOP September 2023