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Nov 16, 2022

Everyday Health

Why Can't I Crush or Split Certain Pills?

Why Would I Want to Split or Crush My Medication?

Have you ever crushed your pills to make it easier to swallow? Crushing the medication into powder may seem like the easiest way to take the medication. Certain medications can be crushed and mixed into something like applesauce to avoid difficulty swallowing while also making the medication more palatable.

However, for medications with special coatings, crushing the tablets can make the medication ineffective or even dangerous for you. It also leads to a loss of medication throughout the process of crushing and mixing that can lead to unsafe variations in dosage. If you find swallowing a medication difficult, speak with your healthcare provider (HCP) about possible options to make the medication administration as easy as possible.

Another common thing people do is splitting a tablet into halves. Your doctor has reduced your dose by half, and you have leftover medication. In this case you might be tempted to just split the medication into two new doses. Even though it can be cost effective, the medication itself may then be less effective and even possibly dangerous when split. In addition, the split is never an accurate 50/50 and therefore this makes the dosage unequal day to day. Therefore, speak to your HCP about before making any alteration to your medication regime.

Different Types of Pills

Before we discuss which pills shouldn't be crushed or split let's talk about different types of medication. “Pill” medications come in multiple forms but can be easily divided into “tablets” and “capsules”.

Tablets

Tablets are medication forms that are created by compressing a mixture of powders, both active drug ingredients and other filler ingredients into a variety of shapes and colours.

  • Immediate release tablets

    These tablets are the simplest, with all medication components getting released relatively quickly after ingestion. They dissolve in a similar way to a sugar cube; the contents are relatively uniform and therefore dissolve in a linear fashion as the liquid of your digestive system touches each newly exposed portion of the tablet it dissolves.

  • Extended-release tablets

    These medications are formulated in such a way as to ensure that the drug gets released from the tablet very slowly over time. This allows the medication to reach a steady concentration in your body and have this concentration be maintained by the slow release of medication.

  • Enteric coated tablets

    These kinds of tablets have a special coating that stops them from dissolving in your stomach. This is necessary for three main situations: (1) when a medication would get destroyed in the acidic environment of the stomach, (2) when the stomach would get irritated by the contents of a medication, or (3) when a medication needs to be released into a specific section in your digestive system following the stomach.

Capsules

Capsules are medications composed of an outer shell enclosing the inner medication. The medication inside can be in a number of formations, including liquid and powder. This is an effective way of getting this liquid or powder directly into your stomach using the outer shell as a vehicle.

Which Medications Cannot Be Split or Crushed?

Extended-Release Medications

Extended-release medications are formulated in such a way that the medication gets released at a consistent rate for a longer period of time. If split or crushed, the particular formulation is disrupted. Instead of the medication being released at a low but constant concentration, it would then be released all at once. This could lead to a toxic amount of the medication in your body all at once which is dangerous. The medication concentration will then wear off rapidly, leaving you without a therapeutic concentration of medication in your body until the next dose.

Enteric-Coated Medications

Enteric coated medications are another example of a medication that should not be split or crushed based on its specific formulation. The coating on the outside of the medication is required to be intact in order to transport the medication through the contents of the stomach and to the rest of the digestive system past the stomach. Breaking this barrier could cause damage to the medication, damage to your stomach, or could cause the medication to be released too soon. If the medication is released too soon in the digestive system, it may not reach its target and therefore may not work properly.

Tablets with Sensitive Dosages

Some medications are very specific in their dosages, while others have some “wiggle room”. For example, 250 mg and 255 mg of acetaminophen do not have any major therapeutic or safety differences in a normal healthy adult. In contrast, for certain medications such as carbamazepine (anti-seizure drug), something like a small 5 mg can make a huge therapeutic difference. Epilepsy has to be controlled very carefully and the dose of anti-seizure medication is very specific for each individual patient. Even minute differences in daily dosage can lead to a lack of effective therapy and potentially trigger a seizure.

When you split a tablet in half, you lose tiny particles of the medication. Even if it looks like the split was relatively precise, there are tiny bits of the medication lost that then changes your precise dosage. This is even more pronounced when you crush the tablets, as much more of the medication is lost on the utensil used for crushing as well as in the bowl and in transfer to your mouth. This minute change in dosage can therefore be detrimental for medications like anti-seizure drugs, as the dosage needs to be so specific. If you or someone you are caring for is struggling to take their medication whole, it is therefore essential for you to speak with your HCP about getting a different dosage form to ensure safe and effective drug management.

Capsules

There are also various concerns when it comes to opening capsules. Opening a capsule of a medication that has a narrow dosage range will lead to loss of medication and therefore an altered dose which can lead to severe dangers in certain medical conditions, as previously discussed.

Another major reason to avoid opening a capsule is to prevent exposing the contents to the atmosphere. This could potentially cause damage or changes to the medication and its safety and/or effectiveness. Some drugs may react with light, moisture, or oxygen that either lead to loss of active ingredient or even lead to a reaction that results in toxic results. It is therefore best to keep capsules whole to avoid any dangerous effects.

What Can I Do If My Medication Can’t Be Split, But I Struggle to Swallow it Whole?

Speak with your healthcare provider! If you are struggling to take your medication whole and feel as though you would benefit different formulation, that is something a doctor or pharmacist can assist you with. Splitting or crushing a medication that should not be split or crushed is not the solution, as it not only may make your medication ineffective but also could be very dangerous to you. There are many alternatives available, such as liquid solutions or suspensions of medications that can make swallowing easier in a safe way.

References:

  1. Crushing tablets and opening capsules – what can go wrong? - Veterinary Prescriber. (2022). Retrieved 18 September 2022, from https://www.veterinaryprescriber.org

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