Tablet Crushing Issues

Many people struggle at times to take medicine because of swallowing difficulties. As a result people have often resorted to crushing tablets or opening capsules to allow them to take their medication (Preston & Morris, 2005).

What are the implications of tablet crushing or opening capsules?

Crushing tablets or opening capsules can cause a major change to how your medicine works. 

Tablets and capsules come in many different forms. Some are designed to be released over several hours, others have special coatings to protect your stomach or to protect the active ingredient from the stomach acid. It might not always be easy for you to tell if it is safe for you to crush your medicine.

If a tablet is crushed or a capsule opened, it could mean that the medicine is released into your body all at once when it should be released slowly over many hours. It could also make your medicine less effective because you do not receive the correct dose, or even dangerous because you may receive all of the dose in one go.

When is it ok to crush tablets or open capsules?

If it is OK for you to crush your tablets or open your capsules it will say this in the patient information leaflet which was supplied with your medication. For many other drugs it may not be acceptable to crush them or empty out the capsule's content. It is very important that you ask your pharmacist before doing so.

If you cannot swallow your medication in some cases there may be no choice but to crush up tablets or open capsules. Your pharmacist will be able to give you more advice on this.

Remember, your circumstances may change. The prescription your GP has written for you may no longer be the most appropriate way for you to take your medication.  The only way your GP is going to know that you are having problems swallowing your medicines is if you tell them. Always let your GP, nurse or pharmacist know if you have difficulties swallowing your medicines.

Sarah's story

"I had always been very close to my Gran and she was like a second mother to me.
As she got older her health worsened, she had a stroke and also had some heart problems. Although she was fiercely independent, she reluctantly admitted at the age of 81 that she could no longer manage on her own and went to live in a care home. Every time I went to see her, she begged me to take her home for a holiday. Eventually, the home agreed that she could stay with me for a week.

When I picked her up from the care home I was shocked at how she had deteriorated. She complained of feeling sick and dizzy every morning and also said that her chest pains were getting worse. I talked to the nurse who said that Gran was on the strongest dose of heart drug there was and that because she couldn't swallow her tablets very well, they were crushing them between two teaspoons and putting them in her tea every morning.

Naturally, I did the same and never thought to question whether there might be anything wrong with doing this. After a few days, she became very ill and her chest pains so bad that we had to take her to A&E in the middle of the night.

 She had a massive heart attack and later died. I felt devastated. Had it been something I had done wrong? I talked to the doctor and he questioned me about my Gran's care and in particular her medication.

I showed him her tablets and explained what I had been doing to help her swallow them. He said that these pills should never be crushed and that she would have been receiving a huge dose of medication, which is why she felt ill in the morning and then for the rest of the day and night she would have had no drug to protect her heart.

Although he said I wasn't to blame. I just wish someone had warned me about tablet crushing, I hope this never happens to anyone else's Gran.."

Alison's story

"I had always been very fit and healthy, or so I thought. I was out jogging one morning when I just lost the feeling in my legs, I collapsed and was taken to hospital. After lots of tests it was discovered that I'd had a major stroke. Initially I  recovered fairly well, but had some problems with swallowing. Food was too "lumpy" and always "stuck" in my  throat. I then  developed a chest infection and was  prescribed antibiotic capsules, but I didn't seem to be getting any better.

Because of my swallowing difficulties, the capsules were being opened and the contents put into my tea to make it easier to swallow, but the hot water was stopping the medication from working. Fortunately one of the nurses realised what was happening and got the doctor to change my prescription to a liquid medicine. I then recovered quickly from the chest infection and am now having regular physiotherapy to help with the after effects of the stroke."

These case studies which recount the experiences of Sarah and Alison are based on telephone interviews, however, the names and details have been changed to protect the privacy of those involved. This was a pre-agreed condition of the interviews taking place. Neither person wished to be identified in order to protect themselves and their families.

There is a solution.

Inform your pharmacist, doctor or nurse that you are having problems taking your medication . They will be able to advise you if your medicine is available in a liquid form. This will make the medicine easier for you to swallow and will help to ensure that your treatment is working as effectively as it should be.

For further information about dysphagia visit: www.swallowingdifficulties.com

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