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Pharmacological Risks Of Medicines Manipulation

The act of crushing tablets or opening capsules, which are not designed to be administered in this way, alters the formulation of the medication and potentially can have serious negative consequences for the patient.

A proper medicines management procedure always avoids any kind of manipulation.

Eight reasons not to manipulate medicines, unless licensed for this purpose:

  1. The rate or site of absorption may be affected.
  2. Crushing medicines which are active over a small concentration range, such as digoxin, phenytoin, lithium and warfarin, can reduce efficacy and/or cause side effects.
  3. Medicines which are coated to prevent absorption in the stomach will be broken down in the stomach causing irritation or failure to reach the intended site of action.
  4. Crushing a slow release medication means that the patient may receive a large overdose very quickly, followed by a period of time when no active drug is being absorbed by the body.
  5. Crushing of medicines which are coated to disguise the flavour of the drug, e.g. ibuprofen, quinine, will result in the patient receiving an unpalatable medicine, which could adversely impact on compliance with treatment.
  6. A coating may prevent the administrator from suffering contact sensitisation, such as a skin rash from drugs such as chlorpromazine.
  7. With any crushed tablet there is a risk of inhalation by the administrator and this is of greatest concern when hormonal or cytotoxic treatments are prescribed.
  8. A crushed tablet or opened capsule which is not designed for administration in this way is no longer a licensed product, making the prescriber and / or administrator and / or the person advising this practice legally liable if the patient suffers any harm as a result of the practice.