"Don't rush to crush"
If you or someone you look after is finding it hard to swallow tablets or capsules (solid medicines), you might think that the answer is to crush a tablet or open a capsule to make swallowing medication easier.1 Mixing the contents of a capsule with food or adding a crushed tablet to a drink may seem a better option than asking your doctor or nurse to change a prescription to a more suitable format such as a Liquid Medicine. It is not safe to crush a tablet or open a capsule without first checking with a healthcare professional such as a Pharmacist or your Doctor.2 Guidelines state that a recommendation to manipulate a solid dose medication is only to be made as a very last resort.3
Why you shouldn’t crush4
Crushing tablets or opening capsules which aren’t designed to be taken in this way:
- Can cause serious side effects
- May prevent the medicine from working properly
- Could alter how the body processes and responds to the drug
Many modern medicines are the result of significant research and development using specialised techniques which influence how a medicine works within the body.
It isn’t always possible to tell just by looking at a tablet or capsule if a tablet does have a special modification or coating. Each of the modifications or coatings has been developed and included for a specific purpose and will be damaged by crushing.
Sugar or film coating – surrounds the tablet normally to make it taste better or easier to swallow. Crushing these types of tablets may make them to taste very unpleasant.
Enteric coating – tablets with an enteric coating should never be crushed. These enteric coatings are placed around a drug to protect the drug from the acid environment, protect the stomach from the drug or deliver the drug to the site of action.
Modified release – this means the medicine has been modified so it is released slowly and doesn’t need to be taken so often, they should never be crushed. If a modified release preparation is damaged then the whole dose can be released too quickly in the body, this will mean you will receive a very high dose and be more likely to experience side effects.
What to do instead of crushing
Do not crush your tablets or open capsules unless a Pharmacist or Doctor has advised you that it is safe and appropriate to do so. Instead:
- Go and see your doctor or nurse who will be able to prescribe your medicine in a form that is more appropriate for you, such as a liquid medication. Many tablets and capsules are available as liquid medicines, which can be easier to swallow.5
- Ask your pharmacist’s advice to whether a tablet can or can’t be crushed, capsule opened or mixed with food.2
Guidelines for healthcare professionals state that they should always ask a patient about swallowing difficulties before prescribing a medicine3, so if you haven’t been asked, make sure you tell your doctor, nurse or pharmacist that you’re having any difficulties swallowing your medication.
1. Strachan I, Greener M. Medication related swallowing difficulties may be more common than we realise. Pharmacy in Practice, December 2005 | 2. https://www.nhs.uk/common-health-questions/medicines/can-i-crush-medicines-before-taking-them/ (last accessed 4th March 2020) | 3. Wright D, Chapman N, Foundling-Miah M et al. Consensus guideline on the medication management of adults with swallowing difficulties. In: Foord-Kelcey G, editor. Guidelines – summarising clinical guidelines for primary care. 30th ed. Berkhamsted: Medendium Group Publishing Ltd; October 2006. | 4. Wright D et al. Prescribing medicines for patients with Dysphagia. A handbook for healthcare professionals. 2011 | 5. Medicines Management and Older People- a guide for healthcare professionals. Edited by R Greenwall. August 2016.