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10 Jun 2022

This is why you shouldn't crush pills

A third of people find swallowing tablets tricky, but grinding them up could do you more harm than good

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.

We asked community pharmacist Sid Dajani for insights on what to watch out for and what you can do to make swallowing your meds easier.

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Why some pills shouldn't be crushed 

If you have trouble taking pills whole, it may be possible to get them in different forms such as dispersible tablets.

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.

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. 

It can be tempting to crush some medications instead, but this could potentially alter both their action and their safety.

Here are some of the key reasons to take care before messing with your meds:

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.

  • 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 - for example, the non-steroidal anti-inflammatory drugs diclofenac (also known as Voltarol) and naproxen. 
  • 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, such as metformin SR for type 2 diabetes.

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.

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.

'For example, a long-lasting, slow-release painkiller might only work for eight of the 12 hours intended if you crush it up,' says Sid.

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.

For example, nifedipine - a calcium channel blocker used for high blood pressure - is highly sensitive to light, so it has a special photo-protective coating to protect it from degradation.

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.

These include breast cancer drug tamoxifen, rheumatoid arthritis drug methotrexate and prostate medication finasterade, as well as chemotherapy (cytotoxic) tablets and oral contraceptives or hormone replacement therapy.

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Trouble swallowing pills: what you can do

Research from 2021 published in the journal Patient Prefer Adherence found that around a third of people have difficulty swallowing tablets or capsules whole, so what can you do if you are one of them? We asked Sid for tips:

Get your medication in a different format

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). 

Plenty are - painkillers such as Voltarol are also available as a patch or gel, as are contraceptives and HRT. However, in the case of over-the-counter products, they do tend to be more expensive.

If it's a supplement, many now come in a 'gummy' or chewable format. See our guide to vitamins and supplements you do and don't need for more, and our vitamin D guide for tips on where to get tablets, sprays and gummies cheapest.

Try techniques for swallowing meds more easily

  • The 'lean forward' technique. This is particularly effective for taking capsules - you put the medication on your tongue, take a medium sip of water then lean your head forward as you swallow.
  • The 'pop bottle' technique. This involves filling a plastic bottle with water, placing the tablet on your tongue before clamping your lips tightly around the bottle opening.

Researchers in a 2014 study on swallowing tablets who devised both techniques found they improve tablet swallowing compared to standard techniques such as sipping water from a glass - in the case of the bottle technique by up to 60%.

Chat to your pharmacist

There are some techniques pharmacists use that may be appropriate for you, but it's best to discuss with your pharmacist first to ensure it's safe and you know what to do:

  • Dispersing tablets in water The NHS England Specialist Pharmacy Service (SPS) says that many immediate-release tablets will disperse sufficiently in water without the need for crushing, but there's a specific process to follow to ensure you do this correctly.
  • Crushing pills properly If your tablets are suitable for crushing, the SPS advises using a tablet crusher, crushing syringe or a pestle and mortar, always ensuring to give the water used to rinse out the meds to the patient, too, to ensure they get the full dose. 

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Other tips for using meds safely

Ask your pharmacist about how you should take your pills if you're not sure.

Follow instructions about food

Certain meds have to be taken on an empty stomach to ensure they are absorbed before food next enters the stomach, while others need food in the stomach to protect its lining against irritation.

In other cases - such as with cholesterol-lowering simvastatin, calcium channel blockers including amlopidine, and the blood-thinning drug warfarin - you should avoid eating grapefruit or drinking grapefruit juice as it increases the level of medicine in your blood.

Store medication as instructed

If you store medication incorrectly, it could become less effective to the extent that your doctor might up your dose because they think it's not working. 

A daily pill organiser might sound like a good idea if you've got a few to keep track of, but if your medication needs to be stored with a desiccant to keep it dry it's best to keep it in its original container to preserve its quality, and it's easier to keep track of use-by dates too.

Protect your identity

It's a fiddly job, but Sid warns it's worth removing the name labels on your meds before recycling them: 'There's a lot of information on there, which someone could use for identity theft, but they can also tell if you've been administered controlled drugs that they could target you for to sell on.'

You can also take them (or any out-of-date meds) to your pharmacist who will have provision for secure disposal.

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