Prescriptions: To Crush or Not to Crush

Do you have trouble swallowing what some people call “horse pills”?  You know, the ones that look like they should have a Popsicle stick to hold onto?  

Although that’s an exaggeration, the fact is, that some pills are down-right intimidating to swallow!  But before you cut or crush this huge thing sitting in your hand, be aware of the risks involved.

Abundance of Caution

The Institute for Safe Medication Practices has compiled a list of name-brand and generic medications. Click here to see if yours is one that must be taken in its original form.

Dysphagia

Dysphagia is the difficulty or inability to swallow.  This is a common condition in geriatric patients.  But sometimes the reason a person has trouble swallowing a large pill can be psychological, due to a fear of choking or having a near-choking experience earlier in life.

It’s important to ask your doctor to examine and rule out any other more serious conditions related to difficulty swallowing.  

It’s always the best strategy to take your medication as prescribed, in its original form.  And always finish the course of the prescription by taking all the doses, even if you are feeling improved.  

When it’s Not Safe

CD, CR, DA, ER, XR, XL

By cutting or crushing some medications, more of the dosage may be absorbed into the bloodstream quickly.  This can cause a temporary overdose and leave no medicine for the body the rest of the day. Annette Enababor, Director of Pharmacy at St. David’s Georgetown Hospital explains, “Many drugs are made with different release technology. Crushing and cutting some medications may result in higher blood concentrations or poor absorption, making them potentially harmful or ineffective.”  

So, a good rule-of-thumb is to check the ending of your medication’s name. CD, CR, or DA initials mean that these medications have a controlled-release, a timed-release or a delayed-action. If it ends in ER, XR, and XL, it means that they deliver the medication slowly over a 24-hour period. 

It’s also not at all wise to crush another person’s pills, as in the situation of a nursing home staff person administering medication to a nursing home patient. Some cancer-related medications are toxic when they are inhaled.  

When it’s Safe

But, having that explained all the reasons to be cautious and when not to alter medications, there are many instances when crushing, cutting or halving a medication is perfectly safe.  First, use a pill-splitter or a mortar & pestle for these jobs.  Crushing pills by banging on them in a sandwich bag will not make consistently-sized pieces and waste costly prescriptions.  

Annette adds, “It is best to follow the labeling on the prescription bottle and reach out to your pharmacist with questions.” If you still have doubts, are unsure, or feel you just cannot take the dosage as given in the prescription, ask your doctor or pharmacist about your medication.