The Purpose of Chewable Tablets
Chewable tablets are a specific dosage form designed to be broken down by chewing in the mouth before swallowing. They are helpful for individuals who have difficulty swallowing whole pills, a condition known as dysphagia, which is common in older adults and young children. Chewing helps break down the tablet, increasing the medication's surface area, which can lead to faster absorption. Common chewable medications include certain antacids, vitamins, and some children's pain relievers. Thoroughly chewing these tablets ensures the medication works correctly and reduces the risk of choking.
Can I Crush a Chewable Tablet Instead of Chewing?
While chewing is the intended method, chewable tablets can often be safely crushed if a patient is unable to chew. Since they are typically immediate-release, crushing them and mixing with a small amount of soft food is a common practice. However, it is crucial to first consult with a healthcare professional like a doctor or pharmacist. They can confirm if crushing is safe for a specific medication and provide proper instructions. Using a dedicated pill crusher is recommended to ensure a fine powder and prevent loss of medication.
The Dangers of Crushing the Wrong Medication
Altering any medication without professional guidance is risky. Crushing pills can change how they work, potentially making them ineffective or dangerous. The main concern is with modified-release medications, such as extended-release (ER, XR, XL), sustained-release (SR), or long-acting (LA) drugs. These are designed to release medication slowly; crushing them releases the entire dose at once, potentially causing a toxic overdose. Enteric-coated (EC) tablets have a protective layer that prevents stomach irritation or protects the drug from stomach acid. Crushing these destroys the coating, potentially reducing effectiveness or causing stomach issues. Buccal or sublingual tablets, meant to dissolve in the mouth, also lose their intended effect if crushed. Additionally, crushing certain hazardous drugs can create dangerous airborne particles.
Comparing Medication Types: What Can and Cannot Be Crushed
Understanding different medication types is vital before considering crushing. Always check for suffixes like ER, XR, SR, LA, or EC on medication names.
| Medication Formulation | Safe to Crush? (After consulting a pharmacist) | Reason | Examples |
|---|---|---|---|
| Immediate-Release (IR) | Generally Yes | Designed for quick release upon ingestion. | Some standard pain relievers, uncoated tablets. |
| Chewable Tablets | Often Yes | Designed to be broken down in the mouth; usually are immediate-release. | Children's Tylenol, some antacids. |
| Extended-Release (ER, XR, XL, SR) | NEVER | Crushing causes 'dose dumping'—a rapid, potentially toxic release of the entire dose at once. | OxyContin, Wellbutrin XL, Cardizem CD. |
| Enteric-Coated (EC) | NEVER | Crushing destroys the protective coating, leading to stomach irritation or drug inactivation. | Ecotrin (Aspirin), Dulcolax, Protonix. |
| Capsules (with beads/pellets) | Varies; some can be opened | The capsules can sometimes be opened and the beads sprinkled on food, but the beads themselves must not be crushed. Check label. | Adderall XR, Focalin XR. |
| Hazardous Drugs | NEVER | Risk of exposure to the person crushing the medication. | Methotrexate, tamoxifen. |
Conclusion: Always Ask First
Before altering any medication, always consult a pharmacist or doctor. While crushing chewable tablets may be possible if chewing is difficult, it's not universally safe, and errors can be severe. Improper medication administration contributes to numerous adverse drug events annually. Medications like extended-release and enteric-coated pills should never be crushed due to risks of overdose, increased side effects, or treatment failure. If swallowing pills is a problem, healthcare providers can suggest safer alternatives like liquids, patches, or different medications.
For more information on medications that should not be altered, you can refer to the Institute for Safe Medication Practices (ISMP) which often publishes lists and guidelines.
