For many people, swallowing pills can be a difficult or unpleasant experience. This leads some to consider chewing or crushing medications to make them easier to ingest. However, this seemingly simple solution can have serious and dangerous consequences when it comes to softgel capsules. The design of a softgel is deliberate, and altering it by chewing can fundamentally change how the medication works, potentially making it ineffective or even toxic.
The Unique Purpose of a Softgel Capsule
Softgel capsules are a specific type of oral medication delivery system, distinct from traditional tablets. Their soft, gelatin-based outer shell is designed to protect a liquid or semi-solid fill until it reaches the correct part of the digestive tract. Chewing the softgel breaks this protective seal prematurely, releasing the contents too early. This sabotages the carefully engineered properties of the medication. For instance, the capsule may be designed to mask an unpleasant taste, protect the active ingredient from stomach acid, or enhance the drug's bioavailability, or rate of absorption, in the intestine. Chewing undermines all these functions.
Potential Dangers and Altered Effects of Chewing Softgels
Altering the intended release of a softgel, whether through chewing or opening, can lead to a number of adverse effects. These range from the drug not working as intended to experiencing a sudden, harmful overdose.
Altered Absorption and Bioavailability
Softgels often contain a liquid formulation of the active ingredient, which helps improve its bioavailability and allows the body to absorb it more effectively. Chewing can disrupt this process, causing the active ingredient to be absorbed incorrectly or not at all. Some drugs are meant to bypass the stomach and be absorbed in the intestines, and chewing destroys the enteric coating that makes this possible.
The Risk of Overdose with Extended-Release Formulations
Extended-release (ER or XR) medications, whether in softgel or tablet form, are formulated to release a small, steady dose of the drug over a long period. Chewing these formulations breaks the controlled-release mechanism, causing the entire dose to be released and absorbed at once. This can result in a sudden and dangerous overdose, leading to serious side effects or toxicity. This is especially dangerous for powerful drugs like certain opioids.
Adverse Side Effects
Chewing a softgel can also expose your mouth and throat to a drug or chemical that is not meant to be released there. This can cause severe irritation, a bad taste, or even ulcers. The concentrated liquid fill may also cause stomach irritation if the protective shell is bypassed.
Loss of Potency
Some active ingredients are highly sensitive to stomach acids and can be neutralized if exposed too early. Chewing the capsule releases the contents into the stomach, where they can be destroyed before they have a chance to enter the bloodstream and take effect. This means you might not receive the therapeutic benefit of the medication at all.
Alternatives to Chewing for Swallowing Difficulties
If you have difficulty swallowing softgels, do not resort to chewing them. Instead, consider these safer alternatives after consulting with a pharmacist or doctor:
- Ask for an alternative formulation: Many medications are available in liquid, chewable tablet, or other forms that don't require swallowing a whole capsule. A pharmacist can tell you if a safer alternative exists for your specific medication.
- Use the lean-forward method: For capsules, a study published in Harvard Health describes a method where you place the capsule on your tongue, take a sip of water, and then tilt your chin towards your chest before swallowing. This has shown an 89% improvement in swallowing capsules for some patients.
- Mix with soft foods: Some capsules are designed to be opened and sprinkled onto soft foods like applesauce or pudding. However, you must confirm with your pharmacist that this is safe for your specific medication first.
Comparison: Swallowing vs. Chewing Softgels
| Feature | Swallowing (As Directed) | Chewing (Against Instructions) |
|---|---|---|
| Drug Absorption | Controlled and optimal, in the correct part of the GI tract. | Uncontrolled, premature, or potentially incomplete. |
| Bioavailability | Maximized for therapeutic effect. | Compromised, potentially leading to under-dosing. |
| Safety | High, minimizes side effect and overdose risk. | Increased risk of overdose, toxicity, and side effects. |
| Protective Coating | Intact, protects against stomach acid and masks taste. | Destroyed, exposes contents to the mouth and stomach prematurely. |
| Onset of Action | As intended by the manufacturer (e.g., rapid, delayed, or extended). | Altered, potentially too fast or too slow. |
| Ease of Use | Can be difficult for some, but safe swallowing methods are available. | Perceived as easier, but unsafe and ineffective. |
Conclusion
In summary, it is not okay to chew softgels unless specifically instructed to do so by a healthcare provider or the product's label. The risks, which include altered absorption, the potential for overdose with extended-release drugs, and damage to the protective shell, far outweigh the convenience of avoiding a large pill. For those with persistent difficulty swallowing, the safest and most responsible course of action is to speak with a pharmacist or doctor. They can provide guidance on appropriate, and safe, alternatives. Taking medication as prescribed is critical to ensuring it works effectively and without causing harm.
Additional resources
- MedlinePlus: A service of the U.S. National Library of Medicine, MedlinePlus offers comprehensive drug information, including specific instructions for taking various medications safely.
