Do Not Open or Crush Tablets or Capsules Without Checking with Your Doctor or Pharmacist!

Information in this column comes from Public Citizen’s newsletter:  Worst Pills, Best Pills News. 

Some patients find it difficult or impossible to swallow large tablets or capsules.  This is especially true of the elderly, people with Parkinson’s disease or dementia, and young children.  To cope with this problem, patients may crush or chew tablets, or open capsules and sprinkle the resulting powder or fragments onto food or into liquids.  A review article from Prescrire International in 2014 warned that for many medicines this may have very serious results.  Drug companies combine their medicines so that they will be released at a specific rate and in specific locations in the digestive tract, such as the stomach or small intestine. Crushing, opening or chewing the medication can result in overdosing, underdosing or direct toxic injury to the lining of the mouth, stomach, or intestines.  

Drugs that have a low margin of safety for overdosing include digoxin (Lanoxin) and blood thinners.  Serious injuries including death can occur with tampering with these drugs.   A drug such as Prilosec, frequently given for gastroesophageal reflux (so called heartburn) and/or ulcers can be made ineffective by crushing or chewing the tablet, allowing the stomach acid to inactivate the Prilosec and rendering the drug ineffective.  Prilosec and related drugs are available over the counter.  The label advises consumers to swallow the medicine whole.  Many people ignore these warnings.  Do not be one of them!  You should never crush a tablet, open a capsule or chew one without checking first with the prescribing health care provider or the dispensing pharmacist.  There may be a smaller tablet or capsule of the same drug, or another drug that you can swallow, or that can be safely crushed or opened before ingesting.  

Sadja Greenwood  MD, MPH

Magnificent Trees Should Not Go Down the Drain

 This article is taken from a report by the Natural Resources Defense Council, (NRDC).

Below the Arctic Circle, the largest intact old growth forest rings the globe.  Canada’s share of this boreal forest is vast.  It is a dense mix of spruce and fir trees mixed with aspen and birch, with peat bogs and verdant wetlands. More than 3 billion birds migrate there to breed – whooping cranes, the great gray owl, and a majority of North American songbirds.  Year-round residents include the Canada lynx, moose, pine marten and woodland caribou, as well as more than 600 communities of indigenous people who have relied on the forest’s bounty for millennia.  

Canada’s boreal forest is being leveled at an alarming rate – a million acres a year.  The oil and gas industries have added to the destruction, but the greatest threat is from logging, driven in large part by the rapacious demand in the U.S., the destination of more than 3/4ths of all boreal wood products.  The wood ends up as lumber, packaging and throwaway tissue products like paper towels and toilet tissue.  No major brand of toilet paper, facial tissue or paper towels, such as Procter & Gamble, Kimberly-Clark or Georgia-Pacific contains any recycled content. A recent paper by Shelley Vinyard at the NRDC, entitled The Issue with Tissue: How Americans are Flushing Forests Down the Toilet was followed by a call to action targeting Procter & Gamble, maker of Charmin. the top selling brand of  toilet paper in the U.S.  More than 80,000 NRDC members and online activists wrote to the Procter & Gamble’s CEO.  

The NRDC has evaluated several brands of paper products that are sustainable: Green Forest, 365 Bath Tissue, Natural Value, Earth First, Seventh Generation, and Trader Joe’s Bath Tissue.  Note that 365 Sustainably Soft and Trader Joe’s Super Soft Bath Tissue do not make the grade as sustainable.  

Another critical threat to the forest’s survival is the extraction of tar sands oil, which levels the forest and transforms the denuded earth into an industrial area of strip mines and toxic tailings pits.  The NRDC and its allies have fought to stop three quarters of the dozen tar sands pipelines the industry proposed, and continue to fight the Keystone XL pipeline. 

Worldwide, boreal forests store more carbon per hectare than any other forest biome, making them one of the best natural defenses against climate change.  Mandy Gull, deputy grand chief of the Cree Nation, says: As Indigenous peoples in the boreal forest, we live on the food from our land.  The forest is our supermarket, with aisles of berries and meats and fish.  My hope is that, once people know that their choice of tissue will determine whether food will be there for us tomorrow, they will help protect our homelands by switching to recycled and responsibly sourced products.

For the full report from the NRDC, including a buyer’s guide to tissue products, go to : nrdc.org/tissues. Sadja Greenwood, MD, MPH