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
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