Pharmacists have warned that crushing certain medicines, particularly modified-release tablets, can cause drugs to enter the body too quickly, increasing the risk of excessive drug levels, severe side effects and treatment failure.
Modified-release medicines are specially formulated to control how quickly, how long or where their active ingredients are released in the body. They may carry labels such as MR, SR, XL or LA, depending on the medicine and its formulation.
The UK National Health Service Specialist Pharmacy Service says modified-release preparations are generally unsuitable for crushing because doing so can destroy the mechanism that controls drug release. This may cause the medicine to be released too quickly, potentially resulting in higher blood levels and toxic effects, or at the wrong site in the digestive system, reducing its effectiveness.
The United States Food and Drug Administration similarly advises that some extended-release medicines should be swallowed whole because crushing, splitting or chewing them can compromise their safety or effectiveness.
Speaking on the issue, the Medical Director and Superintendent Pharmacist of Engraced Pharmacy, Lagos, Jonah Okotie, explained that modified-release medicines were designed to release their active ingredients at a specific rate, over a particular period or at a particular location to achieve the desired treatment effect.
He warned that crushing such medicines could expose patients to an excessive amount of the active ingredient at once, potentially resulting in unwanted effects and treatment failure.
Okotie explained that a medicine designed to work gradually could produce an unnecessarily high concentration in the body when its release mechanism was destroyed.
He added that the consequences could include excessive exposure to the medicine, unwanted side effects, wastage and failure of treatment.
The pharmacist therefore advised patients who have difficulty swallowing tablets not to alter their medicines on their own.
“Modified release medications must not be split. If for any reason, the client cannot swallow, consult your Pharmacist, who, if need be, should converse with your Physician to see if they can work around it or get you an equivalent alternative to ensure the desired treatment outcome,” he said.
Okotie noted that modified-release characteristics are usually indicated on the primary and secondary packaging of medicines, stressing the importance of proper counselling before patients begin using them.
He also urged pharmacists to clearly explain how medicines should be taken and factors that could affect their effectiveness.
Similarly, a Community Pharmacist with Pedov Healthcare Limited, Pedro Ebomese, warned that crushing modified-release medicines could expose patients to the entire dose within a short period rather than over the intended duration.
He explained that destroying the release mechanism could lead to excessive drug levels and toxicity.
Ebomese added that premature release could also leave patients without adequate drug coverage for the remainder of the period the medicine was intended to work.
He advised patients who cannot swallow their medicines to speak with a pharmacist instead of crushing the tablets themselves, noting that alternative formulations may be available depending on the specific medicine.
Importantly, not every tablet should automatically be crushed or left whole. Whether a medicine can be crushed depends on its specific formulation. Some medicines may be safely dispersed or split under particular instructions, while modified-release tablets and certain specially formulated medicines may not be suitable for crushing.
Patients who have difficulty swallowing should therefore check with a pharmacist or doctor before crushing, splitting or chewing any prescribed medicine.
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