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Crushing tablets or opening capsules: many uncertainties, some established dangers

FEATURED REVIEW For patients who have difficulty swallowing, a common solution is to crush tablets or open capsules. Before crushing a tablet or opening a capsule, it is better to consider and research the impact it will have on the drug's effects. It is sometimes preferable to use a different dosage form, or a different active ingredient.
Full review (6 pages) available for download by subscribers.

Abstract

  • For patients who have difficulty swallowing, a common solution is to crush tablets or open capsules. What are the consequences of this practice? We reviewed the main evidence available using the standard Prescrire methodology.
     
  • The clinical consequences for the patient of crushing tablets or opening capsules can be serious: alteration of the drug's absorption can result in sometimes fatal overdose, or conversely underdosing, rendering the treatment ineffective. When it disrupts a drug's sustained-release properties, the active ingredient is no longer released and absorbed gradually, resulting in overdose. When a gastroresistant layer is destroyed by crushing, underdosing is likely.
     
  • The active ingredient released may degrade on contact with light, moisture or the food with which it is mixed for administration.
     
  • The person who crushes the tablets or opens the capsules is exposed to drug particles, which may be carcinogenic, teratogenic or fetotoxic. They are sometimes allergenic.
     
  • In practice, there are many drugs that should never be crushed or opened. Before crushing a tablet or opening a capsule, it is better to consider and research the impact it will have on the drug's effects. It is sometimes preferable to use a different dosage form, or a different active ingredient.

©Prescrire 1 September 2014

"Crushing tablets or opening capsules: many uncertainties, some established dangers" Prescrire Int 2014; 23 (152): 209-214. (Pdf, subscribers only)

Download the full review.
Pdf, subscribers only