Jaime Herndon is a freelance health/medical writer with over a decade of experience writing for the public.
Gagandeep Brar, MD, is a board-certified hematologist and medical oncologist in Los Angeles, California.
If you have difficulty swallowing pills and there aren't alternatives like syrups, crushing pills may be a reasonable option. However, not every pill can be crushed as it may affect the absorption of the drug and decrease its intended effect.
Before crushing a pill, talk with the prescribing physician about whether this is safe to do. If a pill can be crushed, there is a right way and wrong way of doing this. Here is a primer that can help.
Not every pill can be crushed. There are times when doing so can decrease the drug's effectiveness or increase the risk of side effects and overdosing.
The types of pills below should not be crushed.
Enteric -coated drugs should never be crushed, broken, or chewed. The pills are coated to reduce stomach irritation. The special coating is gradually dissolved as it passes through the stomach so that the drug begins to be released as it passes into the intestine.
Some drugs are also enteric-coated to avoid teeth staining or to prevent stomach acids from destroying the drug. If not swallowed whole, these drugs may be less effective and more likely to cause side effects.
Enteric-coated tablets often have "-EN" (for enteric) or "-EC" (enteric-coated) tagged at the end of the brand name.
Some examples of enteric-coated drugs include:
You can often tell that a pill is enteric-coated when it is has a slight sheen. If in doubt, call your pharmacist.
Sustained-release drugs are similar to enteric-coated medications in that they are meant to be absorbed slowly rather than all at once. Crushing the pill causes the drug to be released all at once. These products typically have brand names that end with "-CR" (controlled-release), "-DA" (delayed-action), and "-ER" or "-XR" (extended-release), among others.
Drugs like this can include things like:
This reduces its effectiveness as the drug concentration will be high at first and then drop quickly so that there is no more left in the body. The initial high levels can also increase side effects' risk (or severity).
You should never crush narcotics, also known as opioids . These drugs have a high potential for drug addiction and are designed to be released at a controlled, steady rate.
The rapid release of opioids in the bloodstream can intensify the effects of the drug, including pain relief and feelings of euphoria. This can increase the risk of a drug overdose. It can also increase the risk of addiction because the body becomes accustomed to the rapid burst of the drug and requires more and more to achieve the same effects.
Some of the more commonly prescribed opioids include:
Not all pills can be crushed. These include pills that are enteric-coated or sustained-release. Opioid drugs especially should never be crushed as it increase the risk of addiction and overdose.
Many pharmacies place stickers on pill packaging stating they should not be crushed. If you don't see a warning label, ask your doctor or pharmacist before crushing any pill.
There are three safe and effective ways to do this if a pill can be crushed.
This gadget works by grinding the pill to a fine powder to mix with food or a beverage.
Most pill crushers are hand-held devices that you twist to achieve a fine grind. Others look like a stapler or garlic grinder that you grip to crush the pill.
This tried-and-true device is always a good option but may not be as easy if you have arthritis. Buy a mortar and pestle with smooth surfaces, which prevents the powered drug from getting lost in the grooves. Use the device only for pill crushing to avoid contamination.
You cannot crush certain pills, but they may be able to be split. If this is the case, you can buy an inexpensive pill-splitter that cuts pills neatly in half or even quarters.
Drop the pill into a levered box and close the lid. The splitter helps you avoid cutting your finger with a knife if the pill is small or round.
Some people are tempted to crush their pills by placing them in a plastic bag and hitting them with a hammer or mallet. But this is a problem for several reasons:
It is also not a good idea to mix crushed pills. If you need to crush two or more pills, each should be crushed separately and taken separately.
In addition to crushing pills currently, you need to find out which foods you can or cannot mix the medication with. You can safely mix many drugs with things like applesauce, fruit juice, pudding, or water, but not just food.
Certain foods can reduce the effectiveness of the crushed drug. For example, grapefruit juice can significantly affect how a drug is absorbed and metabolized (broken down or activated) in the body, altering its levels in the bloodstream.
Even if you can mix the pill with food, your healthcare provider may advise you to take it with only a small amount of soft food. While sprinkling it over yogurt or porridge may help erase any bitter taste, you can lose a lot of the drug if you don't finish the bowl and scrape the bottom thoroughly.
You may also need to take certain drugs without food and deal with the bitter taste that some drugs leave.
If you or your child have difficulty swallowing pills, ask your doctor or pharmacist if there are other formulations you can take. This may include chewable tablets, gummies, syrups, suspensions, powders, suppositories, and dissolvable sublingual (under the tongue) pills.
Crushing a pill is only half of the issue. You also need to know which foods or beverages are OK to mix the drug with and, in some cases, how much food you can mix with it.
Crushing pills may be OK if you or your child have trouble swallowing pills. Still, it's important to remember that not all medications can be crushed, especially enteric-coated or sustained-release tablets and opioid drugs.
If you can crush a pill, use a recommended method like a pill crusher or a mortar and pestle to grind the pill to a fine powder. Ask your doctor or pharmacist how you should take the powdered drugs, including which foods or beverages are acceptable to take them with.
If the drug you take cannot be crushed, ask your doctor if there are other formulations you can take, like syrups or suspensions.
If you have trouble swallowing pills, talk to your doctor to determine whether there may be a medical cause for this. Dysphagia , the medical term for difficulty swallowing, can be caused by any number of things, including acid reflux, untreated ulcers, or certain neurological conditions.
Swallowing problems are sometimes easily treated and may help you improve your ability to swallow pills and your overall quality of life.
Like crushing pills, chewing certain medicines can cause problems.
Most importantly, some medications release the active drug at a steady rate. Chewing them can alter the drug absorption and action. It may also cause mouth, throat, or stomach irritation.
There are certain formulations of Tylenol (acetaminophen) that you can crush, but those that are extended-release should not be broken up.
Extended-release Tylenol contains 650 milligrams (mg) of acetaminophen. Extended-release Tylenol must be swallowed whole to avoid side effects like nausea and stomach pain.
You can safely dissolve some medications in water or another substance such as applesauce. However, you need to check with your doctor and pharmacist to be sure that your medication will not cause side effects or complications if it’s taken as a dissolved substance.
If you do get the okay, be sure to consume all the medication. It’s easy for some to get left behind or discarded, which can lead to a missed dosage.
Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide!
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