In addition, many drugs in tablet or capsule form are designed to release their active ingredients even more slowly, over a period of 12 to 24 hours as the tablets or granules from the capsule pass through the small intestine.
This sustained-release also called controlled-release, long-acting and extended-release design provides the convenience of once- or twice-daily dosing and minimizes the variation in the amount of drug in the blood over the course of a day. This design can improve patient compliance and drug effectiveness while decreasing the risk of adverse effects. Crushing a tablet, opening a capsule or chewing either of these can circumvent many of the protective design features intended to control when and where a drug is released in the digestive tract.
Depending on the drug, this can result in overdosing, underdosing or direct toxic injury to the lining of the mouth, stomach or intestines. The Prescrire International review highlighted examples of each of these potentially dangerous circumstances for several commonly used drugs. For some drugs, crushing, chewing or opening a tablet or capsule before swallowing can cause the rapid absorption of a large amount of the drug, potentially resulting in an overdose.
Digoxin is approved by the Food and Drug Administration FDA to treat heart failure and to slow the heart rate in patients who develop atrial fibrillation, a common abnormal heart rhythm characterized by an irregular and often rapid heart rate.
According to the authors of the Prescrire International review, crushing digoxin tablets before swallowing may increase the risk of other dangerous abnormal heart rhythms. Likewise, the authors noted that opening capsules containing the oral anticoagulant dabigatran PRADAXA will increase the amount of drug that is absorbed, exposing the patient to a greater risk of serious bleeding. Sustained-release drugs also should not be crushed or chewed before swallowing because doing so will cause the dangerously rapid absorption of a large dose that was intended to be released slowly over many hours.
See text box, below , for stories of patients who have been seriously harmed or killed after ingesting tablets that were chewed or crushed. Here are just a few examples published in the medical literature of patients who have been injured or have died after ingesting a sustained-release drug that was chewed or crushed:.
In contrast to the prior examples, for some drugs, crushing tablets, opening capsules or chewing either of these before ingestion can result in patients receiving an insufficient dose of the active ingredient. This occurs commonly with medications that have an enteric coating, designed to protect the active ingredient from being destroyed as the tablet or capsule passes through the stomach.
The authors of the Prescrire International review referenced a case of a year-old man who had severe heartburn. He was diagnosed with severe gastroesophageal reflux disease. His doctor prescribed the proton pump inhibitor omeprazole twice daily. The omeprazole tablets were crushed before being administered via a tube placed in his stomach. Crushing the tablets likely compromised the integrity of their coating, allowing the stomach acid to inactivate the omeprazole, thus rendering the drug ineffective.
Omeprazole also is available over the counter OTC. Finally, the authors of the Prescrire International review reported that some medications have a coating that is intended to prevent the active ingredients from causing ulcers and tissue injury in the mouth, stomach or intestines.
For example, crushing certain iron supplements available in tablet form can cause ulcers in the mouth due to exposure to the iron. Mankind Pharma Limited shall not be held liable, in any circumstance whatsoever. Home Blog What are Capsule Covers made up of? Are they Safe?
Next post How Effectively do Birth Contr Popular Post. What are Capsule Covers made up of? Instead of disintegrating like a tablet does in the stomach, a suppository is designed to melt and release the drug.
Most suppositories are made from the same fats and oils found in chocolate, which cause the suppositories to melt when placed in the body. What you need to remember is that if you have difficulty swallowing tablets, check the medicine box and ask your pharmacist whether it would be all right to chew or crush your medicine.
Much of the time, this will be fine. Portsmouth Climate Festival — Portsmouth, Portsmouth. Edition: Available editions United Kingdom.
Become an author Sign up as a reader Sign in. Look for a warning on the box before you attempt to crush or chew tablets, or cut capsules open. The swallowing of capsules can be particularly difficult. This is because capsules are lighter than water and float due to air trapped inside the gelatine shell. In comparison, tablets are heavier than water and do not float. The usual method of swallowing oral solid dose forms - placing on the tongue, filling the mouth with water, tilting the head back and swallowing - works well for tablets because they do not float and gravity, when the head is tilted back, assists swallowing.
If this technique is used with a capsule, it will float on the water in the front of the mouth, placing it in the anatomically incorrect location for ease of swallowing see figure 1. Instead a 'lean-forward' technique has been suggested, 1 , 2 in which the capsule floats to the back of the mouth and into a good position to be swallowed easily see figure 2.
Brown 1 in noted that this 'lean-forward' technique was "almost universally unknown" amongst physicians, nurses and pharmacists.
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