Swallowing medication is not always easy. Some people find the tablets too large, others have difficulty swallowing or simply prefer to crush them to make it easier to take. But behind these widespread habits sometimes hide real health risks. Because not all medicines can tolerate being crushed or cut. Explanations
Crushing your medications: a practice far from harmless
Particularly among the elderly, swallowing problems are common. In healthcare establishments, it is therefore common for certain tablets to be crushed or capsules to be opened in order to facilitate their administration. A practice also observed in patients suffering from psycho-behavioral disorders or confusional states.
But this method, although widely used, is not without consequences. A study carried out at Rouen University Hospital even highlighted the extent of this practice after a significant increase in wrist tendinitis among nurses… caused by the repeated use of medications.
The main danger lies in the loss of effectiveness of the treatment. Many tablets have a protective coating intended to preserve the active ingredient from light, air or even gastric juices. By crushing the medicine, this protection disappears.
Medications to never crush
Some treatments then become less effective, while others may instead be released into the body too quickly. This is particularly the case for sustained-release medications, designed to release their active substance gradually throughout the day.
The study cites for example: “sustained-release medications (such as Kaléorid ® LP and Topalgic ® LP), which, when the matrix explodes, are active for one hour and no longer cover the entire day.
Same problem for gastro-resistant forms like Dépakine®, Dépamide® or Inexium®: “being no longer protected by gastric juices, (they) appear less active”.
Another risk mentioned by specialists: overdose. With certain medications such as carbamazepine, a sustained-release antiepileptic drug, crushing the tablet can cause the active ingredient to release too quickly.
Cutting your tablets: a bad reflex in certain cases
For convenience or to adjust a dose, many patients also cut their tablets in half. However, here again, this habit can pose a problem.
The first thing to check is the presence of a groove on the tablet. As Dr Gérald Kierzek explains in a previous article: a tablet with a cut line is called “scored”. It was designed to be split without changing its effectiveness. This is the case for certain antihypertensives or paracetamol.
But even when a tablet can be cut, it should not be done haphazardly.
“Always use a pill cutter, and especially not a kitchen knife,” warns Dr. Gérald Kierzek.
Imprecise cutting can result in uneven doses and compromise treatment effectiveness.
Medications that should never be cut
Conversely, certain medications should definitely not be divided. When a tablet does not have a groove, it is often because its coating plays an essential role.
Dr. Gérald Kierzek reminds in particular that you should never cut:
- Enteric-coated tablets like Aspirin Protect®;
- Sustained release capsules;
- Drugs with a narrow therapeutic margin such as warfarin or digoxin;
- Opioids and opioid treatments.
The specialist warns in particular: “A broken tablet can cause a sudden release of the dose, with risk of immediate overdose..
What to do when a medicine is too big?
But what should you do when faced with a tablet that is too large? If swallowing a tablet becomes difficult, the first instinct should be to seek advice from a healthcare professional. Doctor and pharmacist can suggest more suitable alternatives.
As our expert points out, there are often alternatives: drinkable forms, effervescent tablets, oral solutions or already scored tablets.
And if the tablet can indeed be cut, it is better to use a tablet cutter specially designed for this rather than a kitchen utensil.
On the other hand, you should never crush or open a medicine without medical advice. Behind this banal gesture may hide a significant reduction in the effectiveness of the treatment… or on the contrary a risk of overdose.