“Can I just crush this tablet?”
It sounds like a simple question, but the answer can be surprisingly complicated.
Parents may want to crush a tablet because their child cannot swallow it. Older adults may have difficulty swallowing larger medications. Caregivers may need to administer medications through a feeding tube. Sometimes patients simply wonder whether they can open a capsule and mix the contents with food.
My interest in this topic actually started years ago during my pharmacy internship, when I worked on a research project in a hospital about drug administration through enteral feeding tubes.
The project required me to look beyond the active ingredient. I researched how medications were actually formulated—including their inactive ingredients, coatings and drug-release mechanisms—to determine whether a tablet could be crushed, a capsule could be opened, or a medication could appropriately be administered through a feeding tube.
It taught me an important lesson that I still use in pharmacy practice today:
A tablet isn’t simply compressed medication, and a capsule isn’t always just a container filled with powder.
The way a medication is manufactured can determine where, when and how quickly the drug is released into your body.
That means crushing a tablet or opening a capsule may sometimes be appropriate. In other situations, doing so can completely change how the medication works.
So before reaching for a pill crusher, it helps to understand what is actually inside your medication.
Understand How Your Medication Is Designed
Immediate-Release Tablets
Immediate-release medications are generally designed to release their active ingredient relatively soon after administration.
Many conventional immediate-release tablets may be suitable for crushing, but immediate-release does not automatically mean crushable.
The pharmacist still needs to consider the specific medication, product formulation, safety of exposure to the powder and other factors before recommending that a tablet be crushed.
Enteric-Coated Tablets
An enteric coating is designed to remain intact in the acidic environment of the stomach and dissolve later in the gastrointestinal tract.
There may be a reason for this. The coating might protect an acid-sensitive medication from the stomach environment, or prevent the medication from being released until it reaches a different part of the gastrointestinal tract.
Crushing an enteric-coated tablet destroys this protective design.
For that reason, enteric-coated tablets generally should not be crushed.
Delayed-Release Medications
Delayed-release medications are designed so that the active ingredient is not released immediately after the medication is swallowed.
But this is where things become interesting.
Sometimes the capsule itself can be opened while the granules inside must remain intact.
Omeprazole delayed-release capsules are a good example. For certain products, the capsule can be opened and the pellets sprinkled onto applesauce. However, the pellets should be swallowed without crushing or chewing them.
Lansoprazole delayed-release capsules provide another example. Product instructions for certain formulations allow the capsule to be opened and the intact granules sprinkled onto specific soft foods, including applesauce or yogurt.
That is why a pharmacist might tell you:
“Yes, you can open the capsule and sprinkle the contents on applesauce—but don’t crush or chew the pellets.”
Other capsules should not be opened at all.
The answer depends on the exact medication and product.
What About Extended-Release Tablets?
You may see abbreviations such as:
ER, XR, XL, SR, CR or LA
These generally indicate that the medication has been designed to release its active ingredient over a longer period rather than all at once.
For patients, the safest rule is simple:
Do not crush an extended-release medication unless a pharmacist has confirmed that it is appropriate for that exact product.
Crushing some extended-release medications can destroy their release mechanism and cause the medication to be released much more quickly than intended. This can potentially produce unpredictable or dangerously high drug concentrations.
Not All Extended-Release Tablets Are Made the Same Way
This is where pharmaceutical formulation becomes particularly interesting.
Different manufacturers can use different technologies to control drug release.
Some tablets use a polymer matrix, which may contain ingredients such as hypromellose. When the tablet comes into contact with gastrointestinal fluids, the matrix hydrates and helps control how the medication diffuses out of the tablet over time.
Other medications use specialized coatings, coated pellets, multiple layers or other delivery systems to control when and how quickly the medication is released. Research into extended-release matrix tablets demonstrates how polymers and the physical structure of a dosage form can significantly influence its dissolution characteristics.
For a pharmacist, understanding how the extended-release property was engineered can therefore be important when evaluating possible alternatives for someone who cannot swallow the original medication.
However, seeing hypromellose or another polymer on an ingredient list does not mean that the patient should crush the tablet. Crushing changes the tablet’s physical structure and surface area and can change how the drug is released.
The decision needs to be made product by product and medication by medication.
Some Medications Require Particular Caution
Changing the release characteristics becomes especially concerning when rapid release could substantially increase drug exposure or the risk of serious adverse effects.
Bupropion XL is a good example.
Bupropion XL tablets are specifically intended to be swallowed whole. The prescribing information warns against cutting, chewing or crushing the tablets because doing so can cause the medication to be released too quickly and may increase the risk of adverse effects, including seizures.
This illustrates why the question isn’t simply:
“Can I physically crush this tablet?”
The more important question is:
“What happens to this medication when I change the way it was designed to release?”
What About Medications Given Through Feeding Tubes?
Administration through an enteral feeding tube introduces another layer of complexity.
The pharmacist may need to consider:
- whether the medication can be crushed or opened;
- where the feeding tube ends, such as the stomach or intestine;
- the size of the tube;
- whether particles could block the tube;
- whether the medication interacts with enteral nutrition;
- whether a liquid formulation is too viscous or concentrated; and
- whether changing the site of drug delivery could affect absorption.
This was one of the most valuable lessons from my internship research: how you administer a medication can be just as important as which medication you administer.
Changing the Formulation May Change the Dosing Schedule
Consider a medication that has been specifically formulated as an extended-release tablet so that it can be taken once daily.
If an appropriate immediate-release liquid formulation is prepared instead, that liquid may no longer have the technology that allowed the original tablet to release medication gradually throughout the day.
The pharmacist and prescriber may therefore need to determine whether the patient’s total daily dose should instead be divided into smaller doses given more frequently.
For example, a once-daily extended-release dose should not automatically be converted into the same amount of an immediate-release liquid taken once daily.
Depending on the medication, the pharmacist and prescriber may need to consider its half-life, absorption, pharmacokinetics, therapeutic range, available immediate-release dosing information and the patient’s individual circumstances before determining an appropriate dose and dosing schedule.
This is one reason why pharmaceutical compounding involves more than simply turning a tablet into a liquid.
Have Difficulty Swallowing Your Medication?
If you have difficulty swallowing a tablet or capsule, don’t crush or open it without checking first. Ask your pharmacist whether the medication can be safely modified or whether another dosage form may be more appropriate.
If you’re wondering whether your medication can be prepared as a customized liquid formulation, speak with our compounding pharmacists at Atria. We can review the specific medication, its formulation and release characteristics, and work with your prescriber when needed to determine whether a compounded liquid or another dosage form may be an appropriate option.
Reference
- Grissinger M. Preventing Errors When Drugs Are Given Via Enteral Feeding Tubes. P&T. 2013;38(10):575–576. https://pmc.ncbi.nlm.nih.gov/articles/PMC3875244/
- U.S. National Library of Medicine. Bupropion Hydrochloride Extended-Release Tablets (XL) Prescribing Information. DailyMed.
- U.S. National Library of Medicine. Omeprazole Delayed-Release Capsules Prescribing Information. DailyMed.
- U.S. National Library of Medicine. Lansoprazole Delayed-Release Capsules Prescribing Information. DailyMed.