How to Crush Pills Safely and Correctly

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.

If a pill can be crushed, there is a right way and wrong way of doing this. Here is a primer that can help.

Which Pills Can Be Crushed?

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 Pills

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.

Enteric-coated tablets often have "-EN" (for enteric) or "-EC" (enteric-coated) tagged at the end of the brand name.

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.

Sustained-Release Drugs

Sustained-release drugs are similar to enteric-coated drugs in that they are meant to be absorbed slowly rather than 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.

Sustained-release medications are designed to deliver the drug over a long period of time. Crushing the pill causes the drug to be released all at once.

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 the risk (or severity) of side effects.

Opioid Drugs

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 as 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:

• Fentanyl 
• Hydrocodone
• Methadone
• Demerol (meperidine)
• Exalgo (hydromorphone)
• OxyContin (oxycodone)
• Percocet (oxycodone/acetaminophen)
• Targiniq (oxycodone/naloxone)
• Vicodin (hydrocodone/acetaminophen)
  

How to Crush Pills

Many pharmacies place a sticker on pill packaging stating they that should not be crushed. If you don't see a warning label, ask your doctor or pharmacist before crushing any pill.

If a pill can be crushed, there are three safe and effective ways to do this:

• Pill crusher: 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 in order to crush the pill.
  
• Mortar and pestle: 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.
• Pill splitter: Certain pills cannot be crushed, 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. Simply 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.

What Not to Do

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 can create holes in the bag, causing you to lose medication and reduce the dose.
• The powdered medication can collect in the corners of the bag, making it hard to retrieve.
• Some of the medication may get stuck in the plastic itself.
• It may leave chunky fragments that get caught in your throat, causing choking.

Other Considerations

In addition to crushing pills currently, you need to find out which foods you can or cannot mix the medication with. Many drugs can be mixed safely with things like applesauce, fruit juice, pudding, or water, but not just any 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 the pill can be mixed with food, you may be advised to take it with only a small amount of soft food. While sprinkling it over a bowl of yogurt or porridge may help erase any bitter taste, you can end up losing a lot of the drug if you don't finish the bowl and scrape the bottom completely.

You may also need to take certain drugs without food and have to 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.

Summary

Crushing pills may be OK if you or your child have trouble swallowing pills, But, not all pills can be crushed, especially enteric-coated or sustained-release tablets and opioid drugs.

If a pill can be crushed, 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 the powdered drugs should be taken, 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.

A Word From Verywell

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 not only help you improve your ability to swallow pills but your overall quality of life as well.