How to Crush Pills Safely and Correctly

If you have difficulty swallowing pills (or just have an aversion to it), being prescribed a medication in pill form can seem overwhelming. Crushing pills can help make things easier, but it's important to know how to do that correctly—and to be aware that not all medications can be crushed and remain safe and effective.

Taking a crushed pill, in some cases, is virtually the same as taking one whole. However, there are other times when crushing a pill can heighten the risk of side effects and unintentional overdosing, as well as render the drug ineffective.

For example:

• Enteric coated drugs should not be crushed, broken, or chewed. They are coated to lessen gastric irritation, to prevent teeth staining and infections of the mouth, and to prevent stomach acids from destroying the drug's effectiveness. If they are not swallowed whole, they are ineffective and cause serious side effects.
• Sustained-release drugs have product names ending with CD and CR (controlled release), DA (delayed action), and ER, XR, and XL, (extended release) among others. These medications are designed to deliver the medication slowly over a 24-hour period. Crushing them may lead to an initial overdose and insufficient levels of the medication to be delivered over the course of a day, which can be dangerous.
• Cytotoxic, teratogenic, or hormone drugs: Crushing these medications can lead to inhaling airborne particles. Cytotoxic drugs include chemotherapy treatments and teratogenic drugs include ACE inhibitors. Finasteride is an example of a hormone drug that should not be crushed. If crushing is necessary and approved, caregivers should use caution by wearing gloves and a mask when handling the medication. 
• Narcotics: You should never crush narcotics, such as Oxycontin or Vicodin. When narcotics aren’t taken correctly, there is a high potential for addiction and adverse reactions that could lead to overdose and death.

First off, you may not even need to worry about whether or not you can crush pills prescribed to you if a medication is available in another form (a liquid, patch, injection, or some other alternative) that you could take instead. Talk to your doctor about all your options.

If you must take a medication in pill form, always ask your doctor or pharmacist whether it can be crushed. You should also ask whether it is safe for others to crush medication for you. In some cases, this can cause adverse effects, as is the case with cytotoxic, teratogenic, and hormone drugs.

There are ways to make swallowing pills easier if crushing them (or using an alternative form of the drug) is not a possibility.

If you know a medication can be safely crushed, there are three safe ways to go about it:

• Pill crusher: The easiest way to crush pills is to use a pill crusher. The gadget works by reducing the pill into a fine, powdery substance to be mixed with food or a beverage. Using a pill crusher is simple and requires little physical effort. Plus, the process is very time efficient, as most pills are relatively small and take mere seconds to crush.
• Pill splitter: If you are taking large pills that cannot be crushed, a pill splitter may be the solution. A pill splitter allows you to safely cut a pill in two, making it easier to swallow.
• Mortar and pestle: An old-fashioned mortar and pestle is that heavy bowl and thick stick often used to make guacamole. You can use it to safely grind and mash pills into powder form. This method requires a little more time and physical effort than a pill crusher, however. In addition, it's not very user-friendly for people with arthritis or other joint conditions of the hands and wrists because application of pressure is needed to twist and turn the pestle. (If you use this method, be sure to have a set dedicated to just pill crushing.)

You can buy both pill crushers and pill splitters in drugstores and online. A mortar and pestle set can be found in most cooking supply stores.

When you are done crushing or splitting pills, clean your tools well so no residual drug remains, which could contaminate medications you crush later on.

Some people feel tempted to crush their medication by placing pills inside a plastic bag and bludgeoning them with a hammer or other heavy object, but there are so many things that can go wrong with this method.

• It can make holes in the bag and you could lose some of the medication, which throws off dosing.
• The crushed-up medication can collect in the corners of the bag, making it difficult to get every bit of medication out.
• It may leave chunky pill fragments, rather than a smooth powder.
• It's more time-consuming than any other method.

Take your crushed pills with food or a liquid other than water. While safe, water simply makes for a bitter taste.

Consider what medications may interfere with food and drinks. For example, grapefruit has been known to cause severe reactions, such as blocking the ability of medications to be absorbed by the body. 

Ask your doctor or pharmacist if you are unsure about a food or drink to take with medication. Good food options for mixing crushed medications include:

• Applesauce
• Pudding
• Milk
• Fruit juice

If you have trouble swallowing pills or anything else, talk to your doctor to determine if there's something behind it. Certain health concerns can give rise to dysphagia, and you may not notice any signs of them aside from eating slower, favoring softer foods, and crushing or splitting medications. Swallowing problems are often easily treated. And while it's important to get the help you need to improve in this regard, it's also important to address any underlying concerns as a whole.