How to Crush Pills Safely and Correctly

If you have difficulty swallowing pills and there are no alternatives like liquids or syrups available, 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.

Before crushing a pill, talk with the prescribing physician about whether this is safe to do. If a pill can be crushed, there is a right way and wrong way of doing this. Here is a primer that may help you safely crush medications.

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 travels to the intestine.

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.

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

Some examples of enteric-coated drugs include:

• Entocort EC (budesonide)
• Erythromycin EC
• Pancrelipase EC
  
• Proton pump inhibitors
  

Sustained-Release Drugs

Sustained-release drugs are similar to enteric-coated medications in that they are meant to be absorbed slowly rather than all at once. Crushing the pill causes the drug to be released all at once. These products sometimes have the letters "ER" or "XR" (extended release), "CR" (controlled-release), or "DA" (delayed-action) in their names.

Drugs like this can include things like:

• Adderall XR (dextroamphetamine-amphetamine extended-release)
• Wellbutrin XL (bupropion hydrochloride extended-release)
• Effexor XR (velafaxine HCI extended-release)

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 side effects' risk (or severity).

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 because 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 stickers on pill packaging stating they should not be crushed. If you don't see a warning label, ask your healthcare provider or pharmacist before crushing any pill.

There are three safe and effective ways to do this if a pill can be crushed.

Pill Crusher

This gadget works by grinding the pill to a fine powder to mix with food or a beverage.

Most pill crushers are handheld devices that you twist to achieve a fine grind. Others look like a stapler or garlic grinder that you grip 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, rounded surfaces, which prevents the powered drug from getting lost in the grooves. Use the device only for pill crushing to avoid contamination.

Pill Splitter

You cannot crush certain pills, 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.

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 problematic for several reasons:

• The action 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

You will need to learn which foods you should or should not mix the medication with. You can safely mix many drugs with things like applesauce, fruit juice, pudding, or water, but not just 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 you can mix the pill with food, your healthcare provider may advise you to take it with only a small amount of soft food. While sprinkling it over yogurt or porridge may help erase any bitter taste, you can lose a lot of the drug if you don't finish the bowl and scrape the bottom thoroughly.

You may also need to take certain drugs without food and 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. Still, it's important to remember that not all medications can be crushed, especially enteric-coated or sustained-release tablets and opioid drugs.

If you can crush a pill, use a recommended method like a pill crusher or a mortar and pestle to grind the pill to a fine powder. Ask your healthcare provider or pharmacist how you should take the powdered drugs, including which foods or beverages are acceptable to take them with.

If the drug you take cannot be crushed, ask your healthcare provider 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 help you improve your ability to swallow pills and your overall quality of life.