Many people often find it difficult to swallow large-sized oral tablets or capsules when taking medication, especially when giving medication to children. As a result, they often crush the tablets before ingestion. However, it is important to note that some types of medication should not be crushed as it may not only reduce their therapeutic effects but also lead to significant side effects. Doctors should remind patients that the following medications should not be crushed:
Sublingual Tablets
Sublingual tablets are designed to be placed under the tongue for rapid absorption, such as nitroglycerin. Breaking or crushing these tablets would interfere with their intended mechanism of action and reduce their effectiveness.
Enteric-Coated Tablets
Enteric-coated tablets, like multienzyme tablets containing amylase, gastric protease, and pancreatic enzymes, have a dual-layered sugar coating. The outer layer of the coating contains amylase and gastric protease, which aid digestion in the stomach. The inner layer contains pancreatic enzymes, which need an alkaline environment in the intestines to function properly. Crushing these tablets would result in the loss of the protective coating, especially the pancreatic enzyme, which can irritate the oral mucosa and cause severe mouth ulcers.
Buccal Tablets
Buccal tablets are designed to dissolve slowly in the mouth and are generally harder in texture. They are commonly used for oral and throat diseases, such as Jinsangzi Throat Treasure and Watermelon Frost tablets. Therefore, there is no need to break or crush them.
Capsules
Capsules not only help mask the taste and odor of medications but also enhance their bioavailability upon dissolution in the gastrointestinal tract. Opening capsules would release a strong smell, making it unsuitable for children to take, and it would also be difficult to accurately measure the dosage. Capsules can be divided into regular capsules and sustained-release capsules. Crushing sustained-release capsules would destroy their structure and prevent them from achieving the intended slow-release effect.
Sustained-Release Tablets
Sustained-release tablets are designed to release medications slowly over an extended period of time, ensuring a steady blood concentration and reducing the frequency of administration. These tablets contain a controlled-release membrane that regulates the rate of drug release. Crushing these tablets would damage the membrane, preventing them from achieving the sustained-release effect. In some cases, crushing and ingesting them would cause rapid drug release, leading to a sudden increase in blood concentration and potential drug toxicity.
Controlled-Release Tablets
Controlled-release tablets consist of a semi-permeable membrane, drug layer, and polymer push layer. The push layer absorbs water based on osmotic gradient, resulting in pressure that pushes the drug layer to release medication through laser-drilled micropores in the semi-permeable membrane at a constant rate. Therefore, breaking these tablets would disrupt their structure, causing rapid drug release and significant changes in blood concentration. Hence, they should not be broken or crushed.
Enteric-Coated Tablets
Enteric-coated tablets are regular tablets with an outer coating that only dissolves in the intestines. Breaking or crushing these tablets would cause them to dissolve in the stomach, preventing them from reaching the intestines and exerting their intended effects. In some cases, they may also irritate the gastric mucosa. Therefore, these tablets must be swallowed whole, and crushing them would not only reduce the effectiveness of the medication but also lead to potential side effects.
