Some people are incapable of swallowing tablets because of physical reasons, such as surgery or gastric reflux, while others struggle for psychological reasons. What can these people do when the doctor prescribes a drug that comes in tablet form?
The standard tablet is designed to be swallowed whole. Once in the stomach, it absorbs water, which causes it to swell and break apart. As it breaks apart, the drug dissolves over a predictable period of time, gets absorbed into the bloodstream and moves around the body.
Some people end up chewing tablets or crushing them up and mixing them with their food, but this can sometimes cause the medicine to not work properly. In some cases, ingesting a crushed tablet can even result in death.
Important clues
For a number of reasons some tablets shouldn’t be crushed or chewed. Most importantly, doing so may result in dose dumping; this is when the body very quickly absorbs a large amount of a drug. One consequence of dose dumping is an overdose of the drug, which can lead to death.
Some tablets also come with a special protective layer, called an enteric coating, which is designed to stop it from breaking apart in the stomach. The coating ensures the tablet disintegrates in the small intestine instead. If you chew an enterically coated tablet, the drug will not be absorbed properly and the medicine may be ineffective.
Tablets designed to be chewed have this indicated on their packaging. This is common for drugs designed for young children and certain types of tablets such as multivitamins.
Some medicines are also specifically made into a chewable form, such as some aspirin tablets and certain antacids. These are common medicines that may be taken on a regular basis, and by people known to have trouble swallowing tablets.
Photo – The packaging of most medicines has a printed warning if they shouldn’t be chewed. Ano Lobb/Flickr, CC BY
The packaging of most other medicines will have a printed warning if the tablets shouldn’t be chewed or crushed. A warning sticker may be placed on the box by the pharmacist when she dispenses the medicine, or the instructions on the back of the box will state that the medicine should not be crushed.
The same rules apply for capsules and caplets. Look for a warning on the box before you attempt to chew them or cut them open. But this applies only to the solid forms of capsules. If you’re taking a gelcap formulation (a soft, liquid-filled tablet), then it’s never all right to chew or cut it open. And if you’re in any doubt, ask your pharmacist as she’ll be able to give you a definitive answer.
The alternatives
If you aren’t able to swallow tablets and your doctor has just prescribed you a medicine that comes in a tablet or capsule formulation, then it’s worthwhile asking your pharmacist whether she can provide the medicine in a different form.
Compounding pharmacies can make their own formulations of some drugs. It may be possible for them to dispense the medicine to you as a solution, syrup or an elixir, which are all liquid medicine formulations. And if you’re up for something different, they may be able to formulate a suppository for you.
Suppositories are drug formulations designed to be placed in the rectum. Instead of disintegrating like a tablet does in the stomach, a suppository is designed to melt and release the drug. Most suppositories are made from the same fats and oils found in chocolate, which cause the suppositories to melt when placed in the body.
A suppository is useful for people who can’t swallow tablets for any number of reasons. These may include normal adult patients, but they’re particularly useful for babies, people with swollen throats or severe nausea, or anyone who is unconscious.
What you need to remember is that if you have difficulty swallowing tablets, check the medicine box and ask your pharmacist whether it would be all right to chew or crush your medicine. Much of the time, this will be fine. If it’s not, ask your pharmacist if she can provide an alternative formulation.
Author: Nial Wheate - PhD FRACI CChem FHEA - University of Sydney
Associate Professor Wheate completed a Bachelor of Science degree with 1st class honours from the University of New South Wales whilst at the Australian Defence Force Academy. He then completed a PhD in medicinal chemistry under Professor J. Grant Collins. Since then he has worked in the School of Biomedical and Health Sciences at the University of Western Sydney (Australia) and the Strathclyde Institute of Pharmacy and Biomedical Science (Scotland) before taking up a position in the Faculty of Pharmacy at the University of Sydney (Australia) in 2012. Associate Professor Wheate is currently the Program Director of the pharmacy undergraduate degrees at The University of Sydney and was previously the Head of Cancer Research in the Faculty of Pharmacy. He holds the positions: Member, Academic Board of The University of Sydney Member, University Executive - Student Life Committee Member, Undergraduate Studies Committee (As nominee of the Academic Board) Associate Professor Wheate's research interests lie in drug delivery and pharmaceutical formulation. He has a particular research interest in the drug delivery application of macrocycles (including cyclodextrins, cucurbiturils, calixarenes, and pillararenes) and their host-guest complexes.
