Such drugs include digoxin (LANOXIN) and anticoagulants (blood thinners). This can be particularly dangerous with drugs for which there is only a small difference between a drug level that is effective and one that is toxic - the so-called “narrow therapeutic range” or margin of safety. Drug overdosingįor some drugs, crushing, chewing or opening a tablet or capsule before swallowing can cause the rapid absorption of a large amount of the drug, potentially resulting in an overdose. The Prescrire International review highlighted examples of each of these potentially dangerous circumstances for several commonly used drugs. Depending on the drug, this can result in overdosing, underdosing or direct toxic injury to the lining of the mouth, stomach or intestines. This design can improve patient compliance and drug effectiveness while decreasing the risk of adverse effects.Ĭrushing a tablet, opening a capsule or chewing either of these can circumvent many of the protective design features intended to control when and where a drug is released in the digestive tract. This sustained-release (also called controlled-release, long-acting and extended-release) design provides the convenience of once- or twice-daily dosing and minimizes the variation in the amount of drug in the blood over the course of a day. In addition, many drugs in tablet or capsule form are designed to release their active ingredients even more slowly, over a period of 12 to 24 hours as the tablets or granules from the capsule pass through the small intestine. Only when these tablets or capsules move from the stomach to the small intestine will the coating dissolve, allowing release of the active ingredients. For these drugs to work, the active ingredients must be able to withstand exposure to the strong acid found in the stomach before they are absorbed.įor other drugs containing active ingredients that would otherwise be broken down by stomach acid, manufacturers have designed tablets and capsules with acid-resistant coatings (often called enteric coatings). Drug companies use complex manufacturing techniques to combine these ingredients into final products that are designed to release their active ingredients at a specific rate and in a specific location within the digestive tract, such as the stomach or the small intestine.įor example, some uncoated, immediate-release tablets are designed to disintegrate quickly in the stomach, whereupon the active ingredients are rapidly absorbed into the bloodstream. Inactive ingredients include coating materials, flavorings, dyes and binders that hold tablets or granules from capsules together. Oral medications available in tablet or capsule form contain one or more active ingredients - the actual drug intended to treat a particular disease or condition - and several inactive ingredients. However, an important 2014 review published in Prescrire International warned that many medicines available in tablet or capsule form are not supposed to be crushed, opened or chewed before swallowing - and that doing so may have serious, sometimes deadly, consequences. Some patients also may resort to chewing on the pills or capsules before swallowing. To cope with this problem, patients, caregivers and health care providers frequently crush tablets or open capsules and sprinkle the resulting powder, fragments or granules into food or liquids. Young children also often cannot swallow pills or capsules. This problem is particularly common in older patients with neurological disorders that impair swallowing, such as dementia and Parkinson’s disease xerostomia (decreased saliva production causing dry mouth) and diseases of the throat and esophagus. Some patients find it difficult or impossible to swallow large tablets or capsules.
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