Medication Crushing for Easier Swallowing: Safety Considerations
Crushing medications should be avoided whenever possible due to potential risks of drug exposure and inaccuracies in dosing, but certain medications can be safely crushed when necessary for patients with swallowing difficulties.
When to Consider Crushing Medications
- Crushing medications should only be considered as a last resort after exploring other alternatives for patients with swallowing difficulties 1
- Before crushing any medication, consult with a pharmacist to determine if the medication can be safely crushed 1
- Alternative formulations (liquids, topical applications) should be considered first when available 1
Medications That Should NOT Be Crushed
- Sustained-release or extended-release formulations should never be crushed as this disrupts the controlled release mechanism, potentially causing overdose 2
- Enteric-coated medications should not be crushed as this destroys the gastro-resistant layer, potentially causing underdosing or irritation 2
- Medications with carcinogenic, teratogenic, fetotoxic, or allergenic properties should not be crushed due to exposure risks 2
- Delayed-release medications should be avoided in patients with short bowel syndrome 1
Safe Crushing Practices
- Involve a pharmacist in the decision-making process for crushing medications 1
- Use appropriate tools and techniques to ensure accurate dosing when crushing is necessary 1
- For enteral tube administration, use appropriate syringes and connectors that meet recognized standards to avoid misconnection errors 1
- When using low-dose ENFit syringes, do not shake the syringe to remove drug residue as this can affect dosing accuracy and expose people to the medication 1
Administration Considerations
- Crushed medications can be mixed with small amounts of soft food (like applesauce) to improve palatability 3
- Consider the palatability of crushed medications, as this can affect patient adherence 3
- When administering through enteral tubes, flush the tube before and after administration to prevent blockage 1
- Be aware that some liquid medications may contain sorbitol, which can contribute to diarrhea 1
Special Populations
- For elderly patients with dysphagia, a coordinated effort from the entire care team is necessary to develop an individualized medication administration plan 4
- For patients with short bowel syndrome, consider the site of drug delivery and potential interactions with enteral formula 1
Legal and Clinical Implications
- Using a product outside the terms of its Summary of Product Characteristics carries additional responsibility 1
- Crushing medications may be considered off-label use of licensed medicines in some jurisdictions 1
- Healthcare providers should document the clinical rationale for crushing medications 5
Alternative Approaches
- Consider teaching pill-swallowing techniques or using pill-swallowing aids before resorting to crushing 6
- For medications that cannot be crushed, explore different dosing schedules, formulations, or routes of administration 1, 6
- In some cases, deprescribing may be appropriate if no suitable alternative exists 6
By following these guidelines and consulting with a pharmacist before crushing any medication, healthcare providers can minimize risks while ensuring patients receive necessary medications in a form they can safely take.