Swallowing medication is a significant issue for 15-30% of the healthy population, and this has become more problematic in recent years with the increased use of tablets and capsules as main form of medical treatment across a variety of medical conditions. It is even more of a problem for those individuals who experience dysphagia.
As humans, it is very unnatural to not chew something that we place into our mouths. In order to swallow a medication, we have to suppress this chewing reflex AND the gag reflex that forcefully ejects items that aren’t chewed effectively.
The issue that arises when a person has difficulty swallowing medication, is the tendency to alter the form of a medication to make it easier to swallow.
Crushing changes how effective the medication is:
Crushing reduces how safe the medication is:
|Food Items||Not all medications reacted the same|
Amlodipine delayed by mixing with jam
When crushed, Warfarin + Carbemazapine were delayed when mixed with honey, jam or yoghurt
|Extremely thick fluids (IDDSI 4)|
With xanthan gum based thickening agent
|Delayed release of all medications tested!|
Atenelol (50% after 30 minutes)
Warfarin (14% after 30 minutes)
|Mildly thick (IDDSI 2) and Moderately Thick fluids (IDDSI 3)||Delayed release of all medications tested however to a lesser extent than when mixed with IDDSI 4 fluids|
|Medication Carrier (e.g. ‘Gloup’)||Amount of dose dissolved after 30 minutes is similar to administration with water if dose is whole or crushed|
As soon as you modify the original form of a medication, the manufacturer of that medication will no longer confirm its safety.
If someone takes the medication in the modified form, it is considered to be an ‘off-label use’ as the medication is not being taken the way that it was intended to be taken, and the manufacturer is no longer liable for adverse medication effects!
More Information about crushing medications can be found in the 2018 book ‘Don’t Rush to Crush’ which provides detailed information provided by Pharmacists on the best way to administer medication for people with dysphagia or who require tube-feeding where they can’t have their medications orally.
Always be sure to consult with your Pharmacist before crushing medications or your Speech Pathologist if you are having difficulty swallowing your tablet.
Cichero, J. (2020). ‘Medications and dysphagia: Challenges across the lifespan’. Webinar – Speech Pathology Australia.
Karch, A. M., & Karch, F. E. (2000). Practice errors: A hard pill to swallow. The American Journal of Nursing.
Manrique, Y. J., Lee, D. J., Islam, F., Nissen, L. M., Cichero, J. A. Y., Stokes, J. R., & Steadman, K, J. (2014). Crushed Tablets: Does the Administration of Food Vehicles and Thickened Fluids to Aid Medication Swallowing Alter Drug Release? Journal of Pharmacy & Pharmaceutical Sciences.
Thong, M. Y., Manrique, Y. J., & Steadman, K. J. (2018). Drug loss while crushing tablets: Comparison of tablet crushing devices. PLoS ONE, 1;13(13). DOI: 10.1371/journal.pone.0193683