an article of Lydia AmelaBSP Nurse Assistance
The drugs are presented in different dosage forms that influence its therapeutic activity. However, alteration of the integrity of pharmaceutical forms is very frequent, split or crush the pills. In theory, all drugs should be administered without handling.
Most of the drugs used today are in solid form (in tablets), so it is a common activity to break the pills and even crush them, and open the capsules: due to the patient’s difficulty in swallowing or the behavioral disorders they suffer from, and also to adjust the dose.
- Crush the medication
The swallowing disorders They are common among the elderly and this makes the administration of oral medications sometimes difficult. The same goes for people who suffer. behavioral disorders. Generally one chooses crush the medication and open the capsules to extract their content. This practice seems to be very common in geriatrics and many times it is not given much attention as it is a “common practice”… despite the fact that it can lead to a series of problems.
Crushing medication can carry risks since not all medication can be crushed without suffering significant alterations. It should not be applied to certain medications because there is a risk of eliminate the benefits of its active ingredients. In addition to favoring the conservation of these active principles and protecting them against factors of alteration, the forms of presentation of some medicines mask and correct odors or tastes nasty.
- split the medication
There are many reasons why they are often split the medicines. It is usually done for adjust to treatment and thus obtain the prescribed dose or to swallow the pills more easily.
This can have serious clinical consequences, since sometimes take wrong doses, which could mean a serious health hazard. For example, with some drugs, especially the smallest ones, with a simple mistake when dividing them, the prescribed dose can be exceeded and a degree of toxicity can be produced, with a serious risk to health.
On the other hand, it is generally considered that if the manufacturer marked a dividing line on the tablet it means that they are suitable for breaking. However, this is not always the case, as there is a degree of inaccuracy in splitting due to its shape, size or type of coating.
The pills can be broken either by hand, with a knife, scissors, or with a pill splitter. When the division is not homogeneous, inaccuracy in the dose or waste is favored, since sometimes they are divided into more than two portions. The use of the pill splitter provides a more precise “cut”, but it also produces errors.
The medication partition becomes problematic when dealing with large deviations in doses or when drugs have a narrow therapeutic index, i.e. when a small difference in dosage can make a big difference in therapeutic effects.
However, there are also situations in which patients require a dose of medication that can only be obtained by “splitting” the pill, either because there is no other route of administration or because the patient cannot take the medication in any other way.
- Problems that come with…
Splitting or crushing pills can cause significant variations in the dose administered and may affect the release and absorption characteristics of the drug’s active ingredient. In addition, it can increase the risk of adverse reactions, problems in the efficacy of the drug and/or side effects.
There are pharmaceutical forms that have a special cover, whose purpose is to regulate the speed with which the active ingredient is released. In general, they should not be divided or crushed, since this breaks the mechanism that controls the release and gives rise to an uncontrolled delivery of the drug, and there may be “underdosing” or overdosing. Moreover, it could even reach toxic concentrations or increase the probability of adverse effects.
Also note that there are pharmaceutical forms of enteric coated, whose purpose is that medicines pass intact through the stomach and release the active substance in the intestine to avoid stomach irritation and prevent destruction of the active substance by stomach acids and delay the onset of action. The removal of this cover when crushing them would negatively affect their pharmacological action, could cause irritation of the mucosa of the digestive tract and generate side effects or toxicity.
For their part, sublingual tablets are designed to dissolve quickly and obtain rapid absorption. These medicines are dissolved under the tongue so that they reach the bloodstream in a short time, and if the tablet is crushed, the effect of the medicine is modified.
Finally, indicate that some medicines, when crushed, can disperse in the air and be breathed in, which can represent a risk for the person carrying out this work. For example, there are drugs that are irritating to the mucosa, or teratogenic.
- Alternatives, what can we do?
An alternative is look for other more recommended dosage formsapart from pills, that do not require manipulation.
On the other hand, if a particular drug is not available in an alternative dosage form, it may there is another drug in the same therapeutic groupby which it can be substituted and which can be achieved in one of these other forms.