“The dosage of each dose, how many times a day, before or after meals” are a few of the issues that people usually focus on when taking medications, but in fact, in addition to these, whether a drug can be broken open is also an important aspect of medication, especially for children with swallowing difficulties, the elderly, etc. Experts say that some drugs are not suitable for breaking, including extended-release, controlled-release preparations and enteric preparations, etc. Breaking the drug is likely to destroy the structure of the drug, and may even cause nausea, vomiting and other adverse pharmacological reactions.
How to determine whether the drug can be broken open to take?
We need to make it clear that whether a drug can be broken and taken is determined by the nature of the drug itself and the characteristics of the drug formulation, not just a large tablet can be broken and taken. The wrong way to take the drug may destroy the structure of the drug to play the effect, and in serious cases may even cause adverse reactions, so what are the specific basis for judgment?
First, follow the doctor’s instructions. Doctors often prescribe medication for how to use the corresponding guidance to patients, the need for special attention to the method of taking medication should be highly valued by patients. If the doctor clearly points out that a certain type of medicine can not be broken open to eat, need to take the whole piece, the patient should strictly follow the doctor’s instructions to take the medicine.
Second, read the drug instructions. Drug instructions often cover many precautions for medication, and need to read carefully before taking the drug. If the instructions indicate that it can be broken open and taken, it can be taken with confidence; if the instructions say “this product must be swallowed whole, not chewed or crushed”, then the whole tablet should be taken.
In addition, you can also look at the pill’s scoring. The indentations are designed to make it easier for the patient to break the tablet neatly, but some drugs such as extended-release tablets cannot be judged by the presence of indentations/medium lines on the tablet. Therefore, for drugs with indentations, you should also take into account the contents of the drug instructions or ask your doctor to determine how to use the drug.
What are the common drugs that cannot be broken and why?
The drugs that cannot be broken open include extended-release tablets, controlled-release tablets, enteric-coated tablets and double-coated tablets, which are closely related to the characteristics of the dosage form of the drugs.
Extended-release tablets: The tablets of extended-release tablets are similar to ordinary tablets in appearance, but there is a semi-permeable membrane on the outside of the tablets. After the oral tablet enters the patient’s stomach, the gastric juice can enter the tablet through this semi-permeable membrane to dissolve part of the drug, forming a certain osmotic pressure, pushing the drug to seep out from the micro-pores on the membrane and releasing it slowly within a certain period of time, which makes this kind of drug can maintain its efficacy for a longer period of time.
When taking such drugs, if chewed (or grinded), it will destroy its semi-permeable membrane, i.e., the effect of slow release of drugs cannot be achieved, thus affecting the efficacy of drugs. For example, breaking open potassium chloride extended-release tablets (tretinoin) can lead to a high concentration of potassium chloride release, which can irritate the gastrointestinal tract and may cause vomiting.
Such drugs mainly include: theophylline extended-release tablets, which are commonly used in the treatment of elderly bronchial asthma and pulmonary heart disease; nifedipine (cardiac pain) extended-release tablets, which are commonly used in the treatment of hypertension and coronary heart disease; metronidazole extended-release tablets, potassium chloride extended-release tablets, sodium valproate extended-release tablets (Depakene), ibuprofen extended-release capsules (Fenbid), tamsulosin hydrochloride extended-release capsules, etc.
Controlled-release tablets: Controlled-release tablets are drugs placed in synthetic high-quality inert polymers, so that the drug is released slowly at a constant or near-constant rate, i.e., timed and quantitative release. If chewed (grinded) when taking such drugs, it will destroy the polymer carrying the drug, which not only affects the efficacy, but also can cause side effects.
Commonly used drugs include: nifedipine controlled-release tablets (Byxin Tong), glipizide controlled-release tablets (Rexin), morphine sulfate controlled-release tablets (Methocarbamol), metoprolol tartrate controlled-release tablets (Lijuning), etc.
When broken or crushed, extended-release and controlled-release tablets cause the body to overabsorb the drug first, and then the concentration of the drug will drop to a level that will not last until the next dose. This can cause adverse reactions to the patient caused by the overdose, followed by a variety of possible complications caused by low drug concentrations.
Enteric tablets: An enteric tablet is a drug dosage form that is not released or barely released in the stomach for a specified period of time, but is mostly or completely released in a part of the intestine after entering the intestine. This late release drug effect is usually achieved by wrapping a film coating of enteric material around the surface of the drug.
If these drugs are broken open, the enteric coating will be damaged, resulting in the destruction of the drug components that cannot resist the decomposition of gastric acid, which not only greatly reduces the effectiveness of the drug, but also may increase the adverse drug reactions. For example, if cefuroxime tablets are broken open, the efficacy will be reduced; aspirin enteric-coated tablets, erythromycin enteric-coated tablets, anti-inflammatory pain enteric-coated tablets, etc. may cause gastric ulcer, gastric bleeding and other phenomena.
Commonly used enteric tablets include: aspirin enteric tablets, thymus enteric peptide enteric tablets, indomethacin (anti-inflammatory pain) enteric tablets, serrapeptase enteric tablets (Dasian), omeprazole (Loxac) enteric capsules, diammonium glycyrrhizate enteric tablets (Glycine), diclofenac sodium enteric tablets (diclofenac pain), etc.
Double-layer sugar-coated tablets: multi-enzyme tablets are often used in this drug dosage form. The multi-enzyme tablets contain amylase, pancreatic enzyme and pepsin. The tablets are double-layered, the outer layer is sugar-coated and contains amylase and pepsin, which play the role of digestive aid in the stomach; the inner layer is enteric-coated and contains pancreatic enzymes, which play the role in the alkaline environment of the intestine. If the tablets are broken (grinded), the pancreatic enzymes will lose the outer protective coating and cannot reach the intestine. Moreover, if the pancreatic enzymes remain in the mouth, they will irritate the oral mucosa and can cause mouth ulcers in serious cases.
In addition, there are several other points of medication knowledge that need to be brought to your attention.
Whether a drug can be “broken” and used is not necessarily related to whether it can be “chewed” or “ground”.
Some drugs can be broken open even though it is stated in the instructions that they cannot be ground or chewed.
Capsules can also be broken open for use
Some capsules, such as Bifidobacterium trisporus capsules, have a note in the instruction manual that “the capsule can be opened for patients with swallowing difficulties”, so the capsule can be broken open for use.
The same drug may not always be broken open
The same drug produced by different manufacturers, some marked can be broken open to take, but some are not marked, which may be related to the different production processes of drugs. Therefore, when using drugs from different manufacturers, be sure to read the instructions carefully, not blindly according to the previous method of medication, in order to avoid adverse consequences.
Finally, it is recommended that you read the drug instructions carefully before using the drug. If the instructions do not clearly indicate whether the drug can be broken and taken, you can ask your doctor and try not to break the drug and take it easily.