For some people, swallowing pills is difficult. A natural solution may be to cut or crush tablets or even mix them into food to make taking medications easier. While this approach works with some medicines, it’s important to know that not all medications are safe to alter. Crushing, chewing, or breaking certain pills can change the way they work in the body—sometimes with dangerous consequences.
Why Crushing or Chewing Can Be Risky
Many medications are designed with special coatings or release mechanisms so that the drug is absorbed into the body in a very specific way. When that design is changed—by breaking, chewing, or crushing—the medication may act too quickly, too strongly, or not at al
As a general rule, medications should not be crushed or chewed if they are formulated as:
- Delayed Release (DR)
- Extended Release (ER)
- Controlled Release (CR)
- Enteric Coated (EC)
These formulations are carefully engineered to release medication gradually or at a specific point in the digestive tract. Crushing or chewing them disrupts this timing.
You can often spot these medications by their name suffixes, such as: ER, DR, CR, LA, SR, XR, CC, CD, SA, XL.
Opioids: A Serious Warning
Long-acting opioid medications are particularly dangerous when altered. Crushing them can cause something called dose dumping—a rapid release of the entire dose at once. This can lead to a fatal overdose.
In addition, many long-acting opioid products are designed with abuse-deterrent formulations that deactivate the medication if tampered with. Some examples include:
- OxyContin
- Oxecta
- Embeda
- Zohydro
- Hysingla
Because of the risks, it is critical never to crush or chew these medications.
Common Medications That Should NOT Be Crushed or Chewed
Here are just a few commonly prescribed medications that should be taken whole:
- Diltiazem (Cardizem) tablets
- Bisacodyl (Dulcolax) tablets or capsules
- Mycophenolate (CellCept) tablets or capsules
- Claritin-D (loratadine-pseudoephedrine) tablets
- Hydromorphone (Exalgo) tablets
- Methylphenidate (Concerta) tablets
- Duloxetine (Cymbalta) capsules
This is not a complete list, but it highlights how everyday medications can be impacted.
How to Stay Safe
- Check the package insert:Medication guides included with prescriptions are the most reliable source of information.
- Ask the pharmacist:If a patient has difficulty taking pills, your pharmacist can review options like liquid formulations, dissolvable tablets, or compounded alternatives.
- Refer to trusted resources:The Institute for Safe Medication Practices (ISMP) offers a comprehensive “Do Not Crush” list at ismp.org.
At HospiceChoice Rx, we know that medication management can be challenging, especially for patients with swallowing difficulties. While it may seem helpful to crush or break pills, doing so can put patients at risk by altering how the medicine is meant to work.
This blog is for informational and educational purposes only and is not a substitute for medical advice, diagnosis, or treatment provided by a qualified health care provider.