Health
Crushing drugs can reduce efficacy, worsen side effects, say pharmacists
Iyanuoluwa Abiola
Crushing modified-release tablets can cause medicines designed to be released gradually to enter the body too quickly, exposing patients to toxic effects, severe side effects and treatment failure, pharmacists have warned.
They explained that modified-release medicines are specially formulated to control how quickly or where their active ingredients are released in the body.
The pharmacists cautioned that crushing such tablets could destroy the mechanism designed to regulate the release of the medicine, causing too much of the drug to enter the body at once instead of being released gradually as intended.
They urged patients who have difficulty swallowing tablets not to crush their medicines on their own, but to consult a pharmacist or doctor about safer alternatives.
Modified-release medicines are formulations designed to alter the rate or timing of drug release. They may be labelled with terms such as MR, SR, XL or LA, depending on the product and its release characteristics.
The UK National Health Service Specialist Pharmacy Service says modified-release preparations are usually unsuitable for crushing because doing so can cause the drug to be released too quickly, resulting in higher blood levels and a risk of toxic effects, or cause it to be released at the wrong site in the gastrointestinal tract, reducing its effectiveness.
The US Food and Drug Administration also advises that when manipulating an extended-release medicine could affect its safety or effectiveness, patients should be instructed to swallow the tablets whole and avoid crushing, splitting or chewing them.
The World Health Organisation has identified unsafe medication practices and medication errors as major causes of preventable harm, stressing the need for safer medication use by patients and health professionals.
In an exclusive interview with PUNCH Healthwise, the Medical Director and Superintendent Pharmacist, Engraced Pharmacy, Idimu, Lagos, Jonah Okotie, explained that modified-release medicines were specially prepared to release their active ingredients at a particular rate, duration or location to achieve the desired therapeutic effect.
Okotie warned that crushing such medicines could expose patients to excessive amounts of the active ingredient at once and undermine the intended treatment.
“Crushing will not only increase exposure to the unwanted effects of the medicine on the body, but it will also likely cause the product to fail,” he stated.
He explained that a medicine designed to work gradually could produce an unnecessarily high concentration in the body when its release mechanism was destroyed.
“A medicine designed to work slowly will have it dumped on the system at once, causing a tsunami effect where the concentration of the medicine will be unnecessarily high compared to what it should have been, leading to exaggerated effects which can be inimical to the health of the person concerned. Harming instead of healing them,” he stated.
Okotie added that the consequences could include excessive exposure to the medicine, unwanted effects, wastage and treatment failure.
The MD of Engraced Pharmacy cautioned patients against independently altering the form of their medicines, particularly when they had difficulty swallowing tablets.
“Modified release medications must not be split. If for any reason, the client cannot swallow, consult your Pharmacist, who, if need be, should converse with your Physician to see if they can work around it or get you an equivalent alternative to ensure the desired treatment outcome,” he advised.
Okotie noted that modified-release characteristics were usually indicated on the primary and secondary packaging of medicines, stressing that proper counselling was essential before patients began using them.
“For modified medicines, it is clearly stated in the primary and secondary packs. So, before taking any medicine, especially prescription medicines, counselling is essential. Professionalism can make the difference between treatment success and failure, life and death,” he stated.
He also stressed pharmacists’ responsibility to explain how medicines should be taken and the factors that could affect their effectiveness.
“For pharmacists who do not advise or counsel their patients when they’re administering medications, you can almost say that borders on professional misconduct because your responsibility as a pharmacist is that when you are giving medication to somebody, you are advising or counselling the person what that medicine is, what the medicine is being used for and how the person is to take the medicine, including the things the person can do or take that may, in one way or the other, affect that medicine,” the pharmacist stated.
Speaking exclusively with PUNCH Healthwise, a Community Pharmacist with Pedov Healthcare Limited, Pedro Ebomese, warned that crushing modified-release medicines could expose patients to the entire dose within a short period rather than over the intended duration.
“These are medications that can last a longer period of time in your body,” he stated.
Ebomese explained that destroying the release mechanism could result in excessive drug levels and toxicity.
“If you go and crush such a tablet, you understand, you might be getting into trouble because if it is a dangerous drug that shouldn’t get to your body all at once, you will be having an issue with overdose and high toxicity because you are taking a drug that was modified to stay in your body for like 24 hours. Now, by crushing it, you are releasing it into your body at the same time. Your body physiology will not be able to accommodate everything all at once,” he stated.
He added that premature release could also leave patients without adequate drug coverage for the remainder of the intended dosing period.
“By crushing it, one, you have damaged, destroyed the manufacturer’s intent. Two, you are exposing yourself to toxicity. Three, you might get every one of the drugs in your system within a short period of time. So, at other times of the day, you are not protected,” Ebomese stated.
Pedov’s pharmacy manager advised patients who could not swallow their medicines to discuss the problem with a pharmacist rather than deciding to crush the tablets themselves, noting that alternative formulations may be available depending on the medicine.
“The only way you can mitigate such mistakes by the patients is that they should constantly involve the pharmacist in that establishment,” Ebomese advised.
Copyright PUNCH
All rights reserved. This material, and other digital content on this website, may not be reproduced, published, broadcast, rewritten or redistributed in whole or in part without prior express written permission from PUNCH.
Contact: health_wise@punchng.
