What are the considerations when crushing tablets or opening capsules in a care home setting?

Iram Husain, Regional MI Manager/Pharmacist , London Medicines Information ServiceSource UKMiPublished

Summary of considerations

  • How essential is the medication? Are there alternative formulations (e.g. liquids, patches or sublingual tablets) or medications that can be used?
  • Before a person crushes or opens a medication, a pharmacist should always be consulted to find out if this is possible and this should be approved by the prescriber and documented in patient records.
  • There are solid dose formulations that should never be crushed or opened without appropriate advice from a pharmacist such as some enteric coated tablets or capsules, modified release preparations, hormone, steroid, antibiotic or chemotherapy (cytotoxic) medicines.
  • Additional patient monitoring may be required which the pharmacist will advise on.
  • When administering medication via feeding tubes (PEG, NG, NJ) other issues need to be considered. If medicines are given via the feeding tubes without the correct advice, drug bioavailability may be altered, tubes may become occluded or drugs may bind to the feeding tube. Factors affecting drug delivery via feeding tubes are discussed in ‘how do the different types of enteral feeding tubes available affect drug administration?’.

In certain circumstances tablets may need to be crushed or capsules opened, but crushing a tablet or removing powder or granules from a capsule might affect the way a medicine works and may even cause side effects. This MQA considers the various options for medication administration when these circumstances arise, e.g. patient preference, swallowing difficulties, dysphagia.