Some Medicines Should Not Be Crushed, Split, or Chewed!
SafeMedicationUse.ca has received a report about an incident involving slow-release tablets of the powerful pain medicine hydromorphone. Slow-release medicines may be labelled as “long-acting”, “extended-release”, “controlled-release” or other similar terms. Slow-release tablets are generally intended to be swallowed whole. They should not be crushed, split, or chewed. If a slow-release tablet is crushed, split, or chewed, a large amount of the medicine may be released all at once. This could cause serious harm.
The consumer involved in this incident had cancer of the esophagus and wished to remain at home. To help manage pain, the consumer was given prescriptions for both slow-release and regular-release hydromorphone tablets. However, as the cancer got worse, the consumer became unable to swallow anything. A type of feeding tube, called a gastrostomy tube or G-tube, was inserted into the stomach. Since the slow-release hydromorphone tablets had to be swallowed whole, the consumer was unable to take them and they could not be given through the G-tube. Therefore, the consumer was given a prescription for an injectable form of hydromorphone, and family members were trained to give the injections.
On a day when a home care nurse was visiting, the consumer was experiencing severe pain. At the time, the slow-release hydromorphone tablets were still in the home. Although family members told the home care nurse that the injectable hydromorphone was available, the nurse did not give an injection to treat the pain. Instead, the nurse crushed one of the slow-release hydromorphone tablets, mixed it with some liquid, and tried to give the mixture through the G-tube. This mixture blocked the tube. The nurse tried to unblock the tube, but these efforts were unsuccessful and caused more pain for the consumer. The consumer was taken to the emergency department but was discharged with the G-tube still blocked. Family members eventually cleared the tube. Later, they realized that pushing the crushed tablet through the G-tube could have made a large dose of the medicine enter the consumer's body all at once, which could have been dangerous.
SafeMedicationUse.ca has the following advice to help prevent harm in similar situations:
- Always check with your pharmacist before crushing, splitting, or chewing any tablet or capsule or before opening any capsule. If you have difficulty swallowing pills, ask your pharmacist for advice. The pharmacist may be able to suggest another form of the medicine or another similar medicine that is easier to swallow.
Take note of any additional labels or warnings on containers of non-prescription and prescription medicines (see Figure 1). Look for warnings that advise against crushing, splitting, or chewing the medicine. Examples of the types of medicines that should not be crushed, split, or chewed include products that are "controlled", "sustained", "prolonged", or "extended" release and medicines that are "enteric coated".
- Figure 1: Take note of additional labels such as the one shown in this example.
© PharmaSystems Inc. Permission received from PharmaSystems Inc. to use this label example within this SafeMedicationUse.ca newsletter
- Make sure that you and your caregivers understand any changes that your prescriber makes to your medicines. Keep a list of all the medicines you take, and share it with all of your caregivers. Read more
- If you have a question or concern about your medicines or other aspects of your healthcare, speak up! Read more
- If you or a family member is taking an opioid pain medicine such as hydromorphone, be aware of the signs that the person is getting too much of the drug. More information, Watch our video
- If your prescriber tells you to stop taking a medicine, ensure the medicine is disposed of properly. More information: