Information for Health Care Professionals | Tablets and capsules that should not be crushed or opened

These are frequently identifiable by two letters, such as m/r, LA, SA, CR, XL or SR, or the words 'Retard' or 'Slow' at the end of the name. They are designed to be released gradually over a prolonged period of time, reducing the risk of patients suffering side effects. They are taken just once or twice a day.

Crushing or opening an extended release formulation may damage the mechanism for slow absorption causing the patient to experience dangerous peaks and subtherapeutic troughs in drug-plasma concentration.

The graphs below show how the concentration of drug in the body or plasma varies for both an extended release preparation taken once daily that is swallowed whole and for one that is crushed or opened.

The first graph relates to an extended release preparation that has not been crushed or opened. It does not sharply peak but gradually increases and plateaus before gradually decreasing without reaching the point at which the patient is likely to suffer side effects.

However, if the medicine is crushed or opened before you swallow it, the graph will look like the one below. You can see that there is a very sharp, high peak soon after taking the medicine, and this is when you are extremely likely to suffer what could be severe side effects. The amount of drug in the body then tails off and there will not be enough in the body for it to work properly.

These usually have the letters EN or EC at the end of the name.

These medicines are designed to pass from the stomach into the intestine before releasing the active drug. Crushing or opening the medicine will destroy the enteric coating, which could increase the risk of stomach irritation, releasing the drug in the wrong place or reducing its effectiveness.

Crushing or opening hormonal cytotoxic steroidal medicines may cause some of the drug to go into the air. This could be dangerous as it may be received by those around you.

In addition to the above, it is also important to remember that if somebody is helping to give you the medicine, they may have a sensitivity towards it. If this is the case when the tablet is crushed or the capsule is opened, if they come into contact with the medicine they could have a serious reaction.

If you are still considering crushing a tablet or opening a capsule, you should contact your local pharmacist to check whether or not it is a good idea. If not your pharmacist will be able to tell you if a liquid alternative is available.