Study: Medication effectiveness diminishes when patients crush tablets

People who take more than 4 doses of medicine a day appear more likely to crush tablets or open capsules potentially reducing their effectiveness, according to a study published in the Journal of Pharmacy Practice and Research.

Researchers from the Queensland University of Technology (QUT), Brisbane, Australia, recruited 369 consumers from 5 community pharmacies in Brisbane to participate in a structured verbal questionnaire.

Esther Lau, PhD, one of the researchers from QUT's School of Clinical Sciences, and colleagues found that approximately 16.5% of the people they surveyed reported experiencing swallowing difficulties, and that people taking 4 or more doses of medication each day appeared more likely to crush their tablets or open their capsules.

Almost half (44.2%) of the respondents did not think there would be issues with crushing or modifying tablets or capsules.

“It was concerning to us that many of the people surveyed did not seem aware of the potential dangers associated with modifying dosage forms,” Lau said. “We also found that most of the people who modified their medication dosage forms tended to get advice from family and friends.

Related:Americans at risk for alcohol-drug interactions

Overall, 1 in 10 people reported modifying medication dosage forms, regardless of how many doses they were taking.

“What also surprised us was that none of the people we surveyed were advised by a pharmacist on what to do to make it easier for them to swallow their medications,” Lau added. “Many people were also reluctant to seek advice from a health professional before modifying medication dosage forms, and they would not tell a health professional if they experienced difficulty swallowing.”

This study highlights the need for standardized clinical guidelines to approach the management of medications in people with swallowing difficulties. Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia can occur at any age, but it's more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause.

Related: [BLOG]: Medications are the new battlefield and pharmacists are the best "recon" agents

“Standard operating procedures may also reflect that health professionals need to be more assertive in providing consumer education,” Lau said. “This ensures the general public is aware of the potential issues associated with swallowing difficulties and modifying medication dosage forms.

“Pharmacists are the medication experts, and ideally a pharmacist should be involved in advising and providing suitable options for administering medications to patients at risk of swallowing difficulties,” Lau said. “However, managing swallowing difficulties should take an interdisciplinary approach and healthcare professionals need to care for these patients as a team.”

Lau and colleague Manuel Serrano Santos are working with a group of international experts to advocate for an interdisciplinary approach for caring for patients with, or at risk of, swallowing troubles.

Read next: [BLOG]: How to position your hospital pharmacy as a strategic asset