For patients with hypertension
managing blood pressure is always a top priority
Recently, Ms. Zhang from Fujian
after splitting a
sustained-release antihypertensive tablet
fell into a coma, nearly endangering her life
Why is it that sustained-release antihypertensive medications cannot be split? According to Huang Liangjiu, Director of the Pharmacy Department at Hainan Cancer Hospital, whether a tablet can be split or crushed depends on its dosage form. Clinically, there are many types of commonly used tablets, such as regular compressed tablets, film-coated tablets, enteric-coated tablets, coated tablets, sublingual tablets, dispersible tablets, buccal tablets, sustained-release tablets, controlled-release tablets, and effervescent tablets. Among them, dispersible tablets, orally disintegrating tablets, sublingual tablets, and chewable tablets, due to their uniform properties, can rapidly disintegrate and absorb once inside the body. As long as the dose is accurate, they can be split, crushed, or chewed as instructed.
However, many tablets should not be split, chewed, or dissolved in the mouth, as doing so can affect the medications normal absorption and metabolism in the body, increase irritation to the gastrointestinal tract, and even lead to more serious consequences. The following types of medications should never be split.
1.Sustained-Release and Controlled-Release Formulations
Administration method: Unless specifically stated in the instructions, these tablets should generally be swallowed whole, not split, crushed, or chewed.
As the name suggests, "sustained-release" and "controlled-release" tablets are designed with a special coating to control the release rate of the medication, providing more stable and long-lasting effects. Splitting or chewing these tablets will destroy this “coating”, making it impossible to control the release time and location of the medication.
For instance, in the case of Ms. Zhang, because she chewed the tablet, a large dose of the antihypertensive drug was instantly released into her body (known as the "dose dumping phenomenon"), causing her blood pressure to drop drastically, which led to shock and was extremely dangerous.
Its worth noting that some sustained-release or controlled-release tablets can indeed be split, depending on the tablets manufacturing process (these tablets often have a score line).
In short, even for the same medication, there may be variations, where some manufacturers produce tablets that can be split, while others cannot. Therefore, always carefully read the medication instructions before use. If the instructions are unclear or if you are unsure, consult your physician or pharmacist.
2. Enteric-Coated Tablets
Administration method: Generally recommended to be swallowed with water on an empty stomach before meals (unless otherwise specified).
Enteric-coated tablets also have an outer layer that protects the medication from being dissolved in the stomach, allowing it to release only after reaching the intestines. Examples include enteric-coated aspirin and omeprazole enteric-coated tablets.
If taken after a meal, the large amount of food in the stomach may obstruct the medication from quickly reaching the intestines and dilute the stomach acid, raising the stomachs pH levels. This can cause the enteric coating to dissolve prematurely in the stomach, reducing the drugs efficacy and increasing stomach irritation. Therefore, it is best to avoid taking these after meals.
3. Coated Tablets
Administration method: Generally recommended to swallow the whole tablet with water.
Many tablets come with a hard outer coating, and some even have a sweet taste when placed in the mouth. Do not underestimate this coating — it can protect the medication from being destroyed by stomach acid, improve the tablets appearance, mask unpleasant taste, and prevent moisture and light from affecting the medications stability.
If split or crushed, the stability of the medication may be compromised, reducing its efficacy and increasing the risk of adverse reactions. For instance, diclofenac sodium and misoprostol tablets, as well as multienzyme tablets, should not be split or crushed.
4. Capsules
Administration method: Generally, capsules should be swallowed whole with warm water. For infants or toddlers who cannot swallow capsules, consult a doctor or pharmacist to determine whether the capsule can be opened and administered.
“I don’t like swallowing capsules. Can I just take the powder inside orally?”
It is not recommended! The capsule shell not only masks the odor of the medication but also reduces its irritation. Many sustained-release, controlled-release, and enteric-coated medications come in capsule form. Opening the capsule may prevent accurate dosage control and increase the risk of adverse gastrointestinal effects.
For patients such as children who have difficulty swallowing capsules, some capsules are designed to be split, like topiramate capsules for epilepsy. However, how to take the split contents must be done according to the doctor’s instructions.
5. Effervescent Tablets
Administration method: Effervescent tablets must be dissolved in cold or warm water and should be consumed only after the bubbles have completely disappeared. They should never be swallowed or taken sublingually.
“I don’t have warm water nearby. Can I swallow the effervescent tablet directly?”
Absolutely not! Effervescent tablets contain sodium bicarbonate and organic acids, which produce carbon dioxide gas when they come into contact with water, creating a fizzing effect. Swallowing them directly can generate a large amount of gas in the mouth or digestive tract, posing risks of choking or stomach perforation.
There are some special cases, such as vaginal effervescent tablets, which do not need to be dissolved and can be placed directly into the vagina.
6. Chemotherapy Drugs and Targeted Drugs
Administration method: It is not recommended to split these medications (except for a few that are explicitly stated in the instructions as being water-soluble).
Oral chemotherapy drugs are highly toxic. If they are split or crushed, the person handling the drugs may come into direct contact with them, or the powder may come into contact with the eyes or be inhaled into the lungs, posing cytotoxic risks to the body.
Most targeted drugs are usually recommended to be swallowed whole with warm water and should not be split, chewed, or crushed. However, some drugs can be dispersed in half a cup of drinking water without being crushed and can be stirred until fully dissolved. Each medication requires specific analysis.
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Editor | Huang Fei