Medications that should not be crushed

Gracia-Vásquez, Sandra; González-Barranco, Patricia; Camacho-Mora, Ivonne Antonieta; González-Santiago, Omar; Vázquez‐Rodríguez, Sofia

doi:10.1016/j.rmu.2017.03.001

Cited by 20 publications

(22 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Even though pulverizing prescription tablets is customary in clinical practice, for patients who have difficulty swallowing tablets or who require medication via a gastric tube, it is important to note that the efficacy and safety of drugs in powdered form have not been adequately investigated 15 . Approximately 80% of Japanese psychiatric hospitals employ pulverization for patients who need medication administered through a gastric tube, with few adverse events reported 16 .…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that changes in medication quality or effects (stability in light, humidity, and varying temperature; bioavailability, such as absorption; change in flavor; and drug loss during preparation) may occur due to pulverization. Despite several reports predicting adverse events resulting from crushing prescriptions analogous to pharmacological characteristics, 15 there are currently no reports validating this concern pharmacologically. Thus, pulverization performed in accordance with dispensary guidelines or prescribing information is largely deemed safe.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pulverizing medication as a harm reduction and intentional drug overdose prevention strategy: Two case studies

Takanobu

Okazaki²,

Watanabe

et al. 2021

Neuropsychopharm Rep

View full text Add to dashboard Cite

Aims We explored the use of pulverized medication as a new method to prevent intentional drug overdose. Methods This case study presents data obtained from the medical records of two female patients, aged 19 and 27 years, who presented with schizophrenia and neurodevelopmental disorder, respectively. Both patients provided written informed consent. Medication was administered to the two patients in powdered form, as opposed to in tablet form, in an attempt to prevent intentional drug overdose. Results This administration method successfully prevented intentional drug overdose for 3 and 5 years in each case, respectively. However, case‐control or prospective cohort studies are needed to rule out biases, including cognitive bias. Conclusion Pulverizing medication is a simple and effective means of preventing intentional drug overdose by restricting access to the means of suicide, regardless of the type of mental disorder.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pulverizing medication as a harm reduction and intentional drug overdose prevention strategy: Two case studies

Takanobu

Okazaki²,

Watanabe

et al. 2021

Neuropsychopharm Rep

View full text Add to dashboard Cite

show abstract

“…When the prescribed or required dose is unavailable, medicines, especially tablets, are crushed and cut in half to obtain the specific dose. The therapeutic window of enteric coated and sublingual medicines is altered, and the risk of carcinogenicity may increase by splitting tablets [52].…”

Section: Discussionmentioning

confidence: 99%

Patients’ Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan

Aziz

Jiang

Masood

et al. 2019

IJERPH

View full text Add to dashboard Cite

Background: Community pharmacies are an integrated part of healthcare systems worldwide. In low and middle income countries like Pakistan, the paradigm of pharmacy practice is shifting from dispensing medicines to clinical activities. There are disparities in these practices according to location. Pharmacies in urban localities are better than those in rural areas. This qualitative study was conducted to explore patients’ expectations and current practices in rural pharmacies. Methods: A cohort of adult pharmacy visitors (aged > 18 years) that reside in rural community was selected. Consenting participants were recruited by purposive sampling technique until thematic saturation level was achieved. A total of 34 patients were interviewed. Face-to-face interviews were conducted using a semi structured interview guide. All the data were transcribed and used to originate the themes. Results: On analysis, a total of 20 themes were obtained. Sixteen themes pronounced the current provided services. Four themes provided some suggestions for the development of better pharmacies. On call services to provide medicines, limited free extended pharmacy services, interest in patients’ wellbeing, appropriate referral, vaccination, free medical camp, medical services at home, first aid, and counseling were appreciated by patients. Patients stated that medicines are inappropriately stored in unhygienic conditions, prices of medicines are comparatively high, and medicines are substandard. Unavailability of medicines, inept dispensing, limited staffing with poor knowledge, limited working hours, and quackery promotion are challenges in rural pharmacy practice. Patients say that non marginal pricing, informative services, new legislation, and proper vigilance by officials can improve the pharmacy services in rural communities. Conclusions: Patients alleged that rural pharmacies perform deprived practices. To improve service, new legislation and the proper implementation of existing law is needed.

show abstract

“…Patient acceptability and adherence may be reduced when taste masking is affected and the bad taste of the active substance becomes (more) apparent on swallowing 17 . Also, patients and caregivers may not realise that some tablets are not suitable for breaking because of their specific design aspects, meaning breaking may result in dose dumping or a lack of effect 18 . When tablet parts are mixed with food or drink, chemical or physical interactions may occur and the stability or bio‐availability of the tablet parts may be affected 19,20 …”

Section: Tablet Breakingmentioning

confidence: 99%

Developing patient‐centric medicines for older people: Reflections from the draft EMA paper on the pharmaceutical development of medicines for use in the older population

Riet‐Nales

Sundberg

Boer

et al. 2020

Brit J Clinical Pharma

View full text Add to dashboard Cite

Increased global longevity requires a re‐evaluation of current structures in society to adapt to the consequential demographic shift. As (very) old people are prone to impaired human organ and body functions resulting in, for example, multimorbidity, polypharmacy, hospitalisation and problems in medication management, it is increasingly acknowledged that re‐evaluations should include the suitability of pharmaceutical patient care as one of the cornerstones of public health. Following the 2011 European Medicines Agency (EMA) Geriatric Strategy, in 2017 the EMA published the draft “Reflection paper on the pharmaceutical development of medicines for use in the older population”. The draft paper was opened for public consultation and specific attention and feedback (either supportive or with a proposal for revision) was asked on three design aspects: tablet breaking, drug administration through enteral feeding tubes and medication management. Following publication, the draft paper was presented at two public conferences attended by participants from different disciplines. This manuscript is intended to draw the attention of different stakeholder parties to the urgent need to collaborate on the emerging issues arising from increasing longevity and multimorbidity, and especially those associated with pharmaceutical patient care and drug product design, including the need for collaborative research into existing or emerging knowledge gaps. The manuscript focuses on the three aforementioned aspects of pharmaceutical development (tablet breaking, drug administration through enteral feeding tubes and medication management) as these highly relate to medication safety and efficacy and constitute persistent and typical challenges for older people, caregivers and healthcare professionals in daily clinical practice.

show abstract

Medications that should not be crushed

Cited by 20 publications

References 15 publications

Pulverizing medication as a harm reduction and intentional drug overdose prevention strategy: Two case studies

Pulverizing medication as a harm reduction and intentional drug overdose prevention strategy: Two case studies

Patients’ Anticipation for the Pharmacies of Rural Communities: A Qualitative Study from Pakistan

Developing patient‐centric medicines for older people: Reflections from the draft EMA paper on the pharmaceutical development of medicines for use in the older population

Contact Info

Product

Resources

About