Crushing or opening pills

If you or someone you care for struggles to swallow pills, you should discuss it with your doctor or pharmacist.

Alternative forms of the medicine are sometimes available, or you may just need to experiment with some simple swallowing techniques.

This page gives some basic advice and outlines the clinical and legal issues around crushing tablets or opening capsules.

This advice applies to:

adults who have difficulty swallowing pills
parents of children who struggle to swallow pills
nurses or carers of people with dysphagia (swallowing problems)

Finding an alternative form

If you or the person you care for finds it difficult to swallow tablets or capsules, you can ask your GP or pharmacist if there's an alternative form of the medicine.

The Swallowing Difficulties website and the British National Formulary (BNF) may also have details of possible alternatives.

Your pills may also be available in one of the following forms:

a liquid – particularly useful for people with dysphagia who rely on a feeding tube
a dispersible – tablet that disintegrates in water
a buccal – tablet that dissolves when held between cheek and gum
a patch
a suppository – inserted into the bottom or vagina
a cream
an inhaled version

Seek the advice of a doctor or pharmacist if you feel unsure about giving medicine – for example, if you're not sure how to give liquid medicine through a feeding tube.

Crushing tablets or opening capsules

You can ask your GP or pharmacist if your tablets can be crushed, or your capsules opened and dispersed in water, before taking them. Only certain tablets or capsules can be given this way.

The following preparations should never be crushed without seeking professional advice first:

CR or CRT (controlled release, or controlled release tablet)
LA (long-acting)
SR (sustained release)
TR (time release)
TD (time delay)
SA (sustained action)
XL (extended release)

These medications are designed to be released over a predetermined period of time – for example, 12-24 hours.

Generally, when crushing a tablet or opening a capsule, the dose is released over 5-10 minutes, resulting in an initial overdose (and a higher chance of side effects), followed by a period without medication.

Legal issues

A nurse or carer of someone with dysphagia shouldn't alter the form of a medicine by crushing or opening it, unless they've been instructed to do so by a doctor.

If you crush or open the medicine to give to another person, you're administering it in an unlicensed form. If you haven't consulted a doctor about it, this would render you personally liable for any harm caused, and you would have to justify your actions in the event of an adverse reaction.

The Swallowing Difficulties website has more information about the legal consequences of tablet crushing.

10 tips for swallowing pills

1. Moisten your mouth with saliva or water beforehand (a dry mouth makes swallowing harder).

2. Place the pill in the centre of your tongue, and lengthways along your tongue if the pill is oval-shaped.

3. Immediately take a sip of water and wash the pill directly into your throat, throwing your head back.

4. Hold water in your mouth before inserting the pill – suspending the pill in water may help to flush it down.

5. Try using a straw to drink the water (the suction may help).

6. Taking a deep breath may help suppress your gag reflex.

7. Try chewing some food before placing the pill in your mouth, and swallow the food and pill together.

8. Insert the pill into a small piece of bread or marshmallow.

9. After swallowing the pill, follow it up with food to help it go down.

10. Try putting your chin to your chest when swallowing – this will open up your windpipe and may be better for you than throwing your head back.

NB: These tips are based on common sense, rather than scientific evidence, and may not work for everyone.