Crushing down pills has made it much easier for many patients to take drugs – particularly if they struggle to swallow – but it could actually be wasting valuable medication, a study has found.
Pill crushers are used in hospitals, care homes and even at patients’ own homes, whether it’s a professional instrument, or just using the side of a knife or spoon to powder down pills.
However, a research team from the University of Queensland has found nearly a quarter of the medication can be lost in this process. The group studied 24 popular pill-crushing devices and found there were “significant losses” in 18 of them – with some pills losing up to 24 per cent of their substance.
Hand-twist crushers containing a serrated crushing surface were the worst offenders, while some devices with disposable bags or cups also showed “significant” losses, according to the study, published in journal PLOS One.
One way to retrieve some of the lost powder was by washing out the devices twice, but the team noted that wasn’t always possible in busy health facilities. Meanwhile, not cleaning them after each use could also lead to cross-contamination.
“Crushing devices are often shared between patients, and without cleaning, in nursing homes and hospitals,” the study states. “Even with careful crushing and transferring using porcelain mortar and pestle, our study shows that approximately 3 per cent of drug was left in the crushing device and can potentially transfer to the next patient if not cleaned between administrations.”
The authors ultimately concluded that “healthcare professionals and patients need to recognise that tablet crushing can result in significant drug loss.”
Another issue is aerosolization, which can occur during the crushing process. It essentially means the carer or health professional crushing the pills could be exposed to toxic fumes, “especially when crushing chemotherapy drugs”.
While the US Food and Drug Administration recommends less than 3 per cent of mass loss should occur when drugs are crushed, this study found that 19 of the 24 devices studied couldn’t meet those guidelines.
The team urges anyone worried about a patient or loved one swallowing tablets to order the medication in liquid form from the pharmacy, after getting a prescription from a doctor.
Matthew Bellgrove, from National Custom Compounding on the Gold Coast, said his pharmacy regularly makes up patients’ exact medication in easy-to-swallow liquid form.
“Compounding pharmacists have long been aware that some loss of medication can occur when pills are crushed – especially when the operation is performed on a kitchen bench using the back of a spoon or knife,” he said. “Yet some medial professionals still advise patients to do this.”
“The much safer option is to use the services of a fully qualified and reputable compounding pharmacist who will make up your medication in a liquid form. Then you can accurately measure your doses and know you’re getting the exact amount prescribed – no guesswork and no under-dosing leading to negative health outcomes.”
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