Tuesday, May 14, 2013

The case of the crushed pill

When we were with my grandma in the hospital one day a nurse came in to give her her medications (the one's she always takes) and my mom mentioned one of them (with a yellow coating) to the nurse, that is has to be crushed. The nurse was very surprised that this pill was being crushed, as apparently pills with coatings on them should never be crushed. She went on in quite detail as to why this is and was sure that the nurse from the prior day shift would not have crushed it either. My mom said she didn't know, but 5 years ago the doctor told them to start crushing it because the pill would go right through my grandma and come out in her colostomy bag (sorry, TMI!). They've just been crushing it and giving it to her with applesauce.

The nurse said she was going to go call the hospital pharmacist and see what he said and she came back and said he recommended them not crushed. My mom said she would check with grandma's doctor (which if course she forgot to do). Like I mentioned - this nurse was going on and on about this and why it shouldn't be done.

Fast forward to Sunday, while we are all at my mom's for Mother's Day. We are in the kitchen and she is getting my grandma's pills ready and getting out the crusher to crush her yellow pill. I ask her if she asked the doctor about it (no, she keeps forgetting), BUT, she tells me as she's pouring the crushed pill contents into a little bowl, "I've just been picking out as much of the yellow coating as I can before I put it in the applesauce"

OMG! I say "MOM! That's not what the nurse was talking about! It's not the COATING that is bad for her. Coated pills are time realeased into the system. Crushing them can cause all the medication to go into the system at once.  That is what the nurse was concerned about!"

Goodness! So, I finally think my mom understands. I told her they've been crushing this pill for 5 years with no effects, so I'm sure it's ok, but just to make sure to first question this if they are ever told to do it on other medications.  Then I sent her an email yesterday, before she took my grandma back to her caregiver's place, to be sure to tell her caregiver she doesn't need to spend a half hour picking out yellow coating from the crushed pill every day!


  1. Ouch. I am glad someone caught that. Time-released pills are for a reason, sometimes because the dose is too strong to be released all at once, sometimes because it wont be effective if taken while, for example, awake vs while asleep.

  2. I just had to laugh at your mom about the coating. I'm sure I the doc said crush it, it's ok. Maybe her digestive system can't extract the meds if it's not staying in her track long enough...if she has a "bag", aren't her intestines shortened or compromised in some way?
    I am not a dr. nor do I play one on the internet... ;-)

  3. HI,
    I just wanted to comment. I'm a RN and have been for almost 7 years. Those enteric coated medications are meant to be emulsified and broken down in the small intestine, the coating prevents it from being broken down in the stomach and causing some toxic dosing!!!!!

  4. I'm sure since her primary care dr told her to crush this pill (because her system won't absorb it) it's ok - she's been doing it 5 years with no effects. I just thought it hilarious that my mom thought the nurse was saying the coating itself was not good for her, so has been spending time trying to pick out the yellow pieces after she crushes it! Sluggy - I'm not sure how the "bag" and her system all work - I just know that pill went right through her.

    Debbie - it is good info to know, and like I told my mom. she should now know to double check and question any future coated meds my grandma may be told to crush, just to be on the safe side!