Pill crusher guide: which tablets can be crushed, and how to do it

Who a pill crusher helps

Say your father has started to cough on his morning tablets, or you find a half-chewed pill on his plate. He is not refusing his medicine; the tablets are simply hard to get down. A pill crusher turns a suitable tablet into powder that can be taken with a spoonful of soft food.

It is a small, cheap tool, and it fits in a kitchen drawer or a bag. The harder part is knowing which tablets can be crushed at all, and that answer comes from the pharmacist, not from the crusher.

• Someone who gags, coughs or holds tablets in the mouth
• A helper who prepares medicines for a parent at home
• Someone with weak or stiff hands who cannot break tablets with a spoon
• A person who takes several small tablets that the pharmacist has cleared for crushing

Ask the pharmacist first: which pills can you crush

Not every tablet can be crushed. The NHS Specialist Pharmacy Service says modified-release tablets, often marked MR, SR, XL or LA, are usually unsuitable, and that enteric-coated and gastro-resistant tablets should not be crushed. Crushing a slow-release tablet can release the whole dose at once.

The Institute for Safe Medication Practices adds that endings such as ER, XR, SR, CR and CD often mean slow release, but some tablets with no letters should not be crushed either. So take every box and bottle to the pharmacy and ask, one by one: "Can this be crushed, and is there a liquid or a smaller tablet instead?"

The same service warns against crushing cytotoxic medicines unless there is no alternative, and says the person crushing should take care, because the powder can be breathed in or touch the skin. That is why a short list of pills that should not be crushed, written by the pharmacist for your own medicines, is worth more than any general chart.

• Ask: "Is this a slow-release or coated tablet?"
• Ask: "Can I mix the powder with food, and which foods?"
• Ask: "Should I crush these one at a time or together?"
• Ask: "Do I need gloves or a mask for any of these?"
• Write each answer on the medicine list, so every helper follows it

What to check in a pill crusher

Picture the person who will use it every morning. Most home crushers work by twisting a top against a base, so the grip matters more than anything else. A wide, ridged lid is easier for stiff hands than a small smooth one.

Then think about where the powder goes. A smooth grinding surface lets you tip out all of it, so the full dose is taken. A storage compartment is useful for carrying the day's tablets, and a built-in cup helps when you are out.

• A grip the person can turn firmly without pain
• Room for the largest tablet on the list
• A smooth inside, so no powder is left in the ridges
• A storage compartment if tablets travel with the person
• A cutter blade only if the pharmacist has said splitting is fine

Pill crusher and grinder: how the two picks compare

Both picks come from Ezy Dose, made by Apothecary Products. One is a plain twist crusher with a pill store. The other adds a stainless-steel cutting blade and a drinking cup, for someone who both splits and crushes tablets.

The facts below come from the maker's pages. Neither page lists a warning about which medicines can be crushed, so the pharmacist's answer still comes first.

Put simply, Ezy Crush suits someone who only needs crushing and wants something small for the pocket. Cut N' Crush suits someone whose pharmacist has cleared both halving and crushing, and who takes doses away from home.

• Ezy Crush: twist crusher and grinder, part 68255A, with a built-in compartment for up to 4 aspirin-sized pills
• Ezy Crush sizes: small 2.25 x 2.375 in, large 2.875 x 3 in; the Amazon listing is the small one
• Deluxe Cut N' Crush: part 67750, a stainless-steel blade for cutting, a crusher for fine powder, a pill compartment and a drinking cup
• Grip: Ezy Crush lists an easy-grip design for people with dexterity issues; Cut N' Crush lists a contoured grip

Crushing, mixing and cleaning at home

Crush at a clear table, one dose at a time, just before it is taken. Place the tablet in the base, twist until you feel no more grit, then tip the powder onto a spoon. Mix it only with a food the pharmacist has agreed to.

ISMP suggests a spoonful of applesauce for tablets that are safe to crush but taste bad. The NHS service notes that film-coated tablets can taste bitter once crushed. Say your mother dislikes the taste: ask whether a liquid version exists before you try another food.

• Give the whole spoonful, so the full dose is taken
• Crush each dose fresh, not hours ahead
• Rinse and dry the crusher after each use
• Keep the medicine list with the crusher for visiting helpers

Common mistakes and when to ask for help

The real limit is this: a crusher cannot make a slow-release or coated tablet safe to crush. Only the pharmacist or prescriber can change the medicine, often to a liquid or a different tablet.

Trouble swallowing is also worth raising with the doctor in its own right, especially if food, not only tablets, makes the person cough. An occupational therapist can help with grip and the daily routine. If someone chokes and cannot breathe, call 911.

Watch the first week closely. Sit with the person at one dose time and see whether the whole spoonful goes down easily. Ask them, "Is the taste all right, and is the amount too much?", and take the answer back to the pharmacist.

• Crushing a tablet with ER, SR, XL or CR on the box without asking
• Mixing several crushed medicines into one large bowl of food
• Leaving powder in the crusher, so part of the dose is missed
• Crushing ahead for the whole week