Pharmacological Risks Of Medicines Manipulation

According to a report by the Royal Pharmacological Society in 2011, it is important to recognise potential consequences of manipulating a medicinal product.

Changing the way in which a dosage form is presented can alter:

Stability

The stability of the medicine may be compromised after crushing a solid dose form especially if it has an enteric coating. The removal of the coating may lead to the medicine degradation by both the gastric acidic environment & exposure to light.

Pharmacokinetics and bioavailability

Pharmacokinetics and bioavailability of the medicine can change upon crushing of oral solid dose forms which can impact on efficacy and safety. Such changes may be of particularly important consequence for some medicines given their narrow therapeutic windows.^[1]

Irritation effects

The purpose of coating on oral solid dose forms is meant to shield patients from its irritant actions. Some medications may cause oesophageal or stomach irritation or ulceration if tablets are crushed or capsules opened.^[1]

Risks to healthcare workers and carers

Crushing carcinogenic or teratogenic products, preparations containing hormones (oral contraceptives; hormonal replacement therapy), corticosteroids and some other drugs may potentially expose carers or healthcare professionals to health risks through powder aerosolization ^[1],^[2],^[3].

Additionally, some products may also cause irritation if the powder is aerosolised and inhaled or comes into contact with the eyes, skin, or other mucous membranes.^[1]

Taste profile

Many medicines have an unpleasant bitter taste where a coating (sugar/film) is used to help mask the taste of the active substance. Crushing tablets containing bitter or unpleasant taste may hinder patient compliance with the medicine.^[1]

The MODRIC guidelines from Alder Hey state not to manipulate medicines presented as modified release dosage forms (e.g., Controlled Release, Sustained Release, Modified Release) unless specific information from the manufacturer or pharmacist permits manipulation.^[4]

Follow the principles of medicines management to help minimise the need for any kind of manipulation.

ROS000057-006 Sep 2023