Beware, drugs designed to be swallowed shouldn’t be chewed

Many people do the unimaginable when it comes to taking their medications. For instance, some people chew their drugs that are meant to be swallowed with water; while some individuals use soft drinks for their drugs!

According to pharmacists, when people chew drugs that are designed to be swallowed, it not only affects the efficacy of the drugs but also worsens the degree of their side effects.

Experts say for several reasons some tablets shouldn’t be crushed or chewed.

“Most importantly, doing so may result in dose dumping; this is when the body very quickly absorbs a large amount of a drug. One consequence of dose dumping is an overdose of the drug, which can lead to death”, according to pharmacists.

A former National President, Association of Community Pharmacists of Nigeria, Dr. Samuel Adekola, said people should take drugs based on instruction by a pharmacist and not by their own choice.

According to him, chewing or swallowing drugs without water affects their dissolution in the stomach as well as their absorption in the small intestine, thereby making them less effective.

Adekola, who spoke in an exclusive interview with PUNCH HealthWise said chewing enteric-coated drugs could aggravate their side effects such as ulcers because they were not meant to be chewed.

The pharmacists explained, “The essence of using water to swallow drugs is to ease transportation to the stomach where they will dissolve and then to the small intestine where the absorption occurs.

“The pH of the stomach is acidic, so there are certain types of drugs like septrin that require plenty of water when taking them. If you are going to swallow drugs, particularly capsules without water, you run the risk of the drug sticking on the throat and it can cause choking.

“Apart from water-aiding transportation of drugs to the stomach, failure to use water to swallow drugs affects their dissolution in the stomach and  this can create another problem.”

The United Kingdom’s Royal Pharmaceutical Society says it is important to recognise the potential consequences of manipulating a medicinal product.

According to the body, changing how a dosage form is presented can alter its absorption characteristics, result in medicine instability, produce local irritant effects, and cause failure to reach the site of action.

“It may produce occupational health and safety issues and could result in a preparation with an unacceptable taste”, the body added.

 Adekola further noted that chewing tablets without water also had its implications though they were meant to be chewed.

“ Now, when you chew, it just disintegrates, the drug has not dissolved. So, it still has to be transported to the stomach with water where the proper dissolution will take place.

“ This dissolution of the drug will be hampered if not taken with water”, he said.

Giving further insight, the pharmacist noted, “If the drug is not dissolved, it can not be absorbed. Drugs depend on water for dissolution. It is going to hamper the dissolution. Note that after chewing the drugs, some are left in the mouth, and at the end of the day, you are not going to have a total component of the drug delivered to the stomach.

“ It’s only those that the saliva can push to the stomach that will be available for absorption. This can affect the efficacy of drugs and the patient may not get the full concentration.

“Every drug has a percentage that should get into the system for it to be effective. If drugs are stocked in the mouth after chewing, some percentage of the drugs will not get to the stomach where they are supposed to be absorbed.”

 Adekola said the risks of chewing drugs are more with certain enteric-coated drugs that usually cause problems when they get to the stomach.

“ If they get to the stomach, they tend to create problems like ulcers,  for example, aspirin.  We still try to use these drugs because of their usefulness.

“Sometimes, one of the ways that they are being formulated is to make them enterically coated. What that means is that they are protected and shielded from the stomach acid. So, they are allowed to only disintegrate after they leave the stomach.

“When you swallow them, they will not dissolve in the stomach compartments rather they will still be transported down to the small intestine before the dissolution will take place. That way, you will overcome the side effects of induction of ulcers.

“Now,  if you chew them despite the fact that they are bitter, you are aiding their disintegration and dissolution, thereby increasing the chances and degree of their side effects”, he said.

The pharmacist reiterated that enterically coated drugs are not expected to dissolve even in the stomach and therefore, cannot be chewed.

He advised patients to be rational about drug use and to always take drugs based on prescriptions and instructions from healthcare professionals.

Also speaking, another community pharmacist, Biola Paul-Ozieh, blamed the irrational use of drugs on unrestricted access to medicines which she added contributed to the increase in drug abuse among teenagers in the country.

She said, “Parents and guardians have a role to play in ensuring that young Nigerians do not abuse drugs because it predisposes them to chronic diseases. They should ensure that all medicines are bought from pharmacies with the ‘Green Cross’ pharmacy emblem where they will be guided on the usage.”

Meanwhile, Sheila Rivera, a pharmacist with Sharp Rees-Stealy Medical Centres, United States, Trexie Olivar, warns that ‘dry swallowing’ medication can pose a potential choking hazard, and that there are other dangers to this practice that people might not even realize.

“A pill making contact with the lining of the esophagus — the muscular tube that connects your mouth to your stomach — may cause tissue damage and inflammation,” Olivar stated in an online platform, Sharp Healthcare.

This may cause difficulty swallowing, bleeding, heartburn, or chest pain, which may lead to more complications if left untreated.

Almost any kind of drug can be harmful if not swallowed correctly, but Olivar pointed out that pain-relieving medication such as aspirin and ibuprofen; supplements such as potassium chloride and vitamin C; and some antibiotics are among the worst culprits.

Rivera and Olivar recommend drinking a full 8-ounce glass of water when taking medications. Olivar said a full glass of water is best because taking just one or two sips can also cause harm.

“Not drinking enough water may also cause throat irritation and, in some cases, prevent medication from working properly,” she added.