Pharmacy question.

General Questions
#1

As it happens I crush pills everyday for someone who couldn’t take them otherwise.

I have a mortar and pestle, I open capsules and crush tablets. Some are coated and really hard, some uncoated and easily crushed.

So the Mr quits smoking last year and I was cleaning out the pantry shelf and found a card of the Zyban tablets and I noticed it said. Do Not Crush. Several times. In large letters.

I’ve been thinking about it ever since and I can’t really think of why that would be.

So I’m asking you, under what circumstances would it not be wise to crush pills?

And as long as you’re here; Does it matter what you mix it with? (To try and cover the taste.)

#2

Time-release pills can’t be crushed. If you crush them the medication that’s supposed to be released over an extended period is released all at once.

Some pills also have a coating so absorption is delayed until they reach the small intestine, cutting down on stomach irritation.

#3

Zyban is a sustained-release pill. The outside is coated to break down in the lower G-I tract (going by memory so forgive me if I’m a little off). Cutting the tablet in half would also defeat the purpose. Some meds are SR (sustained-release) because they are hard on the stomach. As for mixing, yes there are some concerns. Some meds do not mix well with food, grapefruit for example. My advice speak to your local pharmacist. Hope this helps. Laters.

#4

As a side note, most pharmacies (ie walgreens) now have pill crushers which are very nice. It’s a two part thingie that you put the pill in and screw the top down on to the pill. Even really hard pills crush quite easily and neatly in them. Also they’re about the size of a golf ball, so there’s less surface area to scrape the powder off of.
http://www.dynamic-living.com/pill_crusher.htm

If you do a search on ‘pill crusher’ you’ll come up with quite a few different styles.

#5

Zyban® and Wellbutrin SR® (both bupropion HCl) are sold in a sustained-release formula not because bupropion can be hard on the stomach, but because the original, immediate-release formula caused a higher incidence of seizures than other antidepressants. (The original Wellbutrin was introduced in 1986, I believe, and withdrawn a year or two later.) Burroughs-Wellcome (later Glaxo-Wellcome) reformulated the tablet in a sustained-release formula, which reduced the possible occurence of seizure to an acceptable level (i.e., comparable to other antidepressants).

However, Wellbutrin SR had a hard time re-establishing itself as a first-line depression med because the name was still associated with seizure. (A shame, because IMO, it’s a highly-effective antidepressant, especially for lazy depression, as it’s rather stimulating.) As well, by that time, Prozac® had made its splashy debut.

Gradually, Wellbutrin SR taken its place as a widely-prescribed antidepressant (and Zyban as an aid to smoking cessation), but I doubt many GPs think of it as first-line treatment (though psychiatrists would be more open to the idea). A small dose of Wellbutrin SR added to an SSRI such as Paxil® has been shown to reduce or reverse the incidence of SSRI-induced sexual side-effects. (Wellbutrin on its own doesn’t really cause these kind of side-effects; in fact, it can improve low libido.)

More info here: http://www.wellbutrin-side-effects.com/wonderful-wellbutrin.html

So, back to the point of the OP, to crush Wellbutrin SR tablets would turn them into regular Wellbutrin, releasing all of the medication into the system at once, rather than more gradually - and the risk of seizure would be greater.

A side note: Wellbutrin XL® - a once-daily dosing - is now available in the U.S. The extended-release formulation has been improved. GlaxoSmithKline (formerly Glaxo-Wellcome and SmithKlineBeecham) wanted to release it under a completely different name, to escape the “risk of seizure” curse associated with Wellbutrin, but the FDA said no.

#6

If you’re crushing every pill that comes into the house, you might want to talk to your pharmacist about which ones are safe to crush, and which ones might not be. You might also want to talk to the patient’s doctor about getting liquids prescribed, rather than pills/capsules. As scott mentioned, crushing bupropion is a Very Bad Thing.

Robin

#7

Thanks so much for clearing that up for me.

The Zyban was for the Mr and never crushed, I promise.

The pills I crush are for my bedridden Mother-in-law, 18 a day, we’ve been doing it for a long time now and her Dr. is aware so I doubt there’s a potential problem there.

I am assuming there are no liquid alternatives available.

There is another pill (ducosate sodium), comes in a oil filled little gelatinous orange football. We used to attempt to drain it, oh what fun that was! We’d peirce it then squeeze it, it would shoot somewhere into the room. Most of the oil would end up on our fingertips. We asked but couldn’t get it in another form. After many frustrating mornings involving cursing and swearing, we learned to just stick it into a piece of banana and, voila, problem solved. School’s never out around this place.

I was just curious, as it never even occured to me that it could be a problem with crushing meds, and I just knew someone at the Straight Dope would have an answer. Thanks again!

#8

Your mother-in-law’s doctor may be aware, but it’s still a good idea to consult a pharmacist. They’re the ones who are trained in medicines and how they come. A doctor isn’t necessarily going to know that, and something may slide past him.

Robin

#9

If you know of a compounding pharmacist nearby, they might be very helpful – they specialize in changing the dosage forms of drugs for people who have trouble with the usual forms. For example, they might be able to combine several pills into a liquid form. Pharmaceutical companies manufacture their products in only a few forms to save on costs, so liquids are available for only a few drugs. A compounding pharmacist can prepare a different form – such as a liquid or lozenge – for people who can’t take pills or capsules.

You can search for a compounding pharmacist here.