This study investigated 24 tablet crushing devices for drug loss using different methods to recover the crushed tablet. 24 devices were compared: 3 with disposable cups, 6 with disposable bags, 12 without separate vessels and 3 types of mortar and pestle. One paracetamol tablet was crushed and recovered by tapping the powder out. Where appropriate, depending on crusher size and manufacturer instructions, the powder was also recovered by mixing with water or food. Paracetamol recovery (quantity that can be delivered to a patient) and leftover (quantity remaining in the device) were measured using a validated UV method and the entire experiment was replicated 3 times. Drug recovery ranged from 86.7–98.1% when the crushed tablet was tapped out of the crushers (average loss 5.8%). Significant losses were measured for 18 crushers, particularly manually operated hand-twist crushers with a serrated crushing surface, and some devices with disposable bags or cups. Rinsing the crushed powder with water once resulted in an average of 24.2% drug loss, and this was reduced to 4.2% after a second rinse. If crushing is unavoidable, maximizing medication delivery to the patient is essential. Rinsing twice resulted in similar paracetamol recovery to tapping the powder out; however only water rinses have the potential for direct consumption by the patient, minimizing drug loss across the entire crushing and transfer process.
Thanks for posting helvella and many of us wouldn't have thought there would be much difference when crushing a tablet instead of swallowing whole with water.
I think quite a number of people swallow crushed tablets especially if they find it difficult to swallow it whole.
There was another post today where you replied re: how big the piece of medication which was actually active and where it might be in each tablet. Sorry I can’t find it again but thinking about it during today I was concerned that cutting tablets might cut out the ‘active’ piece altogether OR getting the whole active piece in one dose and nothing in the other sections?
I hope this makes sense. Can you comment again on this or guide me to the post please?
The question of how well the active ingredient is dispersed/spread in the tablet highlights a real issue.
The MHRA have said that is why, in general, "breaklines" on tablets are not meant for dose splitting. Just for identification and so that the tablet can be taken in two parts (i.e. if you cannot swallow them whole).
Some tablets have express instructions for splitting - but in such cases, the MHRA will have determined it is OK.
Some time back, I watched a film of a machine used to produce the powder for making tablets. More or less they bunged the ingredients in and turned it on! But they might mix for a while then add something else. And it wasn't five minutes - more like five hours of continuous mixing. The end result was still a powder - but slightly granular. The active ingredient should be evenly in all the particles.
The MHRA require levothyroxine to be within 90 to 105% of declared potency. I suspect that if a tablet divides cleanly, and nothing is lost, the amount in each half would be within that specification.
And, if it isn't, well, many of us are prescribed alternate day dosing - say, 50/.75 or 75/100. And that is a much larger variation.
the T4 (or T3) isn't really all together in "one active piece" , the grain of sugar comparison was just an example , to give an indication of what size it would be if you stuck all the T4 molecules in a tablet together ... in reality the molecules of T4 (or T3) are fairly evenly distributed throughout the other 'ingredients' (or at least they should be)
Something would have had to go very wrong with the manufacturing process for all the T4 (or T3) to end up in a clump in one part of the tablet .
like cake mixing .. you'd have to forget to mix it at all to get all the baking powder in one bit of cake ,.. mix it properly and it's evenly distributed throughout the cake
tattybogle too. Thank you so much for getting back to me with this excellent info and putting my mind somewhat at rest. I was particularly concerned about T3 (whilst not yet re-attempting it) as I have to introduce it in such small amounts!
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