Why so many pills are TOO BIG to swallow

And why it’s safe to crush or cut up some — but not others

requires additional monitoring to check for potential side- effects. Even though it’s a normal-release drug, it shouldn’t be cut because little is known about the consequences. GLIMEPIRIDE Brand name Amaryl THESE oblong 8mm-wide tablets, which can be yellow, green or pink depending on the dose, are usually scored so they can be split into smaller pieces by doctors to adjust the doses, but also to make them easier to swallow — it’s fine to do this if you take the whole dose. REPALINIDE Brand name Prandin AVAILABLE in various doses and coloured accordingly, this tablet is generally only 6mm wide but can be split and crushed with water if you want.

ACID REFLUX AND GUT PROBLEMS

OMEPRAZOLE Brand names losec or Zanprol A TREATMENT for gastric ulcers and acid reflux, this is an extendedrelease drug that comes in tablet and capsule form. Capsules should be swallowed whole to ensure the drug is only released once they reach the stomach to stop it producing acid. however, they can be opened and the contents mixed with half a glass of water or a slightly acidic fluid such as fruit juice, which helps protect the drug’s potency intact until swallowed — but swallow quickly. PANTOPRAZOLE Brand name Pantoloc A HEARTBURN treatment, these bright yellow oval tablets, nearly 1cm long, are only available in gastro-resistant release form — the coating prevents breakdown as the pill passes through the stomach to ensure its release in the gut. For this reason, they must not even be chewed, let alone crushed. MESALAZINE Brand names Asacol, Pentasa or salofalk THESE are designed to be released in the bowel for treating ulcerative colitis, a type of inflammatory bowel disease. mesalazine is also available as a suppository but both oral pill and suppository are gastro-resistant to make the drug survive the stomach and reach its destination, so you must not split or crush them, as this will cause side- effects and won’t help treat the condition. RANITIDINE HYDROCHLORIDE Brand names Zantac, ranitic USED for heartburn and indigestion, this round tablet (8mm wide) can be crushed or dissolved in water.

INFECTIONS

(antibiotics) ERYTHROMYCIN Brand name Erymax THESE orange capsules and tablets are small and have special coatings in order to protect the drug as it passes through the harsh acidic conditions of the stomach, and reach the gut where it is needed. You must swallow these whole. AMOXICILLIN Brand name Amoxil This comes as a red and white or blue and pink capsule but while it releases the drug normally, it should be swallowed whole to ensure you get the full dose from the small pill. TRIMETHOPRIM Brand names Proloprim, monotrim, and Triprim THESE tablets are white compressed powder and can be split, cut and crushed to ease swallowing. FLUCLOXACILLIN SODIUM Brand name Floxapen THESE caramel- coloured hard gelatin capsules need to be swallowed whole to ensure you get

the entire dose, and there is not enough evidence of the risks of emptying this capsule to do so. CLARITHROMYCIN Brand name Klaricid THESE off-white tablets are available in both normal and extended-release forms. The standard version can be split, but the higher dose extended-release forms cannot — some infections may require faster-acting drugs, whereas others need more consistent long-term release over a day or so after getting to the stomach. Crushing the extended-release tablet can cause overdose.

ANGINA NIFEDIPINE Brand names Adalat, Adipine or Coracten THIS comes as a soft gel capsule or tablet and is an extended-release medication to ensure enough drug is delivered consist- ently over 24 hours, and a special coating to help it reach the gut where it is released.

BOTH the soft gel capsule and tablet are just under 2cm wide, and although large, cannot be split or crushed. DILTIAZEM Brand names Adizem, Dilzem or Kenzem THIS drug is available as a normal and extended-release tablets and capsules. The coating is designed to release the drug over approximately three hours for optimal benefits.

Although the standard pill can technically be split, avoid this as it changes the drug’s activity, meaning it is released too quickly and so does not act as it should to alleviate symptoms. Patients should try and swallow all forms of this drug whole. ISOSORBIDE MONONITRATE Brand names Imdur, Ismo THESE cream-coloured tablets are scored with lines for doctors to guide the right dose for patients, but you should not assume this means you can cut them up smaller to swallow, as they are actually extended-release tablets.

Unless your doctor tells you to, do not break, crush, or even chew these before swallowing. VERAPAMIL HYDROCHLORIDE Brand names Securon or Univer THIS drug is available in standard tablet form and extended-release capsule. The small tablet is usually scored and you can break it in half, or even smaller.

But you must not open and empty the contents of the capsule as this interferes with the release of the active drug, which can be dangerous. LACIDIPINE Brand name Motens THESE white oval tablets are insoluble, but they can be split and crushed, then swallowed with a glass of water.