Most medicines come in the form of tablets or capsules. But what do you do if you or someone you are looking after can't swallow ordinary tablets and capsules or finds it difficult to do so? Read on, and we'll give you some hints.

First, tell your doctor about the problem, so they can take it into consideration when choosing medicines for you or your relative.

However, don't forget your pharmacist. They have a wealth of knowledge about the different forms of medicines, as well as which tablets can and can't be crushed, which capsules can and can't be opened, and what precautions should be taken when doing so.

Is there another form of the medicine?

If you or your relative is having difficulty taking the tablet or capsule form of a medicine, ask your doctor or pharmacist if there is another form that might be more suitable.

Many medicines are available in liquid form, and some tablets and granules can be dissolved in water. Sometimes, a pharmacist can make a liquid form of the medicine for you.

Some medicines come in forms that don't need swallowing. For example, they may come as

• patches that stick to the skin
• drops or tablets placed under the tongue
• drops placed on the inside of the cheek
• suppositories (that go into the anus)
• nasal sprays
• injections.

Is there another medicine in a suitable form?

If no suitable form of the medicine exists, ask your doctor or pharmacist if there is another medicine that comes in a suitable form. This may be preferable to breaking or crushing tablets or opening capsules.

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Can I break up the tablets or open the capsules?

If a suitable alternative does not exist, it may be possible to cut up or crush the tablet, or open the capsule. However, this should be done only after obtaining advice from a pharmacist.

Some tablets or capsules should not be broken, crushed or opened, because they will not work properly, or they will become unsafe or unpalatable. For example,

• slow release tablets and capsules (their long-lasting effects will be destroyed and you may get too much initially)
• enteric-coated tablets or capsules with enteric-coated granules (these have a special coating to protect the lining of the stomach)
• tablets that have a coating to protect them from air or sunlight
• tablets that have a coating to hide their horrible taste.

Some tablets and capsules will not work properly if they
are crushed or opened.

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Crushing tablets and opening capsules

Below is some general advice for breaking, crushing and opening tablets and capsules. However, before going ahead, ask your pharmacist if it is OK to do so, and whether there are any special precautions that should be taken. For example, can the medicine be mixed with liquids other than water, or are there any foods with which the medicine should not be mixed?

Sometimes, simply breaking a tablet in two means that it can be swallowed more easily. Usually, tablets can be broken along the score line (indented line across the middle of the tablet) by hand or with a knife. However, using a special tablet cutter can make the task easier. Cutters can be bought relatively cheaply from pharmacies.

Tablets are best crushed in a special tablet crusher, because it produces a finer powder. Alternatively, use a mortar and pestle, small bowl or two large metal spoons. Dissolve the powder in water or food.

Capsules can be opened and their contents mixed with water or food.

Make sure that you or your relative gets the full dose of the medicine by

• ensuring that none of the medicine is lost when breaking or opening the tablets or capsules
• mixing the medicine with only a small amount of liquid or food (if allowed)
• ensuring that all the mixture is eaten or drunk.

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Watch for changes

Sometimes, breaking or crushing tablets, opening capsules, or using a different form of the medicine alters the way the medicine works. This may result in the medicine working slightly more or less effectively, or causing different side effects. Therefore, for the first few weeks, you should watch out for any new side effects or changes in your or your relative's health.