Drugs intended for swallowing should not be chewed.

Many people use their prescriptions in ways that are unthinkable. For example, some people chew medications that are supposed to be ingested with water, while others take their medications with soft beverages!

Pharmacists claim that chewing medications that are meant to be swallowed not only reduces the medications' effectiveness but also intensifies their adverse effects.

Experts advise against chewing or crushing particular medications for a number of reasons.

Most significantly, doing so could lead to dosage dumping, which is the rapid absorption of a significant amount of a drug by the body. Pharmacists claim that an overdose of the medication, which can result in death, is one effect of dose dumping.

A former head of state, 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.
"Failing to swallow drugs with water affects their dissolution in the stomach, which can create another problem, in addition to water aiding in the transportation of drugs to the stomach."

The Royal Pharmaceutical Society of the United Kingdom asserts that it is critical to acknowledge the possible repercussions of tampering with a pharmaceutical product.

The body claims that altering the way a dose form is provided can change its absorption properties, induce instability in the medication, generate local irritation effects, and prevent the medication from reaching the site of action.

The body went on to say, "It may result in a preparation with an unacceptable taste and may cause occupational health and safety issues."

Adekola added that even though the tablets were intended to be eaten, there were consequences to chewing them without water.

When you chew now, 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.
Aspirin is one example of how they might cause issues like ulcers if they reach the stomach. Because these medications are useful, we continue to try to use them.

Enterically coating them is one kind of formulation that is occasionally used. This indicates that they are sheltered from the acid in their stomach. Therefore, they are only permitted to break down after exiting the stomach.

"They will still be delivered to the small intestine after being swallowed, where they will breakdown before they do so in the stomach compartments. In this manner, you will be able to overcome the negative effects of ulcer induction.

Now, even though they are bitter, if you chew them, you are helping 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.”
Sheila Rivera, a chemist with Trexie Olivar's Sharp Rees-Stealy Medical Centres in the United States, cautions that "dry swallowing" medication can be dangerous and that there are additional risks associated with this technique that people may not even be aware of.

According to an internet portal called Sharp Healthcare, Olivar said, "A pill that comes into contact with the lining of the oesophagus — the muscular tube that connects your mouth to your stomach — may cause tissue damage and inflammation."

If treatment is not received, this could result in further issues like heartburn, chest pain, bleeding, or difficulty swallowing.

Although almost any drug can be dangerous if not taken as directed, Olivar noted that some antibiotics, supplements like potassium chloride and vitamin C, and painkillers like aspirin and ibuprofen are the greatest offenders.

When taking medication, Rivera and Olivar advise consuming an 8-ounce glass of water. According to Olivar, it is advisable to drink a full glass of water because even a single swig can be harmful.

"In addition, dehydration can irritate the throat and, in certain situations, interfere with the effectiveness of medication," she continued.