About preparing medicines

Crushing or dispersing tablets and opening capsules before administration may be necessary in some situations:

• for patients with swallowing difficulties
• for covert oral administration of medicines
• immediately following bariatric surgery

Not all tablets can be crushed or capsules opened and it is important to check beforehand. Checking if tablets can be crushed or capsules opened provides advice.

Carers should only crush tablets or open capsules on the direction of the prescriber. Instructions should be included in the patient’s medicines administration record (MAR) chart and care plan.

Dispersing tablets in water

Many immediate-release tablets will disperse in water without the need for crushing.

Place the tablet in a medicine pot or oral syringe. Add 10ml water (larger volumes may be needed for some tablets) and allow the tablet to disintegrate. Make sure the pot or syringe is rinsed and the rinsing water administered to ensure the full dose is given.

Only disperse medicines one at a time; do not disperse different medicines together. Dispersing should only be performed immediately before administration.

Crushing tablets

For medicines that are suitable for crushing, crush using a tablet crusher, crushing syringe or pestle and mortar. A crushing syringe is preferred for medicines where you must avoid environmental contamination and exposure of a carer. For example, cytotoxics, immunosuppressants, hormones or antibiotics.

Only crush medicines one at a time; do not crush all the patient’s medicines together. Crushing should be performed immediately before administration.

In care homes, if equipment is shared, it must be thoroughly cleaned to avoid contamination between medicines for different patients.

Tablets should only be crushed immediately before administration.

Tablet crusher or pestle and mortar

Crush the tablet to a fine powder.

If you will be giving the medicine with water, use an oral syringe to add 10 to 20ml water to the mortar. Mix well, then draw into the syringe and administer. Rinse the mortar with a little more water and administer the rinsing water to ensure the full dose is given.

Crushing syringe

Crush the tablet to a fine powder in the crushing syringe.

To give the medicine with water, draw up 10 to 20ml water and administer. Then draw up a further 10 to 20ml water, shake and administer to ensure the full dose is given.

Opening capsules

Some hard gelatin capsules can be opened and their contents (powder or granules) mixed with water or administered with food. Some capsules may be too small to be opened easily.

Pull the two sides of the capsule apart and tip the contents into a medicine pot.

If you will be giving the medicine with water, use an oral syringe to add 10 to 20ml water. Stir, then draw into the syringe and administer. Rinse the pot with a little more water and administer the rinsing water to ensure the full dose is given.

Capsules should only be opened immediately before administration.

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