Misc Pill crushing, the good, the bad, and the lies

[Deadeyes]

Ok, so as stated in my Introduction of me, ive been researching the effects of drugs, how they act and how they perform, and the speed at which drugs do they're thing,

however. so sides say some drugs cant be crushed because of certain properties to them, like extended release caps and stuff. but most of these sites arnt too the point, i mean, i picked up my bottle of of Tylenol 2's, and they dont say, hey im a certain tie release. and naturally i cant find a site that says if they are crushed, will they work faster, or not work at all, or if they can even cause Overdose. and the same is with Benadryl.

so my question is. can Benadryl and Tylenol 2's Be crushed?

if so, how will this effect the pill? : Will it decrease it abilities to perform, will it act faster, can it cause an Overdose even at lesser levels ingested.

for years i had issues with pain, and it naturally is starting to effect my sleep habits. now sure granted i could go see a doctor, but honestly i hate prescriptions and doctor visits and such, so thats why i ask these questions, and been researching to see if i can find someone that is willing to give me an answer. so i would like us to be able to sit down, and you guys and gals to answer these questions, and than from there ill know my options.

 

[sekio]

Yes they can be crushed, but pills are designed to disintegrate quickly in the stomach so you're not gaining anything other than making it kick it at most a few minutes earlier. Some people get oral liquid medications or "liqui caps" for this reason.

If the medications are not time released (controlled release, extended release, sustained release) then crushing them is wasting your time and just gives you an opportunity to make a mess. It certainly won't be a miracle fix for your pain conditions.

 

[Lorne???]

^^^ Actually, a lot of medications absorb significantly faster in liquid form. Examples include diphenhydramine(Benadryl), tramadol, certain NSAIDS, etc.

Whether or not just crushing them will suffice I'm not sure, but in some cases dissolving tablets in liquid(and then preferably filtering out binders) will speed up absorption.

But unless you know for sure the drug in question absorbs better, going through that trouble might cancel the time you're gaining out of it.

( Loperamide also absorbs faster in liquid or capsule form, due to it's ridiculously low solubility)

 

[Deadeyes]

^^^ Actually, a lot of medications absorb significantly faster in liquid form. Examples include diphenhydramine(Benadryl), tramadol, certain NSAIDS, etc.

Whether or not just crushing them will suffice I'm not sure, but in some cases dissolving tablets in liquid(and then preferably filtering out binders) will speed up absorption.

But unless you know for sure the drug in question absorbs better, going through that trouble might cancel the time you're gaining out of it.

( Loperamide also absorbs faster in liquid or capsule form, due to it's ridiculously low solubility)

so with that all said what about Tylenol 2 with codeine? thry dont say anything about extended release or anything. so with that work also? and whats a chance of an overdose this way? just so i know not to do it.

 

[f33lg00d]

They are instant release so crushing them is de facto pointless.

 

[Deadeyes]

so pointless being no matter what ill get the same level of med, at the very same time as i would as it was a standard pill? and that it wouldnt increase a chance of Overdose? or pointless to the effect it wont work at all?

 

[f33lg00d]

It will be the same as just swallowing the pills

 

[Deadeyes]

and dissolving it into water? juice? booze?

will it keep the same effects or?

 

[TheLostBoys]

Certain ER pills can be crushed to a fine powder & thrown into some lemon juice for about 5 hours........for pain, it actually works better this way.

 

[Numb19]

^ ya it depends on the formulation. I think in the US this is the case but in some countries like Canada they still have generic or even some brand-name versions of the old crushable formula (no lemon juice needed).

I believe you are referring to OP's or Neo's in Canada. It is pretty much impossible to crush these pills because of the polymer binder. So you'd need to cut them into small pieces with scissors and then soak them in lemon juice or cola. I hear some people say things like 12 hours or even 3 hours. After like an hour or 1.5hrs, it's good to go. IR.

But this also of course inherently increases the danger since the entire dose was designed to be a control release. It's really not something to play around with unless one is extremely cognizant of their usage and tolerance. Some have no choice but to take this route due to their tolerance. It's not a road one would want to end up on in the end.

 

[Deadeyes]

Yup, Canada seems to be years behide on drug plans and medication tactics. Think that is because we fear change. After all, if it's not broken don't change it right? But still I think we should have access to certain methods of pain reduction. And just have them limit the manner to which the medication is given to us. Like I hear they do in the EC.

but still, would dissolving tylenol 2 into water or something have the same effect still as taking the pill. (in the event that maybe you dont want to swallow the pill)

 

[Numb19]

^ I think there is a notable principle that has arisen within the past while where doctors are becoming more and more hesitant to prescribe the old formulas. I believe Canada's new Health Minister also hinted that this (old formula generics) is going to be revisited.

Ironically, last year the FDA approved an ER version of hydrocodone that is easily crushable and contains up to 50mg of hydro.

Also ironically, the main manufacturer of generic oxycontin in Canada has run out of stock as of a couple of months ago lol. How about that! And this will drive people to use stronger opioids or heroin if they can't find a suitable alternative.

 

[Deadeyes]

than where does canadian Hospitals get their stock of oxy from if our manufacturer's dont have it anymore?

would dissolving tylenol 2 into water or something have the same effect still as taking the pill. (in the event that maybe you dont want to swallow the pill)

 

[Numb19]

^ Well it is the main primary manufacturer that is out of stock (Apotex), which has created the shortage. There are other generics but they are not as widely manufactured and their formula is a little different but this still leaves a huge gap.

Plus, as far as I know, Canadian hospitals do not carry stocks of "oxy". They basically stock percocet (here they are allowed to give a maximum of 8 tablets per person per day), morphine and probably fentanyl patches.

And they can always prescribe the Neo's (i.e. with polymer to block crushing), which is what is becoming more and more abundant.

 

[sekio]

dissolving the pill won't change anything

 

[Deadeyes]

Thanks for the answer sekio.

Wait so a doctor may prescrip oxy for after a pain operation such as a root canal, but our hospitals are using something else. What's the underline difference between the too?

 

[Kittycat5]

Percocet is just oxycodone with acetaminophen. Hospitals use morphine because it is cheap, can be used both orally and parenterally, and has a long history of safety and efficacy.

 

[Numb19]

^ percocet is low dose oxycodone (no more than 10mg) with acetominophen which is different than other forms such as OXY IR or Supeudol or Roxicodone, which are higher doses of oxycodone without the acetominophen.

Morphine is generally considered as the "gold standard" for pain within the medical community and it is the main and most abundantly found compound in opium so, yes, it is cheap, it is easier to make and abundant. But other countries such as the UK still use diamorphine (i.e. heroin) in hospitals today (both enteral and parenteral).

 

[sekio]

What drugs are used for pain relief are dependent on many things, legality in the country of usage, doctor's personal preference, hospital policy, bulk buying, availability, etc etc. So while one hospital may use oxycodone and acetaminophen for pain (Percocet) others might use tramadol (Ultram), or codeine and acetaminophen (Tylenol 3).

Some drugs are more effective than others at a dose that provides comparable opioid activity, because they have multiple routes of action. For instance the opioids tapentadol, tramadol, and levorphanol are also serotonin or norepinephrine reuptake inhibitors (or both), and some of them are NMDA antagonists too. (Methadone is another dual action drug). All these factors work together to increase the pain killing efficacy of drugs compared to something like morphine alone. A smart doctor will take this into account when prescribing drugs for pain.

Patient controlled analgesia and IV sedation can be anything from morphine to pethidine/meperidine (Demerol) to fentanyl to hydromorphone (Dilaudid). In Europe but not the Americas people still use heroin as an IV opioid for chronic pain and severe pain like in cancer, they call it diamorphine. Again, it depends on the specific doctor and pharmacist, the patient, and any other interactions.

If someone is on doses of an anti-anxiety benzodiazepine, a muscle relaxer, or a sedating anti psychotic they will need less narcotic drug than someone who isn't because those also potentiate opioid's painkiller action. Lots of drugs do and what other medications the patient takes, even recreational ones, must be factored in when you consider treatment. For instance drinking alcohol or abusing benzodiazepines on methadone is a good way to fall asleep and never wake up, or aspirate vomit and choke to death.

Doctors are hesitant to prescribe opioids because they aren't that great of a painkiller on their own (without something like ibuprofen in Percodan or paracetamol/acetaminophen like in Percocet - both are combinations with oxycodone), they develop tolerance quite rapidly, people abuse them for recreational value or sell them for cash, and in many cases pain could be adequately managed with something like a NSAID, nerve block, or topical local anesthetic. Even when they do prescribe them, opioid drugs should be just one part of a whole symphony of painkillers working together for maximum efficacy. Putting people on pure oxycodone isn't actually that effective in light of its side effects like constipation, itching, sedation, addiction/dependence, etc. when you can put them on low dose oxycodone, caffeine, ibuprofen, and topical lidocaine and have pain relief be complete.

It also depends on the severity of pain, whether the person has undergone narcotic therapy before, their personal sensitivity, any co-existing conditions or medications, all sorts of things. So you can't really say with any certainty that a doctor will always use oxy for a broken arm or whatever. If they consider you prone to abuse narcotics, like you have a prior record or whatever, you can bet they'll try every single non narcotic drug first, and stop treating you if you demand opioids.

For more reference see this cool table called the League Table of Analgesics which shows which painkillers are the most effective and which are worst. Surprisingly drugs like ibuprofen and the newer coxibs are near the top of the list and things like pure codeine are at the bottom (least effective). This is based on thousands of comparative studies. Cool stuff!

 

[Lorne???]

^^^ It is cool stuff, but I have to disagree with a couple of things.

Opioids on there own is still the most effective single agent, that is why they are prescribed besides the risk. I also know many pain patients personally(also my own pain issues, though I was addicted before that, which makes me biased, not to mention hyperalgesia). But NSAIDS and gabapentin didn't do a damn thing once the pain was severe.
(Note that many of these people ended up becoming "addicted" in the psychological sense and abusing they're medication, but not all).
And for analgesia, opioids eventually reach a kind of ceiling, in regards to tolerance, so that, assuming the pain doesn't increase, the patient eventually reaches a dose that works indefinitely. This is part of the rationale with both methadone and the rare heroin assisted clinics; tolerance to opioids only develops rapidly if the opioids are abused. With proper use they remain effective as analgesics for an extended period.

Caffeine is also only suitable for certain types of pain, and even then it is only suitable for acute use(though in fairness, the doses used as a co-analgesic are fairly low).

I do agree 100% with co-analgesics, but calling opioids "not effective" would imply every other analgesic useless, especially seeing as opioids ate the only analgesic with no know ceiling effect(for they're analgesia).

You're absolutely right about methadone, it is well known as an amazing analgesic, but tram and similar drugs have a ceiling effect and unique side effects limiting use.(don't much about tapentadol)l, but it's mechanism of action is similar)

As for morphine, there is a reason it is the gold standard: it has stronger PNS effects than comparable opioids, and a multitude of other advantages. It's side effects can be pretty rough, though, and with it's slow onset one can only wonder why diamorphine is not utilized in the states, especially since both cocaine and meth are Schedule II!

Oxycodone IV should also be utilized in the states, for reasons I've brought up before. One more thing, studies have shown that multiple opioids(including IV morphine/oxycodone together) are more effective than a single agent, despite the WHO's recommendation of using a single opioid.
(The oxy/morphine combo was not only more effective than an equivelant dose of either, but also carried less side effects, particularly in comparison to morphine alone)