Can you crush paracetamol tablets? [ANSWERED]
Drug reviews: use, side effects, effectiveness

Can you crush paracetamol tablets? [ANSWERED]

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Paracetamol is one of the most purchased over the counter painkillers. It is still one of the most prescribed drugs in the UK. Over the counter paracetamol is available in different forms, commonly sold as tablets. Today, I will answer the main question of this post: Can you crush paracetamol?

Summary: 

  • What is paracetamol? 
  • Paracetamol: availability of different forms
  • Can you crush paracetamol?
  • Can you cut paracetamol?
  • Conclusion 

What is paracetamol? 

Paracetamol is a popular painkiller which is widely available over the counter in most retail shops and pharmacies. Paracetamol helps with pain (analgesic) and reduces fever (antipyretic). Unlike ibuprofen or other Non-steroidal Anti-inflammatory Drugs (NSAIDs), paracetamol does not reduce inflammation. 

Paracetamol is commonly used to manage cold and flu symptoms. Generally speaking, paracetamol is well tolerated with a low incidence of side effects. 

Paracetamol: availability of different forms

Each adult form of paracetamol, for example, a tablet or capsule, contain 500mg of paracetamol. Over the counter paracetamol is available as:

  • Tablets
  • Capsules
  • Effervescent (soluble) tablets 
  • Cold and flu powders 
  • Oral liquid 
  • Suppositories 

Can you crush paracetamol?

Before crushing paracetamol, one should consider the use of alternative forms of paracetamol, which may be more suitable in a given situation. 

1. Effervescent paracetamol

Soluble paracetamol can be used by adults and adolescents aged 12 years and above. Effervescent tablets are placed in a glass of water. Once dissolved, a solution is ready to drink.   

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2. Liquid paracetamol

Liquid paracetamol is usually given to children, may also be taken by an adult. Paracetamol for children over six years of age comes at a concentration of 250mg/5ml of oral solution, which means that each 5ml oral solution contains 250mg of paracetamol. The standard adult dose for paracetamol is 1000mg taken four times a day. This equals to 20ml of paracetamol 250mg/5ml four times a day. 

3. Paracetamol capsules

Paracetamol capsules - paracetamol powder contained hard shell capsule

Unlike tablets, in capsule form drug is contained in a shell. Production of tablets and capsules require specific particle size for drugs and other non-active ingredients. Encapsulated paracetamol comes as a fine powder, one that is uniform. This uniformity cannot be achieved by crushing paracetamol tablets at home. 

4. Paracetamol suppositories

Paracetamol suppositories offer a great alternative to other paracetamol formulations. Paracetamol suppositories are equally effective as tablets, for example in temperature reduction (Goldstein et al., 2008). The downside of this formulation (in the UK) is the price. Paracetamol suppositories are expensive, read more in the related post: paracetamol alternatives.

Which medicines should not be crushed?

Certain medicines should not be crushed, for example:

  • modified-release release tablets, 
  • gastro-resistant tablets (enteric-coated tablets) 
  • film or sugar-coated tablets
  • cytotoxic-medicines 
  • drugs with a ‘narrow-therapeutic window‘ as small changes in drug dose (loss of drug during the crushing process) may result in the incorrect dose and may significantly impact treatment.

What about paracetamol: can you crush paracetamol? 

When faced with the above question in the pharmacy, healthcare professionals would most likely recommend trying an alternative formulation in the first place. 

Paracetamol tablets do not fall into any of the ‘special’ formulation categories. Licensing information for paracetamol tablets do not provide any information on crushing.

Paracetamol could be therefore crushed; however, there is always a risk of marginal error, such as losing small pieces of the tablet during crushing or when transferring the powder. Additionally, one needs to consider the unpleasant taste of crushed paracetamol. 

How to crush paracetamol? 

Pestle and mortar is one good option that may be used to crush paracetamol. Plenty of devices are available on the market, which help with crushing the tablets. Mill type of pill crushers turn tablets into powder with little effort producing a fine powder. Amazon.co.uk sells a variety of pill crushers (see example below) which vary in design and price. 

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  • Consistently produces a very fine powder that is easy to consume; The combination of the durable outside casing and crank made from stainless steel metal and the ceramic burrs on the inside ensures that our Pill Grinder pulverizes tablets consistently into a fine powder that is perfect for feeding tubes.

For prescription medicines, patients should follow the directions of the prescriber. Breaking or crushing the tablet is seen as an unlicensed process; therefore, only the prescriber (a doctor) can make this recommendation. 

Can you cut paracetamol? 

Tablets that are scored in the middle can generally be cut in half to achieve a lower, desirable dose. The same advice applies to paracetamol tablets. 

Conclusion

Before crushing paracetamol, patients should consider using alternative formulations, which may be more suitable and acceptable. Paracetamol may be crushed to meet the patient’s specific requirement for dosing. Follow the directions of the prescriber for prescribed paracetamol.

References

Goldstein LH, Berlin M, Berkovitch M, Kozer E(2008). Effectiveness of oral vs rectal acetaminophen: a meta-analysis. Arch Pediatr Adolesc Med. 2008 Nov;162(11):1042-6. doi: 10.1001/archpedi.162.11.1042. PMID: 18981352. Available at: https://doi.org/10.1001/archpedi.162.11.1042 Accessed on 16/05/2021

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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