TO CHEW, OR NOT TO CHEW?
PATIENT DIES AFTER CHEWING MEDICATION
Some medications should never be chewed, cut, crushed, or
diluted. The only way to know is to read label instructions
carefully and/or ask your pharmacist or physician how each
drug should be taken. Unfortunately, not all patients read
the directions or receive and follow this kind of advice from
health providers. The following case illustrates the dangers
when patients are not given appropriate instructions or do
not question how to take medication.
An 83-year-old patient was given Cardizem CDŽ (sustained
release diltiazem capsules) for blood pressure control. Because
the capsule was too large to swallow, the patient chewed the
medication. As a result, her pulse twice slowed to low levels
and the family contacted the pharmacist for advice. Upon learning
that she was chewing the medication, the pharmacist suggested
that the physician substitute immediate release diltiazem
tablets, which are easier to swallow. The prescription was
changed and the patient did well for several months
Months later the patient returned to her physician for a
check up. She was again put on Cardizem CDŽ because the physician
apparently did not review the patient's previous medication
use and neither the patient nor her caregiver reminded the
doctor about the prescription change. Since the patient had
either forgotten or never been warned about the danger of
chewing Cardizem CD, she again began chewing the larger capsules.
She became progressively weaker and died three weeks later.
According to her family, the patient had been alert and intelligent
but had too much faith in her health providers to question
Such instances remind us that medication must be taken carefully
and always according to specific instructions. It also reminds
us that patients can be the last, best check on their own
medication use. A complete medication list reviewed with health
providers on every visit is an invaluable protection against
medication-related problems. Similarly, patients and caregivers
should always ask questions aggressively to fully understand
the treatment they are receiving, clear up doubts or questions
about any aspect of the therapy, and to alert health care
providers appropriately if anything seems amiss.
Institute for Safe Medication Practices