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Whether your medication is prescribed by a doctor or bought over the counter (OTC), it always comes with guidance on how you should take it to make sure it's safe and that it works.

You may be tempted to crush or grind up tablets, especially if you have problems swallowing them, but this isn't always a good idea.

We asked community pharmacist Sid Dajani for insights on what to watch out for and what you can do to make swallowing your meds easier.

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Medication is manufactured in a variety of formats, such as tablets, capsules, liquids or patches. These formulations have different purposes, such as slow-release or easy-swallow formulations, and are rigorously tested for their safety and efficacy.

Easy-swallow formulations are usually available for those who have trouble with tablets, but can be pricey or have impractical storage requirements - such as needing to be kept in the fridge. 

It can be tempting to crush some medications instead, but this could potentially alter both their action and their safety.

Here are some of the key reasons to take care before messing with your meds:

Although many drugs come in standard (or 'immediate release') tablets, others are specially coated to control whereabouts in the body the medication is activated and over what period of time.

It isn't always possible to tell if a tablet or capsule has a special modification or coating just by looking at it. If you're unsure, check the patient information leaflet or ask your pharmacist.

Crushing or splitting enteric-coated or modified-release medication risks too much of the drug being released into your bloodstream too soon.

Not only does this increase the risk of overdose and experiencing side effects, it also means there could be a period of time you won't be benefiting from it at all.

'For example, a long-lasting, slow-release painkiller might only work for eight of the 12 hours intended if you crush it up,' says Sid.

Some drugs are highly sensitive to environmental factors such as light, heat or moisture, which is why they are manufactured in a certain way.

For example, nifedipine - a calcium channel blocker used for high blood pressure - is highly sensitive to light, so it has a special photo-protective coating to protect it from degradation.

There are some medications that could represent a risk to whoever it is that crushes up or splits a tablet, especially if they are drugs that can be absorbed through the skin or inhaled.

These include breast cancer drug tamoxifen, rheumatoid arthritis drug methotrexate and prostate medication finasterade, as well as chemotherapy (cytotoxic) tablets and oral contraceptives or hormone replacement therapy.

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Research from 2021 published in the journal Patient Prefer Adherence found that around a third of people have difficulty swallowing tablets or capsules whole , so what can you do if you are one of them? We asked Sid for tips:

Speak to your pharmacist to see if another version of your meds are available, such as a liquid, a dissolvable or chewable tablet or even a patch (if it's prescribed, you may need to ask your GP to amend the prescription). 

Plenty are - painkillers such as Voltarol are also available as a patch or gel, as are contraceptives and HRT. However, in the case of over-the-counter products, they do tend to be more expensive.

If it's a supplement, many now come in a 'gummy' or chewable format. See our guide to vitamins and supplements you do and don't need for more, and our vitamin D guide for tips on where to get tablets, sprays and gummies cheapest.

Researchers in a 2014 study on swallowing tablets who devised both techniques found they improve tablet swallowing compared to standard techniques such as sipping water from a glass - in the case of the bottle technique by up to 60%.

There are some techniques pharmacists use that may be appropriate for you, but it's best to discuss with your pharmacist first to ensure it's safe and you know what to do:

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Certain meds have to be taken on an empty stomach to ensure they are absorbed before food next enters the stomach, while others need food in the stomach to protect its lining against irritation.

In other cases - such as with cholesterol-lowering simvastatin, calcium channel blockers including amlopidine, and the blood-thinning drug warfarin - you should avoid eating grapefruit or drinking grapefruit juice as it increases the level of medicine in your blood.

If you store medication incorrectly, it could become less effective to the extent that your doctor might up your dose because they think it's not working. 

A daily pill organiser might sound like a good idea if you've got a few to keep track of, but if your medication needs to be stored with a desiccant to keep it dry it's best to keep it in its original container to preserve its quality, and it's easier to keep track of use-by dates too.

It's a fiddly job, but Sid warns it's worth removing the name labels on your meds before recycling them: 'There's a lot of information on there, which someone could use for identity theft, but they can also tell if you've been administered controlled drugs that they could target you for to sell on.'

You can also take them (or any out-of-date meds) to your pharmacist who will have provision for secure disposal.

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