Problems Crushing Multiple Pills And Dividing The Doses

Answer

I certainly understand your concerns about wanting to improve the efficiency and safety of crushing your medications due to your need to dose them via a feeding tube. I'll do my best to address your questions.

Firstly, I would like to emphasize that, in general, crushed medications should be used immediately and not stored for later use. This is for many reasons, but primarily it's because crushing a medication can affect the stability and safety of the drug.

When a medication is crushed or ground, it may become more vulnerable to contamination by bacteria or other substances. Additionally, it destroys the tablet coating, making the crushed powder more susceptible to environmental factors, such as moisture from the air, that can hasten drug degradation.

The FDA (Food and Drug Administration) has this stance:

If your healthcare professional asks you to split [or crush] your tablets, do not split the entire supply of tablets at one time and then store them for later use. That is, make sure that both halves are taken before splitting the next tablet. This is important because split tablets may be affected by factors such as heat, humidity and/or moisture content. For example, a split tablet stored in a damp environment such as in a bathroom medicine cabinet could be affected.

So, having said my piece on that, let's get into what it looks like you are more concerned about, which is an efficient way to crush multiple pills and then divide that crushed powder equally into daily doses.

Options

I am not aware of any consumer product or device that assists with what you're looking for, which again, is a way to crush multiple pills and divide the resulting powder into equal amounts for daily dosing via a feeding tube.

I suppose, theoretically, you could find the average weight of a tablet by using a precise scale, crush several tablets, and then weigh an amount of crushed powder that is equivalent in weight to one tablet. However, I don't recommend this method as you are really opening yourself up to potentially dangerous dosing errors (and, of course, for the reason I mentioned in the section above, that crushed medications generally shouldn't be stored for later use).

I would be specifically concerned with levothyroxine with this method as even small changes in dose can have major clinical effects (the drug is dosed in micrograms after all). Using average tablet weights would just not be the most precise method for accurate dosing.

There are some alternative options that you can consider to make your medication regimen more efficient and accurate though.

One option is to look for the medications (levothyroxine and sertraline in your case) in different dosage forms, such as liquids, which may be easier for you to take through your feeding tube. Levothyroxine is available in liquid form as Tirosint-SOL and Ermeza. Sertraline is available as a solution in a concentration of 20mg/mL.

Another option is to consider working with a compounding pharmacy, which can custom-make the medications into a liquid form or a different dosage form that is easier for you to take. They may even be able to supply your medications in bulk powder form.

It is important to work closely with your doctor and pharmacy to determine the best option for your individual needs. They can help you weigh the benefits and potential risks of each option, and make a recommendation that is safe and effective for you.

Final Words

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