Recently, a woman in Fujian broke open a blood pressure medication tablet to take it, which led to a sudden drop in her blood pressure and even a state of unconsciousness. What happened?

Ms. Zhang has a history of hypertension for over a year. Recently, her highest blood pressure reached / (note: the original text is missing the actual blood pressure reading). She thought it was due to insufficient medication, so she bit off more than half of her daily antihypertensive pill. Unexpectedly, within half an hour, Ms. Zhang suddenly felt dizzy, broke into a cold sweat, and became so weak that she collapsed on the sofa. Her family rushed her to the hospital.

The doctor explained that Ms. Zhang is taking Nifedipine Controlled-Release Tablets, which are equivalent to the dosage of regular Nifedipine tablets. If these tablets are crushed, broken, or ground before ingestion, the large dose of antihypertensive medication will be released into the body instantly, causing a rapid drop in blood pressure.

Which medications should not be split or crushed when taking them?

Controlled-release tablets are coated with an insoluble semipermeable membrane shell that allows water to enter but prevents the drug from exiting, releasing the drug at a constant rate in the body, thereby maintaining the efficacy for an extended period and reducing the frequency of dosing. The onset, absorption, and disappearance of a regular tablet's drug effect typically occur within an hour, requiring the patient to take the medication several times within an hour. In contrast, controlled-release tablets release the drug at a constant rate, with a dosage that is several times that of a regular tablet. Patients only need to take it once a day, and the drug effect is released at a constant rate in the body for about 12 hours. Experts emphasize that controlled-release tablets can release the drug slowly and steadily in the body due to special formulation techniques. Patients should swallow the tablet whole when taking it; chewing, biting, or breaking the tablet will destroy the controlled-release function, effectively resulting in the patient taking a dosage several times higher.

The processes for sustained-release tablets and controlled-release tablets are different, but the purpose is the same: to allow the drug to be released slowly in the body. It is generally not recommended to break them apart for consumption, as this can also lead to a faster release of the drug, triggering adverse reactions. Generally, tablets that can be broken apart for consumption will have scoring marks. For example, Metoprolol sustained-release tablets can be broken apart along the scoring marks for consumption, but they should not be chewed or ground up.

Enteric-coated tablets are designed to bypass the stomach and dissolve in the intestines by being coated with a "enteric coating." If they are broken before ingestion, the medication may dissolve in the stomach, potentially leading to the drug becoming ineffective due to exposure to stomach acid and causing discomfort or irritation to the gastric mucosa.

Once the capsule is broken and taken, the medication may be affected by stomach acid, preventing it from being released at a specific site, thereby affecting its efficacy. Additionally, it may increase adverse reactions of the medication to the gastrointestinal tract. Tips for taking capsules: Tilt your head slightly forward, and swallow the capsule along with water without looking up. This is because capsules are lighter than water, and looking up may cause the capsule to float. After taking the capsule, avoid lying down immediately to prevent it from sticking to the esophagus.

Effervescent tablets contain sodium bicarbonate and organic acids, which produce carbon dioxide gas when mixed with water, creating a fizzing effect. Direct ingestion can lead to the production of large amounts of gas in the mouth or digestive tract, posing risks of suffocation and gastric perforation. They must be dissolved in cold or lukewarm water, and ingestion should only occur after the bubbles have completely dissipated. Swallowing or holding them in the mouth is strictly prohibited.

The time and order of medication need to be kept in mind

Before taking medication, patients should carefully read the instructions, follow the doctor's advice, and also understand the timing and sequence of taking different medications, otherwise it may affect the efficacy of the drugs and even cause adverse reactions. Liu Ying, a chief pharmacist in the Department of Pharmacy at Peking University Third Hospital, stated that patients usually take traditional Chinese medicine about half an hour apart from Western medicine. Tonic medicines are suitable for taking before meals. For medications without specific instructions in the manual, especially those that are irritating to the gastrointestinal tract, it is generally advisable to take them half an hour after meals. Liu Ying emphasized that patients should avoid drinking alcohol while taking sedative-hypnotic drugs, as alcohol itself has a central nervous system inhibitory effect, and sedative-hypnotic drugs also act on the central nervous system. If alcohol is consumed while taking these drugs, it will exacerbate the adverse effects of central nervous system inhibition.

Drug storage requires improper temperature and humidity, which may affect the efficacy

During the medication period, patients should also pay attention to the storage of the drugs, including whether there are special requirements for temperature, humidity, and other aspects, to avoid affecting the efficacy of the drugs and causing adverse effects. Sun Zhengyuan, the chief pharmacist at the Department of Pharmacy, Peking University Third Hospital, stated that some biological preparations, such as insulin, need to be stored within a temperature range of ℃ to ℃. If the temperature is too high or too low, it can cause insulin to lose its activity, thereby affecting its efficacy. In addition to temperature and humidity, some drugs are sensitive to light and can easily decompose when exposed to light, potentially losing or reducing their efficacy. Such drugs need to be stored in a dark place.