Meidcations that should NOT be crushed
If a liquid formulation of a medication is not available, it is sometimes desirable to crush a medication for a patient who is experiencing difficulty swallowing tablets/capsules or has a nasogastric tube placed. However, crushing the tablet/capsule may be an unsafe practice due to the formulation or properties of some medications. The following is a partial list of medications that should not be crushed before administration:
Enteric-coated tablets are designed to remain intact through the stomach and release the medication in the small intestine to prevent destruction of drug by stomach acids, prevent stomach irritation, or delay onset of action. When enteric-coated tablets are crushed, the drug is released too early and may be destroyed by stomach acid or irritate the stomach lining. These include: bisacodyl (Dulcolax®), budesonide (Entocort EC®), enteric-coated aspirin (Ecotrin®), lansoprazole (Prevacid®), omeprazole (Prilosec ®), pancrelipase (Pancrease ®), divalproex sodium (Depakote ®), solifenacin (Vesicare ®), and many erythromycin products.
Extended-release products are formulated to slowly release a medication over an extended period of time. They should not be crushed because it would cause the active ingredient to be delivered all at once and it may potentially deliver a toxic dose of medication and cause an increased risk of adverse effects. Many extended-release formulations have abbreviations affixed to their name (e.g., CR, ER, LA, SR, XL, XR) to identify them as extended- release. These include: diltiazem controlled-dissolution (Cardizem CD®), fexofenadine/pseudoephedrine (Allegra-D®), mesalamine (Asacol ®, Pentasa ®), verapamil sustained-release (Calan SR®, Isoptin SR®), oxybutynin extended-release (Ditropan XL®), propranolol long-acting (Inderal LA®), tamsulosin (Flomax®), divalproex sodium extended-release (Depakote ER®), and many theophylline products.
Some medications have a very bitter taste and are coated to help mask the taste of the active ingredient. If these medications are crushed, the taste of the medication may be unacceptable to patients if taken orally, but not if administered through a feeding tube. These include: cefuroxime (Ceftin®), ciprofloxacin (Cipro®), docusate (Colace ®), ibuprofen (Motrin®), praziquantel (Biltricide ®), indinavir (Crixivan®), raloxifene (Evista ®), topiramate (Topamax®), and imatinib (Gleevec ®).
Medications that are irritants can cause esophageal or stomach irritation or ulceration if crushed or opened. They can also cause irritation if the product is aerosolized and the powder is inhaled, or comes in contact with eyes or skin. These include: alendronate (Fosamax®), atomoxetine (Strattera ®), diflunisal (Dolobid®), ganciclovir (Cytovene ®), ibandronate (Boniva ®), isotretinoin (Accutane ®), piroxicam (Feldene ®), risedronate (Actonel ®), valganciclovir (Valcyte ®), and valproic acid (Depakene ®).
Crushing products with carcinogenic or teratogenic potential may expose healthcare workers to health risks through aerosolization of the product. These include: dasatinib (Sprycel ®), finasteride (Proscar ®), mycophenolate (CellCept ®), temozolomide (Temodar ®), and cancer chemotherapy agents.
Benzonatate (Tessalon Perles ®) can anesthetize local mucosa and cause a loss of the gag reflex.
Oral disintegrating tablets are very fragile and should only be directly placed on the tongue. These include: mirtazapine (Remeron SolTab®), and olanzapine (Zyprexa Zydis ®).
Some medications can directly cause staining of the teeth because of the ingredients or dyes in the product and should be swallowed whole. These include: amoxicillin/clavulanate (Augmentin®), linezolid (Zyvox®), and iron products.
A list of medications that should not be crushed can be found at: DoNotCrush.pdf. If you have any questions regarding the acceptability of crushing a medication or to see if there is a liquid formulation of a medication is available, please contact the Pharmacy serving your area or the Drug Information Center (6-2600).
Similar postings
Top Sales Drugs: Choosing the best option
As a drug’s patent approaches its expiration date, the pharmaceutical company that developed it will often launch a renewed marketing effort. These campaigns — which may include advertisements and supplemental rebates, as well as drug samples and provider visits from sales representatives — are designed to encourage current and p
Top Sales Drugs: Choosing the best option
An Excellent Combination
I had RP surgery in October of 2010; full right nerves spared and partial left nerves spared. Stopped wearing pads after 6 weeks and only experience minor leakage incidents on occasion. Was put on Cialis immediately after catheter removal. After 2 months of taking the medication, I wasn't experiencing meaningful erections (I do realize it's still e
The ED Shot
Hello all- We just wanted th share this wonderful news with you all. My husband had no results with any any of the oral medications after his radical prostectomy, so we tried the alprostadil injection into the penis. Sounds horrible, be he says it just stings a bit, and it works 100% of the time. We just have to be careful that we don't administer
Quetiapine (Seroquel) As An Atypical Antipsychotic
1. Pharmacology: Dibenzothiazepine class An antagonist with affinity binding for 5HT1A/2, D1-2, alpha1-2, and H1 receptors. No affinity for the BZD or muscarinic receptors. 2. Pharmacokinetics: Rapidly absorbed with peak concentrations within 1.5 hours. 100% bioavailable. PB: 83% at therapeutic dosages Vd: 10+ 4 L/kg T1/2: 7 hours Major Metabolic P
Quetiapine (Seroquel) As An Atypical Antipsychotic
Paxil and Weight Gain
My doctor has just put me on Paxil for depression I have been experiencing for about a year now. Of course, my mental health is more important than my weight, but I'm wondering if anyone who is on Paxil has had any weight gain? Also, if you are on Paxil, are you happy with it? Thank you! JS I was on Paxil for about 2 years. I did not gain any weigh
