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Oral dosage forms that should not be crushed

Oral Dosage Forms That Should Not Be Crushed
John F. Mitchell, PharmD, FASHP1
Last updated: March 2012

Drug Product (active ingredient)
2
Dosage Form
Reasons/Comments 3
(ISOtretinoin)
(RABEprazole) Tablet Slow-release
(fentaNYL) Lozenge
Note: this lollipop delivery system requires
Irritant
Note: chewed, crushed, or sucked tablets
may cause oropharyngeal irritation
(NIFEdipine) Tablet
(NIFEdipine) Tablet
(Sinus 12 Hour) Allegra-D (combination) Tablet (guaiFENesin) Tablet

ALPRAZolam ER
(ALPRAZolam) Tablet Extended-release
Ampyra (dalfampridine) Tablet Slow-release Note: formerly fampridine-SR

Amrix (cyclobenzaprine) Capsule Slow-release
Aplenzin (buPROPion) Tablet
Note: maintain pH at less than or
Note: oil emulsion within spheres; taste
Note: Crushing the 23 mg tablet my
significantly increase the rate of absorption; the 5 and 10 mg tablets are not affected Note: tablet coating is an
(sulfaSALAzine) Tablet Enteric-coated

AVINza (morphine)
Note: drug may cause fetal abnormalities;
women who are, or may become, pregnant, should use caution in handling capsules, Biaxin-XL (clarithromycin) Tablet Extended-release Bidex A Biltricide (praziquantel) Tablet Note: chewed, crushed, or sucked tablets

Carbatrol (carBAMazepine) Capsule Slow-release
(niCARdipine) Capsule
Note: although not in the PI, the drug has
a coating that is intended to release the Note: use suspension for children
Note: use suspension for children
CellCept (mycophenolate) Capsule Teratogenic Chlor-Trimeton 12-H (combination) Tablet Note: integrity compromised by chewing or
Cotazym-S (pancrelipase) Capsule Note: capsule may be opened and mixed

Cymbalta (DULoxetine)
Note: may add contents of capsule to
apple juice or applesauce but NOT
Cytoxan (cyclophosphamide) Tablet Note: drug may be crushed but company
Dexilant (dexlansoprazole) Capsule Slow-release Dilatrate-SR (isosorbide) Capsule Drisdol (ergocalciferol) Capsule Drixoral Cold/Allergy (combination) Tablet Drixoral Allergy Sinus (combination) Tablet Note: exposure to the powder may cause
serious skin toxicities; healthcare workers EC-Naprosyn (combination) Tablet (potassium bicarbonate) Tablet Slow-release (a); do not give via N/G tube

Equetro (carBAMazepine) Capsule Slow-release
Note: PI indicates potential teratogenic;
healthcare workers should take appropriate Delayed-Release Evista (raloxifene)
Exalgo (HYDROmorphone) Tablet
Note: breaking, chewing, crushing,

Fentora (fentaNYL) Tablet
Note: buccal tablet; swallow whole
Feosol (ferrous sulfate) Tablet Enteric-coated Feratab (ferrous sulfate) Tablet Enteric-coated Fergon (ferrous gluconate) Tablet Ferro-Sequels (combination) Tablet (metroNIDAZOLE) Tablet
Note: may be dissolved in water or
(metFORMIN) Tablet
(glipiZIDE) Tablet

Glumetza (metFORMIN) Tablet
Guaifed-PD (combination) Capsule
GuaiFENesin
Horizant (gabapentin enacarbil) Tablet Note: exposure to the powder may cause
serious skin toxicities; healthcare workers Note: tablet should be swallowed whole
and not crushed; tablet may be dispersed
Intuniv (guanFACINE) Tablet Slow-release
Invega
Note: see PI for making a suspension
Jalyn (dutasteride/tamsulosin) Capsule Note: women who are, or may become,
(sitagliptin/metFORMIN) Tablets

Jenloga (cloNIDine) Tablet
Note: may add contents of capsule to
Kapidex (dexlansoprazole) Capsule Slow-release Note: named changed to Dexilant

Kapvay (cloNIDine) Tablet

Keppra (levETIRAcetam) Tablet Taste
Note: some extemporaneous formulas are
Note: tablet matrix may remain in stool

LaMICtal XR
(lamoTRIgine) Tablet
Levbid (hyoscyamine) Tablet Slow-release Liquibid-PD (combination) Tablet (brompheniramine) Capsule Extended-release Note: contents of capsule may erode
(fluvoxaMINE) Capsule
(pyridostigmine) Tablet Extended-release (methylphenidate) Capsule Extended-release extended-release Motrin (ibuprofen) Tablet
Mucinex (guaiFENesin) Tablet
Myfortic (mycophenolate) Tablet Slow-release Namenda XR (NIFEdipine) Tablet
(NIFEdipine) Tablet
Note: crushing tablets has resulted in
Note: toxic dose may occur if tablet is

Oleptro (traZODone) Tablet
(oxymorphone) Tablet Extended-release citrate ER
OxyCONTIN
(oxyCODONE) Tablet Extended-release
Note: tablet disruption may cause a
potentially fatal overdose of oxyCODONE
Pancrease (pancrelipase) Capsule Pancrecarb (pancrelipase) Capsule (PARoxetine) Tablet
Note: bioavailability increases by 75%
Note: Orally disintegrating do not swallow;
Prevacid (lansoprazole) Suspension Note: contains enteric-coated granules;

PriLOSEC

PriLOSEC OTC
(NIFEdipine) Tablet
Note: women who are, or may become,
pregnant, should not handle crushed or broken tablets Note: women who are, or may become,
pregnant, should not handle crushed or broken tablets
PROzac Weekly
(FLUoxetine) Tablet
Note: pharmacokinetic NanoCrystal
Note: tablets expand in liquid if broken or
Renvela (sevelamer carbonate) Tablet Note: tablets expand in liquid if broken or
(rOPINIRole) Tablet
Note: Teratogenic potential; healthcare
(methylphenidate) Capsule Extended-release
Ryzolt (traMADol) Tablet
Note: crushing may cause overdose
Note: tablets are not scored and cutting

SEROquel XR
(QUEtiapine) Tablet
Somnote (chloral hydrate) Capsule Note: active ingredients are
surrounded by a wax matrix to prevent
healthcare exposure; women who are, or
may become, pregnant, should not handle
crushed or broken tablets
Note: capsule contents can cause ocular
Note: disruption of capsule may yield high

TEGretol-XR (carBAMazepine) Tablet Extended-release
Note: accidentally opened or damaged
capsules require rigorous precautions to avoid inhalation or contact with the skin or Note: swallow whole; local anesthesia of
Note: contains beads
Note: women who are, or may become,

TRENtal (pentoxifylline) Tablet
Note: unique drug matrix enhances rapid
(acetaminophen) Tablet Slow-release (traMADol) Tablet
Note: tablet disruption may cause a

Valcyte (valGANciclovir)
Teratogenic and irritant potential (i, b) Vimovo (naproxen/esomeprazole) Tablet Note: crushing significantly increases the
(buPROPion) Tablet
(buPROPion) Tablet
(ALPRAZolam) Tablet Extended-release
Note: irritant; avoid contact with skin or
Note: crushed powder may cause

Zyban (buPROPion) Tablet
Capsule may be opened and the contents taken without crushing or chewing; soft food such as applesauce or pudding may facilitate administration; contents may generally be administered via nasogastric tube using an appropriate fluid provided entire contents and washed down the tube. Liquid dosage forms of the product are available; however, dose, frequency of administration and manufacturers may differ from that of the solid dosage form. Antacids and/or milk may prematurely dissolve the coating of the tablet. Capsule may be opened and the liquid contents removed for administration. The taste of this product form would likely be unacceptable to the patient; administration via nasogastric tube Effervescent tablets must be dissolved in the amount of diluent recommended by the manufacturer. Tablets are made to disintegrate under the tongue. Tablet is scored and may be broken in half without affecting release characteristics. Skin contact may enhance tumor production; avoid direct contact.
Disclaimer:
This listing is not meant to represent all products, either by generic or trade name. The author encourages
manufacturers, pharmacists, nurses, and other health professionals to notify him of any changes or updates.
1. Correspondence regarding this list may be addressed to:
John F. Mitchell, PharmD, FASHP
Email: rxmitchell@att.net
2. The generic name is provided merely as a reference point and is only listed for single ingredient medications; it should not be assumed that drugs with the same generic are equivalent to the specific brand name listed relative to crushing or chewing. If questions arise, please check with your pharmacist. 3. Two official USP terms are used to designate special-release medication forms: "extended release" and "delayed
release". Others such as "sustained release", “controlled release", etc. are commonly used on package labeling. The
term "Slow-release" is being used here to signify all such drugs with a special-release mechanism.
Copyright 2011, 2012. No part of this list may be reproduced in any format without the expressed permission of the

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