Section 16: medications: appendix a - do not crush list

Oral Dosage Forms That Should Not Be Crushed
John F. Mitchell, PharmD, FASHP1
Last updated: April 9. 2010

Drug Product (active ingredient) 2
Dosage Form
Reasons/Comments 3
(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 Slow-release

Amrix (cyclobenzaprine) Capsule Slow-release
Aplenzin (buPROPion) Tablet
Note: maintain pH at less than or
Note: oil emulsion within spheres; taste
(sulfasalazine) Tablet Enteric-coated
AVINza (morphine)
Note: drug may cause fetal abnormalities;
should not handle capsules; all woman should use caution in handling capsules, especially leaking capsules Biaxin-XL (clarithromycin) Tablet Slow-release Bidex A Biltricide (praziquantel) Tablet Note: chewed, crushed, or sucked tablets

Carbatrol (carBAMazepine) Capsule Slow-release
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
Capsule, Tablet Teratogenic potential (i) Chlor-Trimeton 12-H (combination) Tablet Concerta (methylphenidate) Tablet Note: integrity compromised by chewing or
Cotazym-S (pancrelipase) Capsule Note: capsule may be opened and mixed
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 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 Embeda (morphine sulfate) Capsule Slow-release
Equetro (carBAMazepine) Capsule Slow-release
Delayed-Release Evista (raloxifene)
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

GlipiZIDE
(glipiZIDE) Tablet
(metFORMIN) Tablet
(glipiZIDE) Tablet

Glumetza (metFORMIN) Tablet
Guaifed-PD (combination) Capsule
GuaiFENesin
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: do not give via NG tubes
Kapidex (dexlansoprazole) Capsule Slow-release Note: named changed to Dexilant
Keppra (levetiracetam) Tablet Taste Note: some extemporaneous formulas are

LaMICtal XR
(lamoTRIgine) Tablet
Levbid (hyoscyamine) Tablet Slow-release Liquibid-PD (combination) Tablet (brompheniramine) Capsule Slow-release Note: contents of capsule may erode
(pyridostigmine) Tablet Slow-release (methylphenidate) Capsule Slow-release extended-release Motrin (ibuprofen) Tablet
Mucinex (guaiFENesin) Tablet
Myfortic (mycophenolate) Tablet Slow-release Naprelan (naproxen) Tablet (NIFEDipine) Tablet
(NIFEDipine) Tablet
Slow-release form within a special capsule
OxyCONTIN
(oxyCODONE) Tablet Slow-release
Note: tablet disruption may cause a
potentially fatal overdose of oxyCODONE
Pancrecarb (pancrelipase) Capsule (PARoxetine) Tablet
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
Protonix (pantoprazole) Tablet Slow-release
PROzac Weekly
(FLUoxetine) Tablet
Note: tablets expand in liquid if broken or
Note: Teratogenic potential; healthcare
(methylphenidate) Capsule Slow-release
Ryzolt (traMADol) Tablet
Note: crushing may cause overdose

SEROquel XR
(QUEtiapine) Tablet
(levo/carbidopa) Tablet Slow-release 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 Slow-release
Temodar (temozolomide)
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: women who are, or may become,
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) Note: crushing significantly increases the
(buPROPion) Tablet
(ALPRAZolam) Tablet Slow-release
Note: irritant; avoid contact with skin or

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 in a liquid form would likely be unacceptable to the patient; administration via 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.
1. Correspondence regarding this list may be addressed to:
John F. Mitchell, Pharm.D., 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 2010. No part of this list may be reproduced in any format without the expressed permission of the author.

Source: http://achhh.net/Files%20&%20Forms/VNAA/data/papers/pdf/343_16.ApdexA.2.pdf