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Which tablets should never be crushed?

Medically reviewed by Sally Chao, MD. Last updated on Nov 10, 2021.

Official answer

by Drugs.com

Not all medications are suitable for crushing. Drugs that should not be crushed are those that are:

  • Designed to be controlled release
  • Coated for protection or taste
  • Dissolvable
  • Liquid-filled gel capsules
  • Hazardous or irritants
  • Intended for a small therapeutic window

They usually have special letters in their name, such as:

  • CC
  • CD
  • ER
  • XR
  • LA
  • XL
  • EC
  • ODT
  • SL

Controlled release

These are designed to release medicine over an extended period to allow less frequent administration. Crushing may mean a fatal dose is released. Formulations include:

Prefix or Suffix Examples Reasons for use

12-hour or 24-hour

CC — Coat core

CD — Controlled delivery

CR — Controlled release

CRT — Controlled-release tablet

DR — Delayed release

DA — Delayed absorption

ER, XR — Extended release

LA — Long acting

SA — Sustained action

Slo- or SR — Slow release

TD — Time delay

TR — Time release

PA — Prolonged action

SSR — Sustained release

XL, XT — Extended release

Mucinex-D 12 hour (guaifenesin and pseudoephedrine hydrochloride)

Adalat CC (nifedipine)

Adderall XR (amphetamine and dextroamphetamine)

Detrol LA (tolterodine)

Isosorbide SR (isosorbide mononitrate)

Cardura XL (doxazosin)

Procardia XL (nifedipine)

Cartia XT (diltiazem)

Longer duration of action

Smoother level of drug release over time

Special release technology to provide fast release followed by extended release all in one drug

Multiple-layered tablets that release as each layer is dissolved

Special matrices that allow the slower release of a drug

Enteric coated

These have a special coating to:

  • Protect your stomach from the drug
  • Protect the drug from stomach acid
  • Target the release of the drug in the intestines

Crushing may lead to the medicine being released too early, being destroyed by stomach acid or irritating your stomach wall.

Prefix or Suffix Examples Reasons for use

EC, EN — Enteric coated

Diclofenac EC (diclofenac)

Ecotrin (aspirin)

Ery-Tab (erythromycin)

The drugs are most soluble in the intestines and need to pass through the stomach intact

Protection from drugs that irritate the stomach

Taste-modified

These medications are sugar-coated to improve their taste. If crushed, the unpleasant taste would surface, which could discourage patients from taking the medication.

Prefix or Suffix Examples Reasons for use

SPT — Strong, persistent taste

TS — Taste

Ceftin (cefuroxime)

Motrin (ibuprofen)

Topamax Sprinkle (topiramate)

Vesicare (solifenacin)

Unacceptable taste

Dissolvable

These are designed to dissolve on the tongue or under the tongue. Crushing or chewing these may cause a loss of dosage.

Prefix or Suffix Examples Reasons for use

ODT — Orally disintegrating tablets

Lamictal ODT solute (lamotrigine)

Zofran ODT (ondansetron)

Maxalt-MLT (rizatriptan)

Zomig-ZMT (zolmitriptan)

Difficulty swallowing in children or in stroke, tumor, multiple sclerosis or Parkinson’s disease patients

Nausea

Prevent patients from hiding medication in the mouth (“cheeking”) to spit out later

SL — Sublingual

Nitrostat (nitroglycerin)

Zubsolv (buprenorphine and naloxone)

Faster absorption (than swallowed tablet or capsule)

Liquid content

Soft gelatin capsules (with liquid filling) should not be chewed or split. Removal of the liquid inside may lead to incorrect dosage.

Prefix or Suffix Examples Reasons for use

LC — Liquid within capsule

LF — Liquid filled

Drisdol (ergocalciferol)

Dulcolax (bisacodyl)

Designed specifically to ensure proper dosage and absorption

Hazardous

These have cancer-causing or baby-harming potential when tampered with. They are hormonal or chemotherapeutic drugs.

Prefix or Suffix Examples Warnings

None

Tamoxifen

Methotrexate

Dutasteride

Finasteride

Skin contact may cause tumor production

Women who are pregnant or may become pregnant should not handle

Irritant

These can irritate the gut lining or skin if tampered with.

Prefix or Suffix Examples Warnings

IR — Irritant

Actonel (risedronate)

Zolinza (vorinostat)

Chewed, crushed or sucked tablets may cause gut ulcers or skin irritation

MMI — Mucous membrane irritant

Isotretinoin

Afinitor (everolimus)

Fosamax (alendronate)

Valcyte (valganciclovir)

Small therapeutic windows

Drugs like warfarin or levothyroxine have small therapeutic windows. If split into uneven parts and taken, the dose may be too high or too low.

Exceptions

Some slow-release tablets are scored and can be divided or halved, but not crushed. Examples include Toprol XL (metoprolol succinate) and Sinemet CR (carbidopa and levodopa). Certain long-acting capsules can also be opened and their contents sprinkled without chewing or crushing. Examples include Kadian (morphine) and Xtampza ER (oxycodone).

References
  1. Institute for Safe Medication Practices (ISMP). Oral Dosage Forms That Should Not Be Crushed. February 21, 2020. Available at: https://www.ismp.org/recommendations/do-not-crush.
  2. Gracia-Vásquez SL, González-Barranco P, Camacho-Mora IA, et al. Medications that should not be crushed. Medicina Universitaria. 2017. Volume 19, Issue 75, Pages 50-63. https://doi.org/10.1016/j.rmu.2017.03.001.
  3. Cornish P. "Avoid the crush:" hazards of medication administration in patients with dysphagia or a feeding tube. CMAJ. 2005;172(7):871-872. https://doi.org/10.1503/cmaj.050176.

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