Oral Dosage Forms That Should Not Be Crushed

Oral Dosage Forms That Should Not Be Crushed 2016 Drug Product Absorica Accutane AcipHex Acticlate

Active Ingredient(s) (isotretinoin) (isotretinoin) (rabeprazole) (doxycycline)

Dosage Form(s) Capsule Capsule Tablet Capsule; Tablet

Actiq

(fentaNYL)

Lozenge

Actonel

(risedronate)

Tablet

Adalat CC Adderall XR AeroHist Plus Afeditab CR Afinitor Aggrenox Alavert Allergy (Sinus 12 hour) Allegra-D Alophen ALPRAZolam ER Altoprev Ambien CR Amibid DM Amitiza Ampyra Amrix Aplenzin Apriso Aptensio XR Aptivus Aquatab C Aquatab D

(NIFEdipine) (amphetamine salts) (combination) (NIFEdipine) (everolimus) (combination) (combination) (combination) (bisacodyl) (ALPRAZolam) (lovastatin) (zolpidem) (combination) (lubiprostone) (dalfampridine) (cyclobenzaprine) (buPROPion) (mesalamine) (methylphenidate) (tipranavir) (combination) (combination)

Tablet Capsule Tablet Tablet Tablet Capsule Tablet Tablet Tablet Tablet Tablet Tablet Tablet Capsule Tablet Capsule Tablet Capsule Capsule Capsule Tablet Tablet

Reasons/Comments Mucous membrane irritant Mucous membrane irritant Slow-release Film-coated (h) (Note: tablet scored in thirds rather than half) Slow-release (Note: this lollipop delivery system requires the patient to slowly allow dissolution) Irritant (Note: chewed, crushed, or sucked tablets may cause oropharyngeal irritation) Slow-release Slow-release (a) Slow-release (h) Slow-release Mucous membrane irritant Slow-release Slow-release Slow-release Enteric-coated Slow-release Slow-release Slow-release Slow-release Slow-release Slow-release (Note: formerly fampridine-SR) Slow-release Slow-release Slow-release (a) (Note: maintain pH at < 6.0) Slow-release (a) Note: oil emulsion within spheres; taste Slow-release (h) Slow-release (h)

You may purchase a wall chart version of this list at: http://onlinestore.ismp.org/shop/item.aspx?itemid=129

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Oral Dosage Forms That Should Not Be Crushed 2016 Aricept 23 mg

(donepezil)

Tablet

Note: crushing the 23 mg tablet may significantly increase the rate of absorption; the 5 mg and 10 mg tablets are not affected Enteric-coated Slow-release Slow-release; Enteric-coated Slow-release (Note: tablet coating is an important part of the slow-release; chewed, cut, or crushed tablets may cause oropharyngeal irritation)

Arthrotec Asacol Aspirin enteric-coated Atelvia

(diclofenac) (mesalamine) (aspirin) (risedronate)

Tablet Tablet Caplet; Tablet Tablet

Augmentin XR AVINza Avodart

(combination) (morphine) (dutasteride)

Tablet Capsule Capsule

Slow-release (b,h) Slow-release (a; not pudding) Note: drug may cause fetal abnormalities; women who are, or may become, pregnant, should not handle capsules; all women should use caution in handling capsules, especially leaking capsules

Azulfidine EN-Tabs Bayer EC Bayer Regular Belsomra

(sulfaSALAzine) (aspirin) (aspirin) (suvorexant)

Tablet Caplet Caplet Tablet

Slow-release (b) Enteric-coated Enteric-coated Note: not scored; no studies available from company

Belviq XR Biaxin-XL Bidex A Bidhist-D Biltricide Biohist LA Bisac-Evac Bisacodyl Bisa-Lax Boniva

(lorcaserin) (clarithromycin) (combination) (combination) (praziquantel) (combination) (bisacodyl) (combination) (combination) (ibandronate)

Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet

Briviact

(brivaracetam)

Tablet

Slow-release Slow-release Slow-release Slow-release Taste (h) Slow-release (h) Enteric-coated (c) Enteric-coated (c) Enteric-coated (c) Note: chewed, crushed, or sucked tablets may cause oropharyngeal irritation Film-coated (b)


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Oral Dosage Forms That Should Not Be Crushed 2016 Bromfed PD Budeprion SR Bunavail

(combination) (buPROPion) (combination)

Capsule Tablet Buccal film

Cabometyx Calan SR Carbatrol Cardene SR Cardizem

(cabozantinib) (verapamil) (carBAMazepine) (niCARdipine) (diltiazem)

Tablet Tablet Capsule Capsule Tablet

Cardizem CD Cardizem LA Cardura XL Cartia XT Cefaclor ER Ceftin Cefuroxime CellCept Cerdelga Charcoal Plus Chlor-Trimeton 12-H Cholbam

(diltiazem) (diltiazem) (doxazosin) (diltiazem) -----(cefuroxime) -----(mycophenolate) (eliglustat) -----(combination) (cholic acid)

Capsule Tablet Tablet Capsule Tablet Tablet Tablet Capsule; Tablet Capsule Tablet Tablet Capsule

Cipro XR Claritin-D 12 Hour Claritin-D 24 Hour Colace Colestid Commit

(ciprofloxacin) (combination) (combination) (docusate) (colestipol) (nicotine)

Tablet Tablet Tablet Capsule Tablet Lozenge

Concerta Contrave

(methylphenidate) (combination)

Tablet Tablet

Slow-release Slow-release Note: chewing or swallowing may result in lower peak concentrations and bioavailability Film-coated Slow-release (h) Slow-release (a) Slow-release Note: although not in the package insert, the drug has a coating that is intended to release the drug over approximately 3 hours Slow-release Slow-release Slow-release Slow-release Slow-release (b) Taste (b) (Note: use suspension for children) Taste (b) (Note: use suspension for children) Teratogenic potential (i) Preferably taken with water Enteric-coated Slow-release (b) Note: capsules may be opened and the contents mixed with food/drink Slow-release (b) Slow-release Slow-release Taste (e) Slow-release Note: integrity compromised by chewing or crushing Slow-release Slow-release (Note: chewing, dividing, or crushing tablets may alter release rate)


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Oral Dosage Forms That Should Not Be Crushed 2016 Coreg CR

(carvedilol)

Capsule

Cotazym-S Covera-HS Creon 5, 10, 20 Crixivan

(pancrelipase) (verapamil) (pancrelipase) (indinavir)

Capsule Tablet Capsule Capsule

Cymbalta

(DULoxetine)

Capsule

Cytovene Cytoxan

(ganciclovir) (cyclophosphamide)

Capsule Tablet

Depakene Depakote Depakote ER Detrol LA Dexilant Diclegis Dilacor XR Dilatrate-SR Dilt-CD Diltia XT Ditropan XL Divalproex ER Doxidan Drisdol Droxia

(divalproex) (divalproex) (divalproex) (tolterodine) (dexlansoprazole) (combination) (diltiazem) (isosorbide) (diltiazem) (diltiazem) (oxybutynin) (divalproex) (bisacodyl) (ergocalciferol) (hydroxyurea)

Capsule Tablet Tablet Capsule Capsule Tablet Capsule Capsule Capsule Capsule Tablet Tablet Tablet Capsule Capsule

Dulcolax Durlaza DynaCirc CR

(bisacodyl) (aspirin) (isradipine)

Capsule; Tablet Capsule Tablet

Slow-release (a) (Note: may add contents of capsule to chilled, not warm, applesauce and consume immediately) Enteric-coated (a) Slow-release Slow-release (a) Taste (Note: capsule may be opened and mixed with fruit puree [e.g., banana]) Slow-release (a) (Note: may add contents of capsule to apple juice or applesauce but NOT chocolate) Skin irritant Note: drug may be crushed but company recommends using injection Slow-release; mucus membrane irritant (b) Slow-release Slow-release Slow-release Slow-release (a) Slow-release Slow-release Slow-release Slow-release Slow-release Slow-release Slow-release Enteric-coated (c) Liquid filled (d) Note: exposure to the powder may cause serious skin toxicities; health care workers should wear gloves to administer Enteric-coated (c); Liquid-filled Slow-release Slow-release


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Oral Dosage Forms That Should Not Be Crushed 2016 E.E.S. 400 Easprin EC-Naprosyn Ecotrin Adult Low Strength Ecotrin Maximum Strength Ecotrin Regular Strength Effer-K Effervescent Potassium Effexor XR Embeda E-Mycin Enablex Entocort EC Envarsus XR Epanova

(erythromycin) (aspirin) (combination) (aspirin) (aspirin) (aspirin) (potassium bicarbonate) -----(venlafaxine) (morphine sulfate) (erythromycin) (darifenacin) (budesonide) (tacrolimus) (omega-3-carboxylic acids)

Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Capsule Capsule Tablet Tablet Capsule Tablet Capsule

Equetro Ergomar Erivedge

(carBAMazepine) (ergotamine) (vismodegib)

Capsule Tablet Capsule

Ery-Tab Erythromycin Base Erythromycin Delayed-Release Erythromycin Stearate Evista Exalgo

(erythromycin) --------------(raloxifene) (HYDROmorphone)

Tablet Tablet Capsule Tablet Tablet Tablet

Exjade

(deferasirox)

Tablet

Extendryl JR

(combination)

Capsule

Enteric-coated (b) Enteric-coated Enteric-coated Enteric-coated Enteric-coated Enteric-coated Effervescent tablet (f) Effervescent tablet (f) Slow-release Slow-release (a) Enteric-coated Slow-release Enteric-coated (a) Slow-release Note: contents of capsule may erode walls of Styrofoam or plastic materials Slow-release (a) Sublingual form (g) Note: package insert indicates potential teratogenic effects; material safety data sheet warns against skin contact; health care workers should take appropriate precautions Enteric-coated Enteric-coated Enteric-coated pellets (a) Enteric-coated Taste; teratogenic potential (i) Slow-release (Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose) Note: do not give as whole tablet, tablets are meant to be given as oral suspension; see company insert Slow-release


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Oral Dosage Forms That Should Not Be Crushed 2016 Extendryl SR Farydak Feen-a-mint Feldene FentaNYL

(combination) (panobinostat) (bisacodyl) (piroxicam) ------

Capsule Capsule Tablet Capsule Lozenge

Slow-release (b) Irritant Enteric-coated (c) Mucous membrane irritant Slow-release (Note: this lollipop delivery system requires the patient to slowly dissolve in mouth)

Fentora Feosol Feratab Fergon Fero-Grad 500 mg Ferro-Sequels Flagyl ER Fleet Laxative Flomax Focalin XR Fortamet Fosamax Gleevec

(fentaNYL) (ferrous sulfate) (ferrous sulfate) (ferrous gluconate) (combination) (combination) (metroNIDAZOLE) (bisacodyl) (tamsulosin) (dexmethylphenidate) (metFORMIN) (alendronate) (imatinib)

Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Capsule Capsule Tablet Tablet Tablet

GlipiZIDE XR Glucophage XR Glucotrol XL Glumetza Gralise Guaifed Guaifed-PD Guaifenex DM Guaifenex GP Guaifenex PSE GuaifFENesin/Pseudoephedrine GuaiMAX-D Halfprin 81

(glipiZIDE) (metFORMIN) (glipiZIDE) (metFORMIN) (gabapentin) (combination) (combination) (combination) (combination) (combination) -----(combination) (aspirin)

Tablet Tablet Tablet Tablet Tablet Capsule Capsule Tablet Tablet Tablet Tablet Tablet Tablet

Note: buccal tablet; swallow whole Enteric-coated (b) Enteric-coated (b) Enteric-coated Slow-release Slow-release Slow-release Enteric-coated (c) Slow-release Slow-release (a) Slow-release Mucous membrane irritant Taste (h) (Note: may be dissolved in water or apple juice) Slow-release Slow-release Slow-release Slow-release Slow-release Slow-release Slow-release Slow-release (h) Slow-release Slow-release (h) Slow-release Slow-release Enteric-coated


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Oral Dosage Forms That Should Not Be Crushed 2016 Hetlioz

(tasimelteon)

Capsule

Note: not scored; no studies available from company

Hista-Vent DA Horizant Hydrea

(combination) (gabapentin) (hydroxyurea)

Tablet Tablet Capsule

Hysingla ER

(HYDROcodone)

Tablet

Slow-release (h) Slow-release Note: exposure to the powder may cause serious skin toxicities; health care workers should wear gloves to administer Slow-release (Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose of HYDROcodone)

Imbruvica

(ibrutinib)

Capsule

Note: not scored; no studies available from company

Imdur Impavido

(isosorbide) (miltefosine)

Tablet Capsule

Slow-release (h) Note: not scored; no studies available from company

Inderal LA Indocin SR InnoPran XL Intelence

(propranolol) (indomethacin) (propranolol) (etravirine)

Capsule Capsule Capsule Tablet

Intermezzo Intuniv Invega Iressa

(zolpidem) (guanFACINE) (paliperidone) (gefitinib)

Tablet Tablet Tablet Tablet

Slow-release Slow-release (a,b) Slow-release Note: tablet should be swallowed whole and not crushed; tablet may be dispersed in water Sublingual form (g) Slow-release Slow-release Note: tablet may be dissolved in 4-8 ounces of water

Isoptin SR Isordil Sublingual Isosorbide Dinitrate Sublingual Isosorbide SR Jakafi

(verapamil) (isosorbide) (isosorbide) (isosorbide) (ruxolitinib)

Tablet Tablet Tablet Tablet Tablet

Slow-release (h) Sublingual form (g) Sublingual form (g) Slow-release Note: see prescribing information for making a suspension


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Oral Dosage Forms That Should Not Be Crushed 2016 Jalyn

(combination)

Capsule

Janumet XR Jentadueto XR Kadian Kaletra Kaon-CL-10 Kapidex

(combination) (combination) (morphine) (combination) (potassium) (dexlansoprazole)

Tablet Tablet Capsule Tablet Tablet Capsule

Mucous membrane irritant (Note: women who are, or may become, pregnant, should not handle crushed or broken tablets [l]) Slow-release Slow-release Slow-release (a) (Note: do not give via NG tubes) Film-coated Slow-release (b) Slow-release (a) (Note: name changed to Dexilant)

Kapvay Kazano

(cloNIDine) (combination)

Tablet Tablet

Slow-release Note: not scored; no studies available from company

K-Dur Keppra

(potassium) (levETIRAcetam)

Tablet Tablet

Keppra XR Ketek Khedezla Klor-Con Klor-Con M Klotrix K-Lyte K-Lyte CL K-Lyte DS Kombiglyze XR

(levETIRAcetam) (telithromycin) (desvenlafaxine) (potassium) (potassium) (potassium) (potassium) (potassium) (potassium) (combination)

Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet

Slow-release Taste (b) (Note: some extemporaneous formulas are pharmacy prepared) Slow-release (b) Slow-release (b) Slow-release Slow-release (b) Slow-release (b,h) Slow-release Effervescent tablet (f) Effervescent tablet (f) Effervescent tablet (f) Slow-release (Note: tablet matrix may remain in stool)

K-Tab LaMICtal XR Lenvima Lescol XL Letairis Levbid Levsinex Timecaps

(potassium) (lamoTRIgine) (lenvatinib) (fluvastatin) (ambrisentan) (hyoscyamine) (hyoscyamine)

Tablet Tablet Capsule Tablet Tablet Tablet Capsule

Slow-release (b) Slow-release Note: may be dissolved in a small glass of liquid Slow-release Slow-release Slow-release (h) Slow-release


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Oral Dosage Forms That Should Not Be Crushed 2016 Lialda Liquibid-PD Lithobid Lodrane 24 Lodrane 24D LoHist 12 Hour Lovaza

(mesalamine) (combination) (lithium) (brompheniramine) (combination) (brompheniramine) (combination)

Tablet Tablet Tablet Capsule Capsule Tablet Capsule

Luvox CR Maxifed DM Maxifed DMX Maxiphen DM Medent-DM Mestinon ER Metadate CD Metadate ER Methylin ER Metoprolol ER Micro K Extencaps Miraphen PSE Morphabond Morphine sulfate extended-release Motrin Movantik Moxatag MS Contin Mucinex Mucinex DM Myfortic Myrbetriq Namenda XR Namzaric Naprelan NexIUM

(fluvoxaMINE) (combination) (combination) (combination) (combination) (pyridostigmine) (methylphenidate) (methylphenidate) (methylphenidate) -----(potassium chloride) (combination) (morphine) -----(ibuprofen) (naloxegol) (amoxicillin) (morphine) (guaiFENesin) (combination) (mycophenolate) (mirabegron) (memantine) (combination) (naproxen) (esomeprazole)

Capsule Tablet Tablet Tablet Tablet Tablet Capsule Tablet Tablet Tablet Capsule Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Tablet Capsule Capsule Tablet Capsule

Slow-release Slow-release (h) Slow-release Slow-release Slow-release Slow-release Note: contents of capsule may erode walls of Styrofoam or plastic materials Slow-release Slow-release (h) Slow-release (h) Slow-release (h) Slow-release Slow-release (b) Slow-release (a) Slow-release Slow-release Slow-release Slow-release (a,b) Slow-release Slow-release (b) Slow-release Taste (b,e) Film-coated Slow-release Slow-release (b) Slow-release Slow-release Slow-release Slow-release Slow-release (a) Slow-release Slow-release Slow-release (a)


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Oral Dosage Forms That Should Not Be Crushed 2016 Niaspan Nicotinic Acid Nifediac CC Nifedical XL Nitrostat Norflex ER Northera Norpace CR Norvir

(nicotinic acid) -----(NIFEdipine) (NIFEdipine) (nitroglycerin) (orphenadrine) (droxidopa) (disopyramide) (ritonavir)

Tablet Capsule; Tablet Tablet Tablet Tablet Tablet Capsule Capsule Tablet

Slow-release Slow-release (h) Slow-release Slow-release Sublingual form (g) Slow-release Note: no studies available from company Slow-release form within a special capsule Note: crushing tablets has resulted in decreased bioavailability of drug (b) Slow-release (b) Slow-release (Note: crushing, chewing, or dissolving tablets may result in overdose or death)

Noxafil Nucynta ER

(posaconazole) (tapentadole)

Tablet Tablet

OFEV Oleptro Omtryg

(nintedanib) (traZODone) (omega-3-acid ethyl esters A)

Capsule Tablet Capsule

Opana ER

(oxymorphone)

Tablets

Oracea Oramorph SR Otezla OxyCONTIN

(doxycycline) (morphine) (apremilast) (oxyCODONE)

Capsule Tablet Tablet Tablet

Slow-release Slow-release (b) Film-coated Slow-release (Note: tablet disruption may cause a potentially fatal overdose of oxyCODONE)

Pancreaze Pancrecarb Pancrelipase Paxil CR Pentasa Pertyze Plendil

(pancrelipase) (pancrelipase) -----(PARoxetine) (mesalamine) (pancrelipase) (felodipine)

Capsule Capsule Capsule Tablet Capsule Capsule Tablet

Enteric-coated (a) Enteric-coated (a) Enteric-coated (a) Slow-release Slow-release Slow-release (a) Slow-release

Taste Slow-release (h) Note: contents of capsule may erode walls of Styrofoam or plastic materials Slow-release (Note: crushing, chewing, or dissolving tablets may result in overdose or death)


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Oral Dosage Forms That Should Not Be Crushed 2016 Pradaxa

(dabigatran)

Capsule

Note: breaking, chewing, or emptying contents of the capsule can result in increased exposure Slow-release (h) Slow-release Note: orally disintegrating do not swallow; dissolve in water only and dispense via dosing syringe of NG tube

Pre-Hist-D Prevacid Prevacid SoluTab

(combination) (lansoprazole) (lansoprazole)

Tablet Capsule Tablet

Prevacid Suspension

(lansoprazole)

Suspension

PriLOSEC PriLOSEC OTC Pristiq Procardia XL Propecia

(omeprazole) (omeprazole) (desvenlafaxine) (NIFEdipine) (finasteride)

Capsule Tablet Tablet Tablet Tablet

Proquin XR Proscar

(ciprofloxacin) (finasteride)

Tablet Tablet

Slow-release Note: women who are, or may become, pregnant, should not handle crushed or broken tablets

Protonix PROzac Weekly QDALL QDALL AR Qudexy XR Ranexa Rapamune

(pantoprazole) (FLUoxetine) (combination) (combination) (topiramate) (ranolazine) (sirolimus)

Tablet Tablet Capsule Capsule Capsule Tablet Tablet

Rayaldee Rayos

(calcifediol) (predniSONE)

Capsule Tablet

Razadyne ER Renagel

(galantamine) (sevelamer)

Capsule Tablet

Slow-release Enteric-coated Slow-release Slow-release Slow-release (a) Slow-release Note: pharmacokinetic parameters may be affected (b) Slow-release Slow-release (Note: delayed release is dependent on an intact coating) Slow-release Note: tablets expand in liquid if broken or crushed

Slow-release (Note: contains enteric-coated granules; mix with water only; not for NG use) Slow-release Slow-release Slow-release Slow-release Note: women who are, or may become, pregnant, should not handle crushed or broken tablets


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Oral Dosage Forms That Should Not Be Crushed 2016 Renvela

(sevelamer carbonate)

Tablet

Note: tablets expand in liquid if broken or crushed (b)

Requip XL Rescon Rescon JR Rescon MX Respahist Respaire SR Revlimid

(ropinirole) (combination) (combination) (combination) (combination) (combination) (lenalidomide)

Tablet Tablet Tablet Tablet Capsule Capsule Capsule

Reyataz

(atazanavir)

Capsule

Slow-release Slow-release (h) Slow-release (h) Slow-release (h) Slow-release (a) Slow-release Note: Teratogenic potential; health care workers should avoid contact with capsule contents/body fluids Note: an oral powder is available, see prescribing information for administration instructions

Ritalin LA Ritalin SR R-Tanna Rytary Rythmol SR Ryzolt

(methylphenidate) (methylphenidate) (combination) (combination) (propafenone) (traMADol)

Capsule Tablet Tablet Capsule Capsule Tablet

Slow-release (a) Slow-release Slow-release Slow-release (a) Slow-release Slow-release (Note: crushing may cause overdose)

Sensipar

(cinacalcet)

Tablet

SEROquel XR Sinemet CR SINUvent PE Slo-Niacin Solodyn Somnote Sprycel

(QUEtiapine) (levo/carbidopa) (combination) (nicotinic acid) (minocycline) (chloral hydrate) (dasatinib)

Tablet Tablet Tablet Tablet Tablet Capsule Tablet

Note: tablets are not scored and cutting may cause variable dosage accuracy Slow-release Slow-release (h) Slow-release (h) Slow-release (h) Slow-release Liquid filled Film-coated (Note: active ingredients are surrounded by wax matrix to prevent healthcare exposure; women who are, or may become, pregnant, should not handle crushed or broken tablet)

Strattera

(atomoxetine)

Capsule

Note: capsule contents can cause ocular irritation


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Oral Dosage Forms That Should Not Be Crushed 2016 Sudafed 12 hour

(combination)

Capsule

Slow-release (b)

Sudafed 24 hour Sular Symax Duotab Symax SR Tagrisso

(combination) (nisoldipine) (hyoscyamine) (hyoscyamine) (osimertinib)

Capsule Tablet Tablet Tablet Tablet

Slow-release (b) Slow-release Slow-release Slow-release Note: tablet may be dissolved in 2 ounces of water

Targiniq ER

(combination)

Tablet

Slow-release (Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose of oxyCODONE)

Tasigna

(nilotinib)

Capsule

Taztia XT Tecfidera TEGretol-XR Temodar

(diltiazem) (dimethyl fumarate) (carBAMazepine) (temozolomide)

Capsule Capsule Tablet Capsule

Tessalon Perles

(benzonatate)

Capsule

Theo-24

(theophylline)

Capsule

Theochron Tiazac Topamax Toprol XL Touro CC-LD Touro LA-LD Toviaz Tracleer

(theophylline) (diltiazem) (topiramate) (metoprolol) (combination) (combination) (fesoterodine) (bosentan)

Tablet Capsule Capsule; Tablet Tablet Tablet Tablet Tablet Tablet

Note: disruption of capsule may yield high blood levels causing enhanced toxicity Slow-release (a) Slow-release Slow-release Slow-release (Note: accidentally opened or damaged capsules require rigorous precautions to avoid inhalation or contact with the skin or mucous membranes [i]) Note: swallow whole; local anesthesia of the oral mucosa; choking could occur Slow-release (Note: contains beads that dissolve throughout the GI tract) Slow-release Slow-release (a) Taste; Taste (a) Slow-release (h) Slow-release (h) Slow-release (h) Slow-release Note: women who are, or may become, pregnant, should not handle crushed or broken tablets


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Oral Dosage Forms That Should Not Be Crushed 2016 TRENtal Treximet

(pentoxifylline) (combination)

Tablet Tablet

Trilipix Tylenol Arthritis Uceris

(fenofibric acid) (acetaminophen) (budesonide)

Capsule Tablet Tablet

Ultram ER

(traMADol)

Tablet

Ultrase Ultresa Uniphyl Uptravi Urocit-K Uroxatral Valcyte Verapamil SR Verelan Verelan PM VESIcare Videx EC Viekira XR Vimovo Viokace Viramune XR Voltaren XR VoSpire ER Votrient

(pancrelipase) (pancrelipase) (theophylline) (selexipag) (potassium citrate) (alfuzosin) (valGANCiclovir) -----(verapamil) (verapamil) (solifenacin) (didanosine) (combination) (combination) (pancrelipase) (nevirapine) (diclofenac) (albuterol) (pazopanib)

Capsule Capsule Tablet Tablet Tablet Tablet Tablet Tablet Capsule Capsule Tablet Capsule Tablet Tablet Tablet Tablet Tablet Tablet Tablet

Wellbutrin SR, XL Xanax XR Xarelto

(buPROPion) (ALPRAZolam) (rivaroxaban)

Tablet Tablet Tablet

Slow-release Note: unique drug matrix enhances rapid drug absorption Slow-release Slow-release Slow-release (Note: film coating is designed to break down at or above pH of 7.0) Slow-release (Note: tablet disruption may cause a potentially fatal overdose of drug) Enteric-coated Slow-release (a) Slow-release Film-coated Wax-coated; prevents upper GI release Slow-release Teratogenic and irritant potential (i, b) Slow-release (h) Slow-release (a) Slow-release (a) Enteric-coated Slow-release Slow-release Slow-release Mucous membrane irritant Slow-release (b) Slow-release Slow-release Note: crushing significantly increases the AUC and Tmax Slow-release Slow-release Note: crushed tablet must be given within 4 hours


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Oral Dosage Forms That Should Not Be Crushed 2016 Xartemis XR

(combination)

Tablet

Xeljanz XR Xigduo XR Xtampza ER Zegerid Zenpep Zohydro ER

(tofacitinib) (combination) (oxycodone) (combination) (pancrelipase) (HYDROcodone)

Tablet Tablet Tablet Capsule Capsule Capsule

Zolinza

(vorinostat)

Capsule

Zortress

(everolimus)

Tablet

Zyban Zydelig Zyflo CR

(buPROPion) (idelalisib) (zileuton)

Tablet Tablet Tablet

Slow-release (Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose) Slow-release Slow-release Slow-release (b) Slow-release (b) Slow-release (b) Slow-release (Note: crushing, chewing, or dissolving capsules may result in overdose or death) Note: irritant; avoid contact with skin or mucous membranes; avoid contact with crushed or broken tablets Note: crushed powder may cause mucous membrane irritation Slow-release Note: not scored; film-coated Slow-release


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Oral Dosage Forms That Should Not Be Crushed 2016 (a) 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 are washed down the tube. (b) Liquid dosage forms of the product are available; however, dose, frequency of administration and manufacturers may differ from that of the solid dosage form. (c) Antacids and/or milk may prematurely dissolve the coating of the tablet. (d) Capsule may be opened and the liquid contents removed for administration. (e) The taste of this product form would likely be unacceptable to the patient; administration via nasogastric tube should be acceptable. (f) Effervescent tablets must be dissolved in the amount of diluent recommended by the manufacturer. (g) Tablets are made to disintegrate under the tongue. (h) Tablet is scored and may be broken in half without affecting release characteristics. (i) Skin contact may enhance tumor production; avoid direct contact.

Disclaimer: This list is not meant to represent all products, either by generic or trade name. While every effort has been made to ensure the accurcay and completeness of the information presented in this chart, the reader is advised that the authors, editor, or publisher cannot be responsible for the currency of the information, for any errors or omissions, or for any consequences that may arrise. Two official USP terms are used to designate special-release medication forms: "extended release" and "delayed release." Others (e.g., sustained release, controlled release) are commonly used on package labeling. The term "Slow-release" is being used here to signify all such drugs with a special-release mechanism.

© ISMP 2016. Permission is granted to reporduce material for internal use within healthcare organizations.


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