Page 1 of 16. Oral Dosage Forms That Should Not Be Crushed. John F. Mitchell,
PharmD, FASHP. 1. Last updated: January 2014. Drug Product.
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)
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Page 1 of 16
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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Page 2 of 16
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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Page 4 of 16
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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Page 5 of 16
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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Page 6 of 16
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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Page 7 of 16
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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Page 9 of 16
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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Page 10 of 16
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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Page 12 of 16
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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