Medication that should not be crushed

Charts medication that shouldn't be crushed

1. Drug Product Active Ingredient(s)* Dosage Form(s) | Reasons/Comments*
Actiq fentaNYL Lozenge Slow-release

this lollipop delivery system requires the
patient to slowly dissolve in mouth

[7
bte
| Ambienen | [extended-release "|

Ampyra lalfampi Tablet Extend
mn SR

2. Drug Product ‘Active Ingredient(s)? Dosage Form(s) —'Reasons/Comments*

alamine le Extended-release (a)

Apriso
Note: maintain pH at less than or equal to

Aquatab C | combination Tablet Slow-release (h)

‘Aricept 23 mg onepe Note: crushing the 23 mg tablet may significantly
increase the rate of absorption; the 5 and 10 mg
tablet are not affected

Asacol | mesalamine Tablet Slow-release

Atelvia risedronate
important part of the delayed release
Augmentin XR combination Tablet Extended-release (b,h)

Avodart dutasteride Capsule 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

Biaxin XL | clarithromycin Tablet Extended-release

Bidhist D combination Tablet Extended-release

EA Tablet ER
bisacody! Tablet Entericcoated (c)

elease (h)

3. Drug Product ‘Active Ingredient(s)? Dosage Form(s) —'Reasons/Comments*

bandronate hewed, cr

oropharyng:

Budeprion SR -ombinai Tablet
Carbatrol | carBAMazepine
Cardizem diltiazem Note: although not in the PI, the drug has a

coating that is intended to release the drug over
approximately 3 hours

Cardizem LA diltiazem Tablet Extended-release
capsule extended

Ceftin cefuroxime e (b)
Note: use in for children

lease

CellCept mycophenolate 'ogenic potential (i)
Chlor-Trimeton | combination Tablet Extended-release (b)
Claritin-D | combination Tablet Extended-release (b)
Colace docusate Capsule Taste (e)

Concerta | methylphenidate Tablet Extended-release

4. Drug Product ‘Active Ingredient(s)? Dosage Form(s) —'Reasons/Comments*

Coreg CR

rvedilol Capsule Extended-release (a)
Note: may add contents of capsule to chilled, not
warm, applesauce and consume immediately

Capsule Extended release (2)

Cymbalta DULoxetine Extended-release (a)
Note: may add contents of capsule to apple juic

or applesauce but NOT chocolate

Cytovene ganciclovir Capsule Skin irritant
Depakote | divalproex Tablet Delayed-release
Depakote Sprinkles | divalproex Capsule Extended-release (a)

dexlansoprazole | Capsule Delayed-release (a)
Dilacor XR | diltiazem Capsule Extended-release
Dilt-CD diltiazem Capsule Extended-release

oxybutynin Tablet Extended-release
Doxidan bisacodyl Tablet Enteric-coated (c)

5. Drug Product ‘Active Ingredient(s)? Dosage Form(s) —'Reasons/Comments*

hydroxyurea Capsule Note: exposure to the powder may cause serio

skin toxicities; healthcare workers should wear
gloves to administer

DynaCirc CR isradipine Tablet Extended-release

Ecotrin (all) aspirin Tablet Enteric-coated

Effer-K potassium bicarbonate Tablet Effervescent tablet (f)

Effexor XR venlafaxine | Capsule Extended-release

E-Mycin erythromycin Tablet Enteric-coated

Entocort EC

Capsule oated (a)

Ergomar | ergotamine Tablet Sublingual form (g)

Ery-Tab erythromycin Tablet Delayed-release; Enteric-coated
Erythromycin Base - Tablet Enteric-coated

Evista | raloxifene Tablet Taste; teratogenic potential (i)

6. Drug Product ‘Active Ingredient(s)? Dosage Form(s) —'Reasons/Comments*

Extendryl (all)
Feldene piroxicam Capsule Mucous membrane irritant

combination Capsule Extended-release (b)

Note: buccal tal
or crushing m:

Fero-Grad 500 mg Tablet Slow-release
Flagyl ER Tablet Extended-release.

Slow-release
Fortamet metFORMIN Tablet Extended-release

Gleeve imatinib Tablet Taste (h)
Note: may be dissolved in water or apple juice

Glucotrol XL | glipizine Tablet Extended-release

Gralise | gabapentin Tablet Extended-release

| combination

7. Drug Product Active Ingredient(s)? Dosage Form(s) Reasons/Comments?

Guaifenex GP combination Tablet Extended-release

Tablet extended-release

Tablet Extended-release

exposure to the powder may cause serious
skin toxicities; healthcare workers should wear

| Hydrea Capsule

gloves to administer

InnoPran XL | propranolol

Intermezzo zolpidem Tablet (sublingual) | (8)
Invega paliperidone Tablet Extended-release
Isordil Sublingual Tablet (sublingual) | (8)

Isosorbide SR isosorbide Tablet Extended-release

Jakafi ruxolitinib Tablet

Janumet

8. Drug Product ‘Active Ingredient(s)? Dosage Form(s) —'Reasons/Comments*

Kaletra lopinavir/ritoavir Tablet

: 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

Kapvay | cloNIDine Tablet Extended-release

Keppra XR | levETIRAcetam Tablet Extended-release (b)
Khedezla Tablet ERGs

Klor-Con M potassium Extended-release (b,h)
Note: to make a liquid, place tablet in 120 mL of
water; disperse for 2 minutes; stir

Extended-release
Note: to make a liquid, break tablet in half and
disperse in 120 mL of water for 2 minutes; stir

K-Lyte CL Tablet Effervescent tablet (f)
Tablet Extended-release (b)

Lescol XL fluvastatin Tablet Extended-release
Letairis ambrisentan Tablet Slow-release

9. Levbid

hyoscyamine

Extended-release (h)

Levsinex

hyoscyamine

Capsule

Extended-release

Lialda

mesalamine

Tablet

Delayed-release

Liquibid

combination

Tablet

Extended-release (h)

Lithobid

lithium

Tablet

Extended-release

Lodrane 24
Lodrane 24D

brompheniramine
combination

Capsule
Capsule

[Extended-release

Extended-release

LoHist 12 Hour
Lovaza

Luvox CR

brompheniramine

combination

fluvoxaMINE

[Tablet
Capsule

Capsule

Extended-release

Note: contents of capsule may erode walls of

styrofoam or plastic materials

Extended-release

Maxifed DM

combination

Tablet

Slow-release (h)

Maxifed DMX

combination

Tablet

Slow-release (h)

Maxiphen DM

combination

Tablet

Slow-release (h)

Mestinon ER

pyridostigmine

[Tablet

Extended-release (b)

Metadate ER

methylphenidate

Tablet

Extended-release

Metadate CD
Methylin ER

methylphenidate
methylphenidate

Capsule
Tablet

[Extended-release (a)

Extended-release

Metoprolol ER

Tablet

Extended-release

Micro K Extencaps

potassium chloride

Capsule

Extended-release (a,b)

Mirapex ER

pramipexole

Tablet

Extended-release

Moxatag

amoxicillin

Tablet

Extended-release

Morphine sulfate extended-release

Tablet

Extended-release

Motrin

ibuprofen

Tablet

Taste (e)

MS Contin

morphine

Tablet

Extended-release (b)

Mucinex

guiaFENesin

Tablet

Slow-release

Mucinex DM

combination

Tablet

Slow-release

Myfortic
Myrbetriq

mycophenolate
mirabegron

Tablet
Tablet

| Delayed-release

Extended-release

Namenda XR

| memantine

Capsule

Extended-release (a)

10. Naprelan

naproxen

Tablet

Extended-release

Nexium

esomeprazole

Capsule

Delayed-release (a)

Niaspan

nicotinic acid

Tablet

Extended-release

Nicotinic Acid

Nifediac CC

| NIFEDipine

| Capsule; Tablet
Tablet

| Slow.release (h)
Extended-release

Nifedical XL

NIFEDipine

Tablet

Extended-release

Nitrostat

nitroglycerin

Tablet

Sublingual route (g)

Norflex ER

orphenadrine

Tablet

Extended-release

Norpace CR

disopyramide

Capsule

Extended-release form within a special capsule

Norvir

ritonavir

Tablet

Note: crushing tablets has resulted in decreased
bioavailability of drug (b)

Noxafil

posaconazole

Tablet

Delayed-release
Note: company literature not available to show
implications

Nucynta ER

tapentadone

Extended-release
Note: toxic dose may occur if tablet is split or
crushed, causing rapid release and absorption of a
potentially fatal dose

Oleptro

traZODone

Tablet

Extended-release

Oracea

doxycycline

Capsule

Delayed-release

Oramorph SR

morphine

Tablet

Extended-release (b)

Orphenadrine citrate ER

Tablet

Extended-release

OxyCONTIN

‘oxyCODONE

Tablet

Extended-release
Note: tablet disruption may cause a potentially
fatal overdose of oxyCODONE

Oxymorphone ER

Tablet

Extended-release

Pancrease Delayed Release

pancrealipase

Capsule

Extended-release (a)

Pancrease MT

pancrealipase

Capsule

Enteric-coated (a)

Pancrecarb

pancrealipase

Capsule

Enteric-coated (a)

Pancrelipase

Capsule

Enteric-coated (a)

11. Drug Product ‘Active Ingredient(s)? Dosage Form(s) —'Reasons/Comments*

Capsule Slow-release (a)

Pre-Hist D | combination Tablet Extended-release (h)

Prevacid | lansoprazole Capsule Delayed-release

Prevacid Suspension lansoprazole Suspension Slow-release

Note: contains enteric-coated granules; mix with
water only; not for NG use

PriLOSEC OTC ‘omeprazole Tablet Delayed-release

Procardia XL NIFEDipine Tablet Extended-release

Proquin XR ciprofloxicin Tablet Extended-release

Protonix pantoprazole Tablet Slow-release
dal Capsule RE
Tablet Slowzele

12. Drug Product ‘Active Ingredient(s)? Dosage Form(s) —'Reasons/Comments*

predniSONE Delayed-relea

able Not

Requip XL rOPINIRole Tablet Extended-release

Rescon JR combination Tablet Slow-relea:
Respahist Capsule Extended-release (a)

Revlimid lenalidomide Capsule Note: teratogenic potential; healthcare workers

e (h)

should avoid contact with capsule contents/body
fluids

Ritalin SR methylphenidate Tablet Extended-release

propafenone Capsule Extended-release

Sensipar cinacalcet Tablet Not
may cau

Sinemet CR levo/carbidopa Tablet Extended:

Rythmol

ts are not scored and cutting
jariable dosage accuracy

elease (h)

Slo-Niacin nicotinic acid Tablet Slow-release (h)

13. Somnote

Active!

chloral hydrate

Capsule

Liquid filled

Sprycel

Strattera

Sudafed 12 hour

dasatinib

‘atomoxetine

combination

Tablet

Capsule

| Capsule

Film-coated

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 irritation

Extended-release (b)

Sudafed 24 hour
Sular

[combination
nisoldipine

Capsule
Tablet

| Extended-release (b)
Extended-release

Symax Duotab

hyoscyamine

Tablet

Controlled-release

Symax SR

hyoscyamine

Tablet

Extended-release

Tasigna

nilotinib

Capsule

Note: disruption of capsule may yield high blood
levels causing enhanced toxicity

Taztia XT

diltiazem

Capsule

Extended-release (a)

Tecfidera
TEGretol-XR

| dimethyl fumarate
carBAMazepine

Capsule

[Tablet

| Delayed-release
Extended-release (b)

Temodar

temozolomide

Capsule

Note: accidentally opened or damaged capsules
require rigorous precautions to avoid inhalation or
contact with the skin or mucous membranes (i)

Tessalon Perles

benzonatate

Capsule

Note: swallow whole; local anesthesia of the oral
mucosa; choking could occur

Theo-24

theophylline

Capsule

Extended-release
Note: contains beads that dissolve throughout the
Gl tract

Theochron

theophylline

Extended-release

Tiazac_
Topamax

diltiazem
topiramate

Tablet; Capsule

_| Extended-release (a)
Taste; Taste (a)

14. Touro CC-LD

combination

Tablet

Extended-release (h)

Touro LA-LD

combination

Tablet

Extended-release (h)

Toviaz

fesoterodine

Tablet

Extended-release

Tracleer

bosentan

Tablet

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

TRENtal

pentoxifylline

Tablet

Extended-release

Treximet

combination

Tablet

Note: unique drug matrix enhances rapid drug
absorption

Trilpix
Tylenol Arthritis

fenofibric
acetaminophen

Capsule
Tablet

[Extended-release

Controlled-release

Uceris

budesonide

Tablet

Note: coating on tablet is designed to break down
at pH of 7.0 or above

Ultram ER

traMADol

Tablet

Extended-release
Note: tablet disruption may cause a potentially
fatal overdose of drug

Ultrase
Uniphyl

pancrealipase
theophylline

Capsule
Tablet

[Enteric-coated

Slow-release

Urocit-K

potassium citrate

Tablet

Wax-coated; prevents upper Gl release

Uroxatral

alfuzosin

Tablet

Extended-release

Valeyte

valGANCiclovir

Tablet

Teratogenic and irritant potential (Lb)

Verapamil SR

Tablet

Extended-release (h)

Verelan

verapamil

Capsule

Sustained-release (a)

Verelan PM

verapamil

Capsule

Extended-release (a)

Videx EC

didanosine

Capsule

Delayed-release

Vimovo

naproxen / esomeprazole

Tablet”

Delayed-release

Viramune XR

nevirapine

Tablet

Extended-release (b)

Voltaren XR
VoSpire ER

diclofenac
albuterol

Tablet
Tablet

| Extended-release

Extended-release

15. Active Ingredient(s)* Dosage Form(s) | Reasons/Comments*

pazopanib crushing significantly increases the AUC and
Tmax; crushed or broken tablets may caus
dangerous skin problems

Drug Product

Zenpep

Zohydro ER

Zolinza v Capsule irritant; avoid contact with skin or mucous
membranes; avoid contact with crushed or broken
tablets

Zyflo CR ei | Tablet