Information about http://www.ismp.org/Tools/DoNotCrush.pdf
Oral Dosage Forms That Should Not Be Crushed …
Tags: accutane, aciphex, actonel, adalat cc, adderall, adderall xr, aerohist, afeditab cr, aggrenox, alavert, alendronate, allegra d, alprazolam, delivery system, dissolution, irritant, oral dosage, pharm d, release capsule, wall charts,Pages: 17
Language: english
Created: Fri May 30 11:43:17 2008
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Oral Dosage Forms That Should Not Be Crushed
John F. Mitchell, Pharm.D., FASHP1
Last updated: June 1, 2008
Wall charts may be purchased by contacting
Facts and Comparisons (800-223-0554)
http://www.factsandcomparisons.com/hospitalpharm/
Drug Product Dosage Form Reasons/Comments 2
Accutane Capsule Mucous membrane irritant
Aciphex Tablet Slow-release
Actiq Lozenge Slow-release
Note: this lollipop delivery system requires
the patient to slowly allow dissolution
Actonel Tablet Irritant
Note: chewed, crushed, or sucked tablets
May cause oropharyngeal irritation
Adalat CC Tablet Slow-release
Adderall XR Capsule Slow-release (a)
AeroHist Plus Tablet Slow-release (h)
Afeditab CR Tablet Slow-release
Aggrenox Capsule Slow-release
Alavert Allergy Sinus 12 Hour Tablet Slow-release
Alendronate Tablet Slow-release
Allegra-D Tablet Slow-release
Allfen Jr Tablet Slow-release
Capsule Slow-release (a)
Alpophen Tablet Enteric-coated
Alprazolam ER Tablet Slow-release
Altoprev Tablet Slow-release
Ambien CR Tablet Slow-release
Amitiza Capsule Slow-release
Amrix Capsule Slow-release
Aplenzin Tablet Slow-release
Aptivus Capsule Note: oil emulsion within spheres; taste
Aquatab C Tablet Slow-release (h)
Aquatab D Tablet Slow-release (h)
Arthrotec Tablet Enteric-coated
Asacol Tablet Slow-release
Ascriptin A/D Tablet Enteric coated
Azulfidine EN-tabs Tablet Enteric-coated
Augmentin XR Tablet Slow-release (b,h)
Avinza Capsule Slow-release (a; not pudding)
Avodart Capsule Note: drug may cause fetal abnormalities;
women who are, or may become,
pregnant, should not handle capsules; all
woman should use caution in handling
capsules, especially leaking capsules
Bayer Enteric-coated Caplet Enteric-coated
Bayer Low Adult Tablet Enteric-coated
Bayer Regular Strength Caplet Enteric-coated
Bellahist-D LA Tablet Slow-release
Biaxin-XL Tablet Slow-release
Bidhist Tablet Slow-release
Bidhist-D Tablet Slow-release
Biltricide Tablet Taste (h)
Biohist LA Tablet Slow-release (h)
Bisac-Evac Tablet Enteric-coated (c)
Bisacodyl Tablet Enteric-coated (c)
Bisa-Lax Tablet Enteric-coated (c)
Boniva Tablet Irritant: do not chew or suck
Note: Potential for oropharyngeal ulceration
Bromfed PD Capsule Slow-release
Budeprion SR Tablet Slow-release
Calan SR Tablet Slow-release (h)
Carbatrol Capsule Slow-release (a)
Cardene SR Capsule Slow-release
Cardizem Tablet Note: although not described as slow release
in the PI, the drug has a coating that is
intended to release the drug over a period of
approximately 3 hours
Cardizem CD Capsule Slow-release
Cardizem LA Tablet Slow-release
Cardura XL Tablet Slow-release
Cartia XT Capsule Slow-release
Cefaclor Extended-Release Tablet Slow-release
Ceftin Tablet Taste (b)
Note: use suspension for children
Cefuroxime Tablet Taste (b)
Note: use suspension for children
CellCept Capsule, Tablet Teratogenic potential (i)
Charcoal Plus Tablet Enteric-coated
Chlor-Trimeton 12-Hour Tablet Slow-release (b)
Cipro XR Tablet Slow-release
Claritin-D 12 Hour Tablet Slow-release
Claritin-D 24 Hour Tablet Slow-release
Colace Capsule Taste (e)
Colestid Tablet Slow-release
Concerta Tablet Slow-release
Commit Lozenge Note: integrity compromised by chewing or
crushing
Cotazym-S Capsule Enteric-coated (a)
Covera-HS Tablet Slow-release
Creon 5, 10, 20 Capsule Slow-release (a)
Crixivan Capsule Taste
Note: capsule may be opened and mixed
with fruit puree (e.g., banana)
Cymbalta Capsule Slow-release (a); may add to apple juice
Cytoxan Tablet Note: drug may be crushed but company
recommends using injection
Cytovene Capsule Skin irritant
Dallergy Tablet Slow-release (b, h)
Dallergy - JR Capsule Slow-release
Deconamine SR Capsule Slow-release (b)
Depakene Capsule Slow-release mucous membrane irritant (b)
Depakote Tablet Slow-release
Depakote ER Tablet Slow-release
Detrol LA Capsule Slow-release
Dilacor XR Capsule Slow-release
Dilatrate-SR Capsule Slow-release
Dilt-CD Capsule Slow-release
Dilt-XR Capsule Slow-release
Diltia XT Capsule Slow-release
Ditropan XL Tablet Slow-release
Doxidan Tablet Enteric-coated (c)
DriHist SR Tablet Slow-release (h)
Drisdol Capsule Liquid filled (d)
Drixoral Allergy Sinus Tablet Slow-release
Drixoral Cold/Allergy Tablet Slow-release
Drixoral Nondrowsy Tablet Slow-release
Droxia Capsule NOTE: exposure to the powder may cause
serious skin toxicities; healthcare workers
should wear gloves to administer
Drysec Tablet Slow-release (h)
Dulcolax Tablet Enteric-coated (c)
Dulcolax Capsule Liquid-filled
DuraHist Tablet Slow-release (h)
DuraHist D Tablet Slow-release (h)
DynaCirc CR Tablet Slow-release
Duraphen II DM Tablet Slow-release (h)
Duraphen Forte Tablet Slow-release (h)
Duratuss Tablet Slow-release (h)
Duratuss A Tablet Slow-release (h)
Duratuss PE Tablet Slow-release (h)
Dynex Tablet Slow-release (h)
Easprin Tablet Enteric-coated
EC-Naprosyn Tablet Enteric-coated
Ecotrin Adult Low Tablet Enteric-coated
Strength
Ecotrin Maximum Tablet Enteric-coated
Strength
Ecotrin Regular Tablet Enteric-coated
Strength
Ed A-Hist Tablet Slow-release (b)
E.E.S. 400 Tablet Enteric-coated (b)
Effer-K Tablet Effervescent tablet (f)
Effervescent Potassium Tablet Effervescent tablet (f)
Effexor XR Capsule Slow-release
Efidac/24 Pseudoephedrine Tablet Slow-release
Efidac/24 Tablet Slow-release
E-Mycin Tablet Enteric-coated
Enablex Tablet Slow-release
Entex LA Capsule Slow-release (b)
Entex PSE Capsule Slow-release
Entocort EC Capsule Enteric-coated (a)
Equetro Capsule Slow-release (a)
Ergomar Tablet Sublingual form (g)
Ery-Tab Tablet Enteric-coated
Erythrocin Stearate Tablet Enteric-coated
Erythromycin Base Tablet Enteric-coated
Erythromycin Delayed-Release Capsule Enteric-coated Pellets (a)
Evista Tablet Taste; teratogenic potential (i)
ExeFen PD Tablet Slow-release (h)
Extendryl JR Capsule Slow-release
Extendryl SR Capsule Slow-release (b)
Feen-a-mint Tablet Enteric-coated (c)
Feldene Capsule Mucous membrane irritant
Fentora Tablet Note: buccal tablet; swallow whole
Feosol Tablet Enteric-coated (b)
Feratab Tablet Enteric-coated (b)
Fergon Tablet Enteric-coated
Fero-Grad 500 mg Tablet Slow-release
Ferro-Sequels Tablet Slow-release
Flagyl ER Tablet Slow-release.
Fleet Laxative Tablet Enteric-coated (c)
Flomax Capsule Slow-release
Focalin XR Capsule Slow-release (a)
Fosamax Tablet Mucous membrane irritant
Gleevec Tablet Taste (h)
Note: may be dissolved in water or apple juice
Glipizide Tablet Slow-release
Glucophage XR Tablet Slow-release
Glucotrol XL Tablet Slow-release
Glumetza Tablet Slow-release
Guaifed Capsule Slow-release
Guaifed-PD Capsule Slow-release
Guaifenesin/Pseudoephedrine Tablet Slow-release
Guaifenex DM Tablet Slow-release (h)
Guaifenex GP Tablet Slow-release
Guaifenex PSE Tablet Slow-release (h)
GuaiMAX-D Tablet Slow-release.
Halfprin 81 Tablet Enteric-coated
Heartline Tablet Enteric-coated
H 9600 SR Tablet Slow-release
Hista-Vent DA Tablet Slow-release (h)
Hydrea Capsule NOTE: exposure to the powder may cause
serious skin toxicities; healthcare workers
should wear gloves to administer
Imdur Tablet Slow-release (h)
Inderal LA Capsule Slow-release
Indocin SR Capsule Slow-release (a,b)
Innopran XL Capsule Slow-release
Intelence Tablet Note: tablet should be swallowed whole and
not crushed; tablet may be dispersed in water
Invega Tablet Slow-release
Isochron Tablet Slow-release
Isoptin SR Tablet Slow-release (h)
Isordil Sublingual Tablet Sublingual form (g)
Isosorbide Dinitrate Tablet Sublingual form (g)
Sublingual
Isosorbide SR Tablet Slow-release
Kadian Capsule Slow-release (a)
Note: do give via N/G tubes
Kaletra Tablet Film-coated
Kaon CL-10 Tablet Slow-release (b)
Keppra Tablet Taste
Note: some extemporaneous formulas are
Pharmacy prepared
Ketek Tablet Slow-release (b)
Klor-Con Tablet Slow-release (b)
Klor-Con M Tablet Slow-release (b, h)
Klotrix Tablet Slow-release
K-Lyte Tablet Effervescent tablet (f)
K-Lyte CL Tablet Effervescent tablet (f)
K-Lyte DS Tablet Effervescent tablet (f)
K-Tab Tablet Slow-release (b)
Lescol XL Tablet Slow-release
Levbid Tablet Slow-release (h)
Levsinex Timecaps Capsule Slow-release
Lexxel Tablet Slow-release
Lialda Tablet Slow-release
Lipram 4500 Capsule Enteric-coated (a)
Lipram PN 10, 16, 20 Capsule Enteric-coated, slow-release (a)
Lipram UL 12, 18, 20 Capsule Enteric-coated, slow-release (a)
Liquibid-D 1200 Tablet Slow-release (h)
Liquibid-PD Tablet Slow-release (h)
Lithobid Tablet Slow-release
Lodrane 24 Capsule Slow-release
Lodrane 24D Capsule Slow-release
LoHist 12 Hour Tablet Slow-release
Luvox CR Capsule Slow-release
Maxifed DM Tablet Slow-release (h)
Maxifed DMX Tablet Slow-release (h)
Maxiphen DM Tablet Slow-release (h)
Medent-DM Tablet Slow-release
Mestinon Timespan Tablet Slow-release (b)
Metadate ER Tablet Slow-release
Metadate CD Capsule Slow-release (a)
Methylin ER Tablet Slow-release
Metoprolol ER Tablet Slow-release
Micro K Extendcaps Capsule Slow-release (a,b)
Miraphen PSE Tablet Slow-release
Modane Tablet Enteric-coated (c)
Morphine sulfate Tablet Slow-release
extended-release
Motrin Tablet Taste (e)
Moxatab Tablet Slow-release
MS Contin Tablet Slow-release (b)
Mucinex Tablet Slow-release
Mucinex DM Tablet Slow-release
Muco-Fen-DM Tablet Slow-release (h)
Myfortic Tablet Slow-release
Naprelan Tablet Slow-release
Nasatab LA Tablet Slow-release (h)
Nexium Capsule Slow-release (a)
Niaspan Tablet Slow-release
Nicotinic Acid Capsule, Tablet Slow-release (h)
Nifediac CC Tablet Slow-release
Nifedical XL Tablet Slow-release
Nifedipine extended-release Tablet Slow-release
NitroQuick Tablet Sublingual route (g)
Nitrostat Tablet Sublingual route (g)
Norpace CR Capsule Slow-release form within a special capsule
Ondrox Tablet Slow-release
Opana ER Tablet Slow-release
Note: tablet disruption may cause a potentially
fatal overdose of oxymorphone
Oracea Capsule Slow-release
Oramorph SR Tablet Slow-release (b)
OxyContin Tablet Slow-release
Note: tablet disruption may cause a potentially
fatal overdose of oxycodone
Palcaps (all) Capsule Enteric-coated (a)
Pancrease MT Capsule Enteric-coated (a)
Pancrecarb MS Capsule Enteric-coated (a)
Pancrelipase Capsule Enteric-coated (a)
Panocaps Capsule Enteric-coated (a)
Panocaps MT Capsule Enteric-coated (a)
Paxil CR Tablet Slow-release
Pentasa Capsule Slow-release
PhenaVent D Tablet Slow-release (h)
PhenaVent LA Capsule Slow-release
Plendil Tablet Slow-release
Pre-Hist-D Tablet Slow-release (h)
Prevacid Capsule Slow-release
Prevacid SoluTab Tablet Orally disintegrating
Note: do not swallow; dissolve in water only
and dispense via dosing syringe or NG tube
Prevacid Suspension Suspension Slow-release
Note: contains enteric-coated granules; mix
with water only; not for use in NG tubes
Prilosec Capsule Slow-release
Prilosec OTC Tablet Slow-release
Pristiq Tablet Slow-release
Procardia XL Tablet Slow-release
Profen II Tablet Slow-release (h)
Profen II DM Tablet Slow-release (h)
Profen Forte Tablet Slow-release (h)
Profen Forte DM Tablet Slow-release (h)
Propecia Tablet Note: women who are, or may become,
pregnant, should not handle crushed or broken
tablets
Proquin XR Tablet Slow-release
Proscar Tablet Note: women who are, or may become,
pregnant, should not handle crushed or broken
tablets
Protonix Tablet Slow-release
Prozac Weekly Tablet Enteric-coated
Pseudo CM TR Tablet Slow-release (h)
Pseudovent Capsule Slow-release (a)
Pseudovent 400 Capsule Slow-release (a)
Pseudovent DM Tablet Slow-release (h)
Pseudovent-PED Capsule Slow-release (a)
Pytest Capsule Note: radiopharmaceutical
QDALL Capsule Slow-release
QDALL AR Capsule Slow-release
Ralix Tablet Slow-release (h)
Ranexa Tablet Slow-release
Razadyne ER Capsule Slow-release
Renagel Tablet Note: tablets expand in liquid if broken or
crushed
Rescon Tablet Slow-release (h)
Rescon JR Tablet Slow-release (h)
Rescon MX Tablet Slow-release (h)
Respa-1st Tablet Slow-release (h)
Respa-DM Tablet Slow-release (h)
Respahist Capsule Slow-release (a)
Respaire 120 SR Capsule Slow-release
Respaire 60 SR Capsule Slow-release
Resperdal M-Tab Tablet Orally disintegrating
Note: do not chew or break tablet; after
dissolving under tongue, tablet may be
swallowed
Revlimid Capsule Note: Teratogenic potential; healthcare
workers should avoid contact with
capsule contents/body fluids
Ritalin LA Capsule Slow-release (a)
Ritalin SR Tablet Slow-release
R-Tanna Tablet Slow-release
Rythmol SR Capsule Slow-release
Santura XL Capsule Slow-release
Note: capsule may be opened and pellets
mixed in water or placed on tongue and
swallowed; do NOT crush or chew pellets
Seroquel XR Tablet Slow-release
Simcor Tablet Slow-release
Sinemet CR Tablet Slow-release (h)
SINUvent PE Tablet Slow-release (h)
Slo-Niacin Tablet Slow-release (h)
Solodyn Tablet Slow-release
Somnote Capsule Liquid filled
Sprycel Tablet 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
Stahist Tablet Slow-release
Strattera Capsule Note: capsule contents can cause ocular
irritation
Sudafed 12 hour Capsule Slow-release (b)
Sudafed 24 hour Capsule Slow-release (b)
Sular Tablet Slow-release
Symax Duotab Tablet Slow-release
Symax SR Tablet Slow-release
Taztia XT Capsule Slow-release (a)
Tegretol-XR Tablet Slow-release
Temodar Capsule Note: If capsules are accidentally opened or
damaged, rigorous precautions should be
taken to avoid inhalation or contact of contents
with the skin or mucous membranes (i)
Tessalon Perles Capsule Note: swallow whole; temporary local
anesthesia of the oral mucosa and choking
could occur
Theo-24 Capsule Slow-release
Note: contains beads that dissolve throughout
the GI tract
Tiazac Capsule Slow-release (a)
Topamax Tablet Taste
Capsule Taste (a)
Toprol XL Tablet Slow-release (h)
Touro CC-LD Tablet Slow-release (h)
Touro LA-LD Tablet Slow-release (h)
Tracleer Tablet Note: women who are, or may become,
pregnant, should not handle crushed or broken
tablets
Trental Tablet Slow-release
Tylenol Arthritis Tablet Slow-release
Ultram ER Tablet Slow-release
Note: tablet disruption may cause a potentially
fatal overdose of tramadol
Uniphyl Tablet Slow-release
Urocit-K Tablet Wax-coated
Uroxatral Tablet Slow-release
Valcyte Tablet Teratogenic and irritant potential (i)
Verapamil SR Tablet Slow-release (h)
Verelan Capsule Slow-release (a)
Verelan PM Capsule Slow-release (a)
VesiCare Tablet Enteric coated
Videx EC Capsule Slow-release
Voltaren XR Tablet Slow-release
VoSpire ER Tablet Slow-release
Wellbutrin SR, XL Tablet Slow-release
Xanax XR Tablet Slow-release
Zolinza Capsule Note: irritant; avoid contact with skin or
mucous membranes; avoid contact with
crushed or broken tablets
ZORprin Tablet Slow-release
Zyban Tablet Slow-release
Zyflo CR Tablet Slow-release
(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 in a liquid 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 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. Correspondence regarding this list may be addressed to:
John F. Mitchell, Pharm.D., FASHP
Email: rxmitchell@wowway.com
2. 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.