Oral Dosage Forms That Should Not Be Crushed 2015
Drug Product
Absorica
Accutane
AcipHex
Acticlate
Active Ingredient(s)
(isotretinoin)
(isotretinoin)
(rabeprazole)
(doxycycline)
Dosage Form(s)
Capsule
Capsule
Tablet
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
Aptivus
Aquatab C
Aquatab D
Aricept 23 mg
(NIFEdipine)
(amphetamine salts)
(combination)
(NIFEdipine)
(everolimus)
(combination)
(combination)
(combination)
(bisacodyl)
(ALPRAZolam)
(lovastatin)
(zolpidem)
(combination)
(lubiprostone)
(dalfampridine)
(cyclobenzaprine)
(buPROPion)
(mesalamine)
(tipranavir)
(combination)
(combination)
(donepezil)
Tablet
Capsule
Tablet
Tablet
Tablet
Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
Tablet
Capsule
Tablet
Capsule
Capsule
Tablet
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)
Note: oil emulsion within spheres; taste
Slow‐release (h)
Slow‐release (h)
Note: crushing the 23 mg tablet may significantly increase the rate of absorption; the 5 mg and 10 mg tablets are not affected
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Page 1 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
Arthrotec
Asacol
Aspirin enteric‐coated
Atelvia
(diclofenac)
(mesalamine)
(aspirin)
(risedronate)
Tablet
Tablet
Tablet, Caplet
Tablet
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)
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
Biaxin‐XL
Bidex A
Bidhist‐D
Biltricide
Biohist LA
Bisac‐Evac
Bisacodyl
Bisa‐Lax
Boniva
(clarithromycin)
(combination)
(combination)
(praziquantel)
(combination)
(bisacodyl)
(combination)
(combination)
(ibandronate)
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Bromfed PD
Budeprion SR Bunavail
(combination)
(buPROPion)
(combination)
Capsule
Tablet
Buccal film
Calan SR
(verapamil)
Tablet
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
Slow‐release
Slow‐release
Note: chewing or swallowing may result in lower peak concentrations and bioavailability
Slow‐release (h)
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Page 2 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
Carbatrol
Cardene SR
Cardizem
(carBAMazepine)
(niCARdipine)
(diltiazem)
Capsule
Capsule
Tablet
Cardizem CD
Cardizem LA
Cardura XL
Cartia XT
Cefaclor ER
Ceftin
Cefuroxime
CellCept
Cerdelga
Charcoal Plus
Chlor‐Trimeton 12‐H
Cipro XR
Claritin‐D 12 Hour
Claritin‐D 24 Hour
Colace
Colestid
Commit
(diltiazem)
(diltiazem)
(doxazosin)
(diltiazem)
‐‐‐‐‐‐
(cefuroxime)
‐‐‐‐‐‐
(mycophenolate)
(eliglustat)
‐‐‐‐‐‐
(combination)
(ciprofloxacin)
(combination)
(combination)
(docusate)
(colestipol)
(nicotine)
Capsule
Tablet
Tablet
Capsule
Tablet
Tablet
Tablet
Capsule, Tablet
Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
Tablet
Lozenge
Concerta
Contrave
(methylphenidate)
(combination)
Tablet
Tablet
Coreg CR
(carvedilol)
Capsule
Cotazym‐S
Covera‐HS
Creon 5, 10, 20
Crixivan
(pancrelipase)
(verapamil)
(pancrelipase)
(indinavir)
Capsule
Tablet
Capsule
Capsule
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)
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)
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])
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Page 3 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
Cymbalta
(DULoxetine)
Capsule
Slow‐release (a) (Note: may add contents of capsule to apple juice or applesauce but NOT chocolate)
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
DynaCirc CR
E.E.S. 400
Easprin
EC‐Naprosyn
Ecotrin Adult Low Strength
Ecotrin Maximum Strength
Ecotrin Regular Strength
Effer‐K
Effervescent Potassium
Effexor XR
(bisacodyl)
(isradipine)
(erythromycin)
(aspirin)
(combination)
(aspirin)
(aspirin)
(aspirin)
(potassium bicarbonate)
‐‐‐‐‐‐
(venlafaxine)
Tablet; Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
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
Enteric‐coated (b)
Enteric‐coated
Enteric‐coated
Enteric‐coated
Enteric‐coated
Enteric‐coated
Effervescent tablet (f)
Effervescent tablet (f)
Slow‐release
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Page 4 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
Embeda
E‐Mycin
Enablex
Entocort EC
Epanova
(morphine sulfate)
(erythromycin)
(darifenacin)
(budesonide)
(omega‐3‐carboxylic acids)
Capsule
Tablet
Tablet
Capsule
Capsule
Slow‐release (a)
Enteric‐coated
Slow‐release
Enteric‐coated (a)
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
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
Extendryl SR
Feen‐a‐mint
Feldene
FentaNYL
(combination)
(combination)
(bisacodyl)
(piroxicam)
‐‐‐‐‐‐
Capsule
Capsule
Tablet
Capsule
Lozenge
Slow‐release
Slow‐release (b)
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
(fentaNYL)
(ferrous sulfate)
(ferrous sulfate)
(ferrous gluconate)
Tablet
Tablet
Tablet
Tablet
Note: buccal tablet; swallow whole
Enteric‐coated (b)
Enteric‐coated (b)
Enteric‐coated
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Page 5 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
Fero‐Grad 500 mg
Ferro‐Sequels
Flagyl ER
Fleet Laxative
Flomax
Focalin XR
Fortamet
Fosamax
Gleevec
(combination)
(combination)
(metroNIDAZOLE)
(bisacodyl)
(tamsulosin)
(dexmethylphenidate)
(metFORMIN)
(alendronate)
(imatinib)
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
Hetlioz
(glipiZIDE)
(metFORMIN)
(glipiZIDE)
(metFORMIN)
(gabapentin)
(combination)
(combination)
(combination)
(combination)
(combination)
‐‐‐‐‐‐
(combination)
(aspirin)
(tasimelteon)
Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
Hista‐Vent DA
Horizant
Hydrea
(combination)
(gabapentin)
(hydroxyurea)
Tablet
Tablet
Capsule
Hysingla ER
(HYDROcodone)
Tablet
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
Note: not scored; no studies available from company
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)
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Page 6 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
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
Isoptin SR
Isordil Sublingual
Isosorbide Dinitrate Sublingual
Isosorbide SR
Jakafi
(zolpidem)
(guanFACINE)
(paliperidone)
(verapamil)
(isosorbide)
(isosorbide)
(isosorbide)
(ruxolitinib)
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Jalyn
(combination)
Capsule
Janumet XR
Kadian
(combination)
(morphine)
Tablet
Capsule
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
Slow‐release (h)
Sublingual form (g)
Sublingual form (g)
Slow‐release
Note: see prescribing information for making a suspension
Mucous membrane irritant (Note: women who are, or may become, pregnant, should not handle crushed or broken tablets [l])
Slow‐release
Slow‐release (a) (Note: do not give via NG tubes)
Kaletra
Kaon‐CL‐10
Kapidex
(combination)
(potassium)
(dexlansoprazole)
Tablet
Tablet
Capsule
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
(potassium)
Tablet
Slow‐release
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Page 7 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
Keppra
(levETIRAcetam)
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
K‐Tab
LaMICtal XR
Lescol XL
Letairis
Levbid
Levsinex Timecaps
Lialda
Liquibid‐PD
Lithobid
Lodrane 24
Lodrane 24D
LoHist 12 Hour
Lovaza
(potassium)
(lamoTRIgine)
(fluvastatin)
(ambrisentan)
(hyoscyamine)
(hyoscyamine)
(mesalamine)
(combination)
(lithium)
(brompheniramine)
(combination)
(brompheniramine)
(combination)
Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
Tablet
Tablet
Tablet
Capsule
Capsule
Tablet
Capsule
Luvox CR
Maxifed DM
Maxifed DMX
Maxiphen DM
Medent‐DM
Mestinon ER
Metadate CD
(fluvoxaMINE)
(combination)
(combination)
(combination)
(combination)
(pyridostigmine)
(methylphenidate)
Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
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)
Slow‐release (b)
Slow‐release
Slow‐release
Slow‐release
Slow‐release (h)
Slow‐release
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)
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Page 8 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
Metadate ER
Methylin ER
Metoprolol ER
Micro K Extencaps
Miraphen PSE
Morphine sulfate extended‐release
Motrin
Movantik
Moxatag
MS Contin
Mucinex
Mucinex DM
Myfortic Myrbetriq
Namenda XR
Naprelan
NexIUM
Niaspan
Nicotinic Acid
Nifediac CC
Nifedical XL
Nitrostat
Norflex ER
Northera
Norpace CR
Norvir
(methylphenidate)
(methylphenidate)
‐‐‐‐‐‐
(potassium chloride)
(combination)
‐‐‐‐‐‐
(ibuprofen)
(naloxegol)
(amoxicillin)
(morphine)
(guaiFENesin)
(combination)
(mycophenolate)
(mirabegron)
(memantine)
(naproxen)
(esomeprazole)
(nicotinic acid)
‐‐‐‐‐‐
(NIFEdipine)
(NIFEdipine)
(nitroglycerin)
(orphenadrine)
(droxidopa)
(disopyramide)
(ritonavir)
Tablet
Tablet
Tablet
Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
Tablet
Capsule
Tablet
Capsule; Tablet
Tablet
Tablet
Tablet
Tablet
Capsule
Capsule
Tablet
Noxafil
Nucynta ER
(posaconazole)
(tapentadole)
Tablet
Tablet
OFEV
Oleptro
(nintedanib)
(traZODone)
Capsule
Tablet
Slow‐release
Slow‐release
Slow‐release
Slow‐release (a,b)
Slow‐release
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 (a)
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)
Taste
Slow‐release (h)
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Page 9 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
Omtryg
(omega‐3‐acid ethyl esters A)
Capsule
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)
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
Pradaxa
(pancrelipase)
(pancrelipase)
‐‐‐‐‐‐
(PARoxetine)
(mesalamine)
(pancrelipase)
(felodipine)
(dabigatran)
Capsule
Capsule
Capsule
Tablet
Capsule
Capsule
Tablet
Capsule
Pre‐Hist‐D
Prevacid
Prevacid SoluTab
(combination)
(lansoprazole)
(lansoprazole)
Tablet
Capsule
Tablet
Enteric‐coated (a) Enteric‐coated (a) Enteric‐coated (a) Slow‐release
Slow‐release
Slow‐release (a)
Slow‐release
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
Prevacid Suspension
(lansoprazole)
Suspension
PriLOSEC
PriLOSEC OTC
Pristiq
Procardia XL
Propecia (omeprazole)
(omeprazole)
(desvenlafaxine)
(NIFEdipine)
(finasteride)
Capsule
Tablet
Tablet
Tablet
Tablet
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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Page 10 of 15
Oral Dosage Forms That Should Not Be Crushed 2015
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
Rayos
(predniSONE)
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 (Note: delayed release is dependent on an intact coating)
Slow‐release
Note: tablets expand in liquid if broken or crushed
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
(methylphenidate)
(methylphenidate)
(combination)
Capsule
Tablet
Tablet
Slow‐release (a)
Slow‐release
Slow‐release
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Oral Dosage Forms That Should Not Be Crushed 2015
Rythmol SR
Ryzolt
(propafenone)
(traMADol)
Capsule
Tablet
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
Sudafed 12 hour
Sudafed 24 hour
Sular
Symax Duotab
Symax SR
Targiniq ER
(combination)
(combination)
(nisoldipine)
(hyoscyamine)
(hyoscyamine)
(combination)
Capsule
Capsule
Tablet
Tablet
Tablet
Tablet
Slow‐release (b)
Slow‐release (b)
Slow‐release
Slow‐release
Slow‐release
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
(diltiazem)
(dimethyl fumarate)
(carBAMazepine)
Capsule
Capsule
Tablet
Note: disruption of capsule may yield high blood levels causing enhanced toxicity
Slow‐release (a)
Slow‐release
Slow‐release
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Oral Dosage Forms That Should Not Be Crushed 2015
Temodar
(temozolomide)
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
Tablet; Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
TRENtal
Treximet
(pentoxifylline)
(combination)
Tablet
Tablet
Trilipix
Tylenol Arthritis
Uceris
(fenofibric acid)
(acetaminophen)
(budesonide)
Capsule
Tablet
Tablet
Ultram ER
(traMADol)
Tablet
Ultrase
Ultresa
Uniphyl
Urocit‐K
Uroxatral
Valcyte
Verapamil SR
(pancrelipase)
(pancrelipase)
(theophylline)
(potassium citrate)
(alfuzosin)
(valGANCiclovir)
‐‐‐‐‐‐
Capsule
Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
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
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
Wax‐coated; prevents upper GI release
Slow‐release
Teratogenic and irritant potential (i, b)
Slow‐release (h)
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Oral Dosage Forms That Should Not Be Crushed 2015
Verelan
Verelan PM
VESIcare
Videx EC
Vimovo
Viokace
Viramune XR
Voltaren XR
VoSpire ER
Votrient
(verapamil)
(verapamil)
(solifenacin)
(didanosine)
(combination)
(pancrelipase)
(nevirapine)
(diclofenac)
(albuterol)
(pazopanib)
Capsule
Capsule
Tablet
Capsule
Tablet
Tablet
Tablet
Tablet
Tablet
Tablet
Wellbutrin SR, XL
Xanax XR
Xarelto
(buPROPion)
(ALPRAZolam)
(rivaroxaban)
Tablet
Tablet
Tablet
Xartemis XR
(combination)
Tablet
Xigduo XR
Zegerid
Zenpep
Zohydro ER
(combination)
(combination)
(pancrelipase)
(HYDROcodone)
Tablet
Capsule
Capsule
Capsule
Zolinza
(vorinostat)
Capsule
Zortress
(everolimus)
Tablet
Zyban
Zydelig
Zyflo CR
(buPROPion)
(idelalisib)
(zileuton)
Tablet
Tablet
Tablet
Slow‐release (a)
Slow‐release (a)
Enteric‐coated
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 Slow‐release (Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose)
Slow‐release
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 2015
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)
Capsule may be opened and the contents taken without crushing or chewing; soft food such as applesauce or pudding may facilitate administration; contents Liquid dosage forms of the product are available; however, dose, frequency of administration and manufacturers may differ from that of the solid dosage form.
Antacids and/or milk may prematurely dissolve the coating of the tablet.
Capsule may be opened and the liquid contents removed for administration.
The taste of this product form would likely be unacceptable to the patient; administration via nasogastric tube should be acceptable.
Effervescent tablets must be dissolved in the amount of diluent recommended by the manufacturer.
Tablets are made to disintegrate under the tongue.
Tablet is scored and may be broken in half without affecting release characteristics.
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 2015. Permission is granted to reporduce material for internal use within healthcare organizations.
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