Manuals+

Medications Not To Be Crushed

This document lists medications that should not be crushed, providing essential information for healthcare professionals to ensure safe and effective medication administration. It details generic names, brand names, dosage forms, and the specific reasons why crushing these formulations is contraindicated.

Side One

GENERICBRANDDOSAGE FORMREASON
AcamprosateCampral®Tablet, capsule1
Acetaminophen* (extended release)Tylenol® Arthritis Pain, Tylenol® 8 HourTablet2
Acetazolamide* (extended release)Diamox® Sequels®Capsule2
Albuterol* (extended release)VoSpire ER®Tablet2
Alendronate*Fosamax®, Fosamax Plus D™Tablet4
AlfuzosinUroXatral®Tablet2
Alprazolam*Niravam™Tablet14
Alprazolam* (extended release)Xanax XR®Tablet2
Ammonium chloride* (enteric coated)(Generic forms available)Tablet1
Amoxicillin and clavulanate* (extended release)Augmentin XR®Tablet2
Aripiprazole* (ODT)Abilify® Discmelt™Tablet14
Aspirin and dipyridamoleAggrenox®Capsule2
Aspirin* (controlled release)ZORprin®Tablet2
Aspirin* (enteric coated)Bayer® Aspirin Regimen Adult Low Strength, Bayer® Aspirin Regimen Regular Strength, Easprin®, Ecotrin®, Ecotrin® Low Strength, Ecotrin® Maximum Strength, Halfprin®, St. Joseph Adult Aspirin, Sureprin 81™Tablet1
AtomoxetineStrattera®Capsule4, 11, 13
Atropine, hyoscyamine, phenobarbital and scopolamine* (extended release)Donnatal Extentabs®Tablet2
Benzonatate*Tessalon®Capsule4, 9
Bisacodyl (delayed release)Doxidan®Tablet2, 17
Bisacodyl* (enteric coated)Alophen®, Bisac-Evac™, Correctol®, Dulcolax®, Femilax™, Fleet® Stimulant Laxative, Modane®, VeracolateTablet1, 17
Brompheniramine* (extended release)Bidhist, Lodrane® 12 Hour, Lodrane® 24, LoHist-12Tablet2, 8
Brompheniramine and pseudoephedrine* (extended release)Bromfenex®, Bromfenex® PD, Lodrane® LD, Histex™ SR, Touro™ AllergyCapsule2
Brompheniramine and pseudoephedrine* (extended release)Lodrane® 12 DTablet2
BudesonideEntocort® ECCapsule1
Bupropion* (extended release)Budeprion™ SR, Buproban™, Wellbutrin XL™, Wellbutrin® SR, Zyban®Tablet2
Carbamazepine* (extended release)Carbatrol®, Equetro™™Capsule2, 5
Carbamazepine* (extended release)Tegretol® XRTablet2
CarbenicillinGeocillin®Tablet3
Carbinoxamine and pseudoephedrine* (extended release)Palgic®-D, Rondec-TR®Tablet2
Cefuroxime*Ceftin®Tablet3
Cetirizine and pseudoephedrineZyrtec-D 12 Hour™Tablet2
Chloral hydrate*Somnote™Capsule3, 9
Chlorpheniramine* (extended release)QDALL® ARCapsule2
Chlorpheniramine* (extended release)Chlor-Trimeton®Tablet2
Chlorpheniramine and phenylephrine* (extended release)Dallergy-JR®Capsule2
Chlorpheniramine and phenylephrine* (extended release)Ed A-Hist®, Rescon® JRTablet2
Chlorpheniramine, phenylephrine and methscopolamine* (extended release)Extendryl® JRTablet2
Chlorpheniramine, phenylephrine and methscopolamine* (extended release)Dallergy®, Drize®-R, Durahist™ PE, Extendryl SR, Hista-Vent® DA, PCM Allergy, RalixTablet2
Chlorpheniramine, phenylephrine and methscopolamine* (extended release)OMNIhist® II L.A., Rescon® MXTablet2, 8
Chlorpheniramine and pseudoephedrine* (extended release)Deconamine® SR, Dynahist-ER Pediatric®, Histade™, Kronofed-A®, QDALL®Capsule2
CinacalcetSensipar™Tablet11
Ciprofloxacin*Cipro®Tablet3
Ciprofloxacin* (extended release)Cipro® XR, Proquin® XRTablet2
Clarithromycin* (extended release)Biaxin XL®Tablet2
Clopidogrel bisulfatePlavix®Tablet1
Clorazepate* (sustained release)Tranxene®-SD, Tranxene®-SD Half Str.Tablet2
Clotrimazole*Mycelex® TrocheTroche14
Clozapine* (ODT)FazaClo®Tablet14
Colestipol*Colestid®Tablet2
CyclophosphamideCytoxan®Tablet12, 13
DarifenacinEnablex®Tablet27
DeferasiroxExjade®Tablet7
Desloratidine* (ODT)Clarinex® RediTabs®Tablet14
Desloratidine and pseudoephedrineClarinex-D® 12 Hour, Clarinex-D® 24 hourTablet2
Dexbrompheniramine and pseudoephedrineDrixoral® Cold & AllergyTablet2

Side Two

GENERICBRANDDOSAGE FORMREASON
DexmethylphenidateFocalin™ XRCapsule2, 5
Dextroamphetamine* (sustained release)Dexedrine® Spansule®Capsule2
Dextroamphetamine and amphetamine* (extended release)Adderall-XR®Capsule2, 5
Diclofenac* (enteric coated)Voltaren®Tablet1
Diclofenac* (extended release)Diclofenac Sodium ER, Voltaren® XRTablet2
Diclofenac and misoprostolArthrotec®Tablet1
Didanosine* (enteric coated)Videx® ECCapsule1
Diethylpropion* (controlled release)Tenuate® Dospan®Tablet2
Diflunisal(Generic forms available)Tablet4
Digoxin*Lanoxicaps®Capsule16
Diltiazem*Cardizem®Tablet2
Diltiazem* (extended release)Cartia XT, Dilacor® XR, Diltia® XT, Diltiazem ERCapsule2
Diltiazem* (extended release)Cardizem® CD, Taztia™ XT, Tiazac®Capsule2, 5
Diltiazem* (extended release)Cardizem® LATablet2
Diphenhydramine and pseudoephedrine* (ODT)Benadryl® Allergy and Sinus Fastmelt™Tablet14
Disopyramide* (controlled release)Norpace® CRCapsule2
Donepezil* (ODT)Aricept® ODTTablet14
Doxazosin* (extended release)Cardura® XLTablet2
DoxycyclineOracea™Capsule2
DoxycyclineDoryx®Tablet1
DronabinolMarinol®Capsule1
DuloxetineCymbalta®Capsule1
Enalapril and felodipineLexxel®Tablet2
Ergocalciferol*Drisdol®Capsule9
Ergoloid mesylates* (sublingual)(Generic forms available)Tablet6
ErgotamineErgomar®Tablet1
Erythromycin*Ery-tab®, PCE®Tablet2
Erythromycin* (enteric coated)Eryc®Capsule1
EsomeprazoleNexium®Capsule1, 5
EszopicloneLunesta™Tablet11
Etodolac* (extended release)Lodine® XLTablet2
FelodipinePlendil®Tablet2
Fexofenadine and psuedoephedrineAllegra-D®Tablet2
FinasteridePropecia®, Proscar®Tablet12
Fluoxetine* (delayed release)Prozac® WeeklyCapsule2
Fluvastatin* (extended release)Lescol® XLTablet2
GanciclovirCytovene®Capsule4
Glipizide* (extended release)Glipizide ER, Glucotrol® XLTablet2
Griseofulvin* ultramicrosizeGris-Peg®Tablet1
Guaifenesin* (extended release)Humibid® Maximum Strength, Mucinex®Tablet2
Guaifenesin and dextromethorphan* (extended release)Amibid DM, Guaifenex® DM, Mucinex® DM, Touro® DM, Tussi-Bid®Tablet2
Guaifenesin and dextromethorphan* (extended release)Allfen®-DM, Mucophen® DM, Guia-D, Q-Bid DM, Respa-DM®, Z-Cof LATablet2, 8
Guaifenesin and phenylephrine* (extended release)Crantex ER, Deconsal II®, Entex® ER, Entex® LA, Guaifed®, PhenaVent™™Capsule2
Guaifenesin and phenylephrine* (extended release)Aldex™™, Ami-Tex LA, Crantex LA, Endal®, Liquibid®-PD, PhenaVent™™ D, Prolex™-D, SINUvent® PE, XPECT-PETMTablet2
Guaifenesin and potassium guaiacolsulfonate* (extended release)Allfen, Humibid® LATablet2, 8
Guaifenesin and pseudoephedrine* (extended release)Respaire®-120 SR, Respaire®-60 SRCapsule2
Guaifenesin and pseudoephedrine* (extended release)Ami-Tex PSE, Guaifenex® GP, Guaifenex® PSE, Zephrex LA®, Maxifed®, Maxifed® G, Mucinex®-D, Nasatab® LA, PanMist®-LA, Touro® LATablet2
Guaifenesin and pseudoephedrine* (extended release)Dynex®, Guaimax-D®, Profen II®, Profen Forte®, Zephrex-LA®Tablet2, 8
Guaifenesin, pseudoephedrine and dextromethorphan* (extended release)Maxifed® DM, Medent-DM, Touro® CC, Touro® CC-LDTablet2, 8
Guaifenesin, psuedoephedrine and dextromethorphan* (extended release)Ambifed-G DM, Coldmist DM, Profen Forte™™ DM, Profen II DM®, Pseudovent™™ DM, Pseudo Max DMXTablet2
Hyoscyamine* (extended release)Cystospaz-M®, Levsinex® TimecapsCapsule2
Hyoscyamine* (extended release)Hyoscyamine ER, Symax™-SRTablet2
Hyoscyamine* (extended release)Levbid®Tablet2, 8
Hyoscyamine* (sublingual)Levsin/SL®Tablet6
IbandronateBoniva®Tablet4
Ibuprofen* (Generic forms available)Tablet3
Indomethacin* (sustained release)Indocin® SR, Indomethacin SRCapsule2
Iron salts* (timed release)Fero-Grad 500®, Ferro-Sequels®, Slow FE®Tablet2

Side Three

GENERICBRANDDOSAGE FORMREASON
Isosorbide dinitrate* (sublingual)Isordil® SublingualTablet6
Isosorbide dinitrate* (sustained release)Dilatrate® SRCapsule2
Isosorbide dinitrate* (sustained release)Isordil® Tembid, Isosorbide Dinitrate SR, Sorbitrate® SATablet2
Isosorbide mononitrate* (extended release)Imdur®Tablet2, 8
IsotretinoinAccutane®Capsule4
IsradipineDynaCirc® CRTablet2
Ketoprofen*(Generic forms available)Capsule2
Lansoprazole*Prevacid®Capsule1, 5
Lansoprazole* (granules)Prevacid Packets for SuspensionGranules1, 10
Lansoprazole* (ODT)Prevacid® SoluTab™Tablet14
Levodopa and carbidopa* (ODT)Parcopa™Tablet14
Levodopa and carbidopa* (sustained release)Sinemet® CRTablet2, 8
Lithium* (controlled release)Eskalith CR, Lithobid®Tablet2
Loratidine* (extended release)Alavert™ Allergy and Sinus, Claritin-D®Tablet2
Loratidine* (ODT)Alavert®, Claritin® RediTabs®, Triaminic® Allerchews™Tablet14
Lovastatin* (extended release)Altoprev® ERTablet2
LubiprostoneAmitiza™Capsule9
Magnesium salts* (delayed release)Mag 64™, Mag Delay®, Mag-Tab® SRTablet2
Magnesium salts* (enteric coated)Slow-Mag®, Maginex™™Tablet1
Meprobamate(Generic forms available)Tablet3
Mesalamine* (controlled release)Pentasa®Capsule2
Mesalamine* (enteric coated)Asacol®Tablet1
Metformin* (extended release)Fortamet®, Glucophage® XR, Glumetza™Tablet2
Methenamine* (enteric coated)Mandelamine®Tablet1
Methylphenidate* (extended release)Metadate® CD, Ritalin® LACapsule2, 5
Methylphenidate* (extended release)Concerta®, Metadate® ER, Methylin® ER, Ritalin SR®Tablet2
Metoprolol* (extended release)Toprol XL®Tablet2, 8
Metronidazole* (extended release)Flagyl® ERTablet2
Minocycline*Minocin®Capsule4
Minocycline* (extended release)Solodyn™™Tablet2
Mirtazapine* (ODT)Remeron Soltab®Tablet14
Morphine sulfate* (extended release)Avinza®, Kadian®Capsule2, 5
Morphine sulfate* (extended release)MS Contin®, Oramorph SR®Tablet2
Mycophenolate*CellCept®Tablet, Capsule12
Mycophenolate* (delayed release)Myfortic®Tablet1
Naproxen* (controlled release)Naprelan®Tablet2
Naproxen* (enteric coated)EC-NaprosynTablet1
Naproxen and pseudoephedrineAleve® Cold & Sinus, Aleve® Sinus & HeadacheTablet2
Niacin and lovastatinAdvicor®Tablet2
Niacin* (extended release)Niacin ER, Niaspan®Tablet2
Niacin* (controlled release)Slo-Niacin®Tablet2, 8
Nicardipene* (sustained release)Cardene SR®Capsule2
Nifedipine*Procardia®Capsule9
Nifedipine* (extended release)Adalat® CC, Afeditab™ CR, Nifedical XL, Nifediac™ CC, Nifedipine ER, Procardia XL®Tablet2
NimodipineNimotop®Capsule9
NisoldipineSular®Tablet2
Nitroglycerin*Nitro-Time®Capsule2
Nitroglycerin (sublingual)NitroQuick®, Nitrostat®Tablet6
Olanzapine* (ODT)Zyprexa® Zydis®Tablet14
Olanzapine and fluoxetineSymbyax™Capsule11
OmeprazolePrilosec®Capsule1
OrphenadrineNorflex™Tablet2
Oxybutynin* (extended release)Ditropan® XLTablet2
Oxycodone* (extended release)OxyContin®Tablet2
Oxymorphone* (extended release)Oprana® ERTablet2
PancrelipaseCreon®, Lipram, Pancrecarb MS®, Pancrease® MT, Pangestyme™, Ultrase®Capsule1, 5, 15
PantoprazoleProtonix®Tablet1
PapaverinePara-Time SR®Capsule2
ParicalcitolZemplar®Capsule9
Paroxetine* (controlled release)Paxil CR®Tablet2
PentoxifyllinePentoxil®, Trental®Tablet2
Phendimetrazine* (sustained release)Bontril® Slow ReleaseCapsule2
Phenylephrine, pseudoephedrine, chlorpheniramine, atropine, hyoscyamine, scopolamineStahist™Tablet2
Phenytoin* (extended release)Dilantin®, Phenytek™™Capsule2
Pioglitazone and metforminActoplus Met™Tablet11

Side Four

GENERICBRANDDOSAGE FORMREASON
PiroxicamFeldene®Capsule4
Potassium bicarbonate and potassium chlorideK-Lyte®Tablet7
Potassium chloride*microK®Capsule2, 5
Potassium chloride*K-Dur®, K-Tab®, Kaon CI®, Klor-Con®Tablet2
Potassium citrateUrocit® KTablet1
Prednisolone* (ODT)Orapred ODT™Tablet14
Procainamide* (extended release)Procanbid®Tablet2
Propantheline(Generic forms available)Tablet3
Propranolol* (extended release)Inderal® LA, InnoPran XL™™Capsule2
Pseudoephedrine* (extended release)Contact® Cold, Dimetapp® 12-Hour Non-Drowsy Extentabs®, Sudafed® 12 hour, Sudafed® 24 HourTablet2
Pyridostigime* (sustained release)Mestinon® Timespan®Tablet2
Quinidine* (extended release)Quinidine Gluconate ER, Quinidine Sulfate ERTablet2
RabeprazoleAciphex®Tablet1
RamelteonRozerem™Tablet11
RanolazineRanexa™Tablet2, 11
Risedronate, risedronate/calciumActonel®, Actonel® with CalciumTablet4
Risperidone* (ODT)Risperdal® M-Tabs™Tablet14
Ropinirol (ODT)Requip®Tablet14
Selegiline* (ODT)Zelapar™Tablet14
SevelamerRenagel®Tablet13
SildenafilRevatio™, Viagra®Tablet11
Sodium bicarbonate* (granules)Brioschi®Granules7
Sulfasalazine* (delayed release)Azulfidine® EN-tabs®, Sulfazine ECTablet1
SumatriptanImitrex®Tablet13
TamsulosinFlomax®Capsule2
TemozolomideTemodar®Capsule4
Theophylline* (extended release)Theo-24®, TheoCap™Capsule2
Theophylline* (extended release)Quibron®-T/SR, Theochron®Tablet2
Theophylline* (extended release)Uniphyl®Tablet2, 8
Thyphoid vaccineVivotif Berna®Capsule1
Tolterodine* (extended release)Detrol® LACapsule2
Topiramate*Topamax® SprinkleCapsule5
Tramadol* (extended release)Ultram® ERTablet2
Trandolapril and verapamil Divalproex Sodium*Tarka®Tablet2
Valproic acid*Depakene®Capsule1, 5
Divalproex Sodium*Depakote®Capsule4, 9
Divalproex Sodium* (extended release)Depakote® ERTablet1
Venlafaxine* (extended release)Effexor® XRTablet2, 11
Verapamil* (extended release)Verelan®, Verelan® PMCapsule2, 5
Verapamil* (extended release)Covera-HS®, Isoptin® SRTablet2
Verapamil* (extended release)Calan® SRTablet2, 8
Zolpidem* (extended release)Ambien™ CRTablet2

Important Notes and Disclaimers

1.
Enteric coated formulation.
2.
Time release formulation.
3.
Unpleasant taste.
4.
Can irritate mucus membranes and/or skin.
5.
Capsule may be opened and contents removed for administration without crushing, chewing, or dissolving.
6.
Tablets are made to disintegrate under the tongue.
7.
Tablets MUST be dissolved in liquid as recommended by the manufacturer.
8.
Tablet is scored and may be broken in half, at the score line, without affecting release characteristics in most situations.
9.
Liquid filled capsule.
10.
Contents may be dissolved in water for administration.
11.
Not recommended by manufacturer. No data available.
12.
Women who are or may become pregnant should not handle crushed or broken tablets.
13.
Miscellaneous
14.
Product designed to dissolve in the mouth.
15.
Once digestive enzyme capsules are opened onto food, swallow immediately to reduce irritation of mucosa. Follow-up with fluid. Contact with foods having pH > 5.5 can dissolve enteric coating.
16.
Crushing diltiazem tablets will alter the controlled-release mechanism resulting in instant release of drug which may cause faster absorption, earlier time to max concentration, and higher max concentration. The duration of effect might be decreased necessitating more frequent dosing when tablets are crushed. Patients who are administered crushed tablets should be closely monitored for exaggerated effect.
17.
Antacids and/or milk may prematurely dissolve the coating of the tablet.

ODT = Orally Disintegrating Tablet

Alternate dosage forms (e.g. liquid, crushable immediate release tablets, non-enteric coated, topical patches) for the product are available. Dose, frequency of administration, and manufacturers may differ from the brand name listed.

This document is not all-inclusive and not all products may be available in all areas. Use of the document also requires health professionals to evaluate individual patient needs (i.e. the list should not be viewed as an absolute contraindication to crushing). References available upon request.

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