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    Do Not Crush Meds

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    This document lists active ingredients, drug products, dosage forms, and comments regarding reasons not to crush specific medications at SFGH. It includes 54 medications across various therapeutic classes that should not be crushed due to being enteric-coated, extended-release, cytotoxic, teratogenic, or having a hazardous ingredient that could be exposed if crushed. Crushing these medications could reduce effectiveness, cause toxicity, or expose healthcare workers to hazardous ingredients. Alternative dosage forms or administration methods are provided when available.

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    Do Not Crush Meds

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    api-249622140
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    This document lists active ingredients, drug products, dosage forms, and comments regarding reasons not to crush specific medications at SFGH. It includes 54 medications across various therapeutic classes that should not be crushed due to being enteric-coated, extended-release, cytotoxic, teratogenic, or having a hazardous ingredient that could be exposed if crushed. Crushing these medications could reduce effectiveness, cause toxicity, or expose healthcare workers to hazardous ingredients. Alternative dosage forms or administration methods are provided when available.

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    This document lists active ingredients, drug products, dosage forms, and comments regarding reasons not to crush specific medications at SFGH. It includes 54 medications across various therapeutic classes that should not be crushed due to being enteric-coated, extended-release, cytotoxic, teratogenic, or having a hazardous ingredient that could be exposed if crushed. Crushing these medications could reduce effectiveness, cause toxicity, or expose healthcare workers to hazardous ingredients. Alternative dosage forms or administration methods are provided when available.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    2K views3 pages

    Do Not Crush Meds

    Uploaded by

    api-249622140
    This document lists active ingredients, drug products, dosage forms, and comments regarding reasons not to crush specific medications at SFGH. It includes 54 medications across various therapeutic classes that should not be crushed due to being enteric-coated, extended-release, cytotoxic, teratogenic, or having a hazardous ingredient that could be exposed if crushed. Crushing these medications could reduce effectiveness, cause toxicity, or expose healthcare workers to hazardous ingredients. Alternative dosage forms or administration methods are provided when available.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    The document discusses medications that should not be crushed and provides reasons why as well as alternatives.

    Many medications should not be crushed due to enteric coatings, extended releases mechanisms or cytotoxic, teratogenic and carcinogenic properties. Reasons are provided for each medication listed.

    Precautions like using PPE (gloves, gown, safety glasses, respirator), handling in a chemotherapy hood and avoiding direct skin contact should be taken for hazardous agents.

    DO NOT CRUSH MEDICATIONS at SFGH

    Active Ingredient

    Drug Product

    Dosage Form

    Reasons/ Comments

    Acitretin
    Alendronate
    Aspirin EC h
    Aspirin/dipyridamole
    Bisacodyl
    Bupropion SR/XL h

    Soriatane
    Fosamax
    Bayer EC, Ecotrin
    Aggrenox
    Dulcolax
    Wellbutrin SR,
    Wellbutrin XL
    Dostinex
    Xeloda
    Tegretol XR
    Somnote
    Leukeran
    Sensipar

    Capsule
    Tablet
    Tablet/ Caplet
    Capsule
    Tablet
    Tablet

    Teratogenj
    Mucous membrane irritant
    Enteric coated, non EC tabs available
    Slow-release
    Enteric coated c
    Slow-release b

    Tablet
    Tablet
    Tablet
    Capsule
    Tablet
    Tablet
    Tablet
    Tablet
    Capsule
    Tablet
    Capsule
    Capsule

    Delayed-release
    Delayed-release
    Extended-release b

    Diltiazem SR h
    Divalproex h
    Docusate
    Dronedarone
    Duloxetine

    Klonopin
    Cytoxan
    Sandimmune, Neoral,
    Gengraf
    Voltaren
    Videx EC
    Cartia XT, Dilacor XR,
    Taztia XT
    Cardizem CD
    Depakote, Depakote ER
    Colace
    Multaq
    Cymbalta

    Reproductive harm, carcinogenj


    Antineoplastic agent i
    Slow-release, reproductive harm, carcinogen b,j
    Liquid filled
    Antineoplastic agent i
    Note: tablets are not scored and cutting may cause
    variable dosage accuracy
    Teratogen j
    Cytotoxic, change order to IV formulation/ route i
    Immunosuppressive b,j

    Capsule
    Tablet
    Capsule
    Tablet
    Capsule

    Dutasteride

    Avodart

    Capsule

    Entecavir
    Ergocalciferol
    Erythromycin
    Etoposide
    Etravirine

    Baraclude
    Drisdol
    Erythrocin
    Toposar
    Intelence

    Tablet
    Capsule
    Tablet
    Capsule
    Tablet

    Felodipine
    Ferrous sulfate
    Finasteride

    Plendil
    Feosol
    Propecia, Proscar

    Tablet
    Tablet
    Tablet

    Guaifenesin h
    Hydroxyurea

    Mucinex
    Hydrea

    Tablet
    Capsule

    Ibuprofen
    Imatinib
    Indinavir

    Motrin
    Gleevec
    Crixivan

    Tablet
    Tablet
    Capsule

    Extended-release b
    Delayed-release, extended-release, teratogen b,j
    Taste e , liquid formulation available
    Reproductive harm j
    Extended-release a
    Note: may add contents of capsule to apple juice or
    applesauce but NOT chocolate
    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 j
    Teratogenic in animal studies j
    Liquid filled d
    Enteric-coated- change order to IV formulation
    Cytotoxic, change order to IV formulation i
    Note: tablet should be swallowed whole and not
    crushed; tablet may be dispersed in water and given
    PO or via feeding tube
    Extended-release
    Enteric coated b
    Note: women who are, or may become pregnant,
    should not handle crushed or broken tablets j
    Slow-release b
    Note: exposure to powder may cause serious skin
    toxicities; healthcare workers should wear gloves to
    administer i
    Taste e , liquid formulation available
    Taste f ; Note: OK to dissolve in water or apple juice
    Taste; Note: capsule may be opened and mixed with
    fruit puree e

    Cabergoline
    Capecitabine
    Carbamazepine XR h
    Chloral hydrate
    Chlorambucil
    Cinacalcet
    Clonazepam
    Cyclophosphamide
    Cyclosporine
    Diclofenac
    Didanosine
    Diltiazem ER h

    Active Ingredient

    Drug Product

    Dosage Form

    Reasons/ Comments

    Indocin SR
    Imdur

    Capsule
    Tablet

    Extended-release a,b
    Extended-release b,f

    Prevacid Solu-tab

    Tablet

    Tablet
    Tablet
    Capsule
    Tablet
    Capsule
    Tablet
    Tablet
    Tablet
    Capsule
    Tablet
    Tablet
    Tablet
    Tablet
    Tablet
    Capsule/ tablet
    Tablet
    Tablet
    Capsule
    Tablet
    Capsule
    Tablet
    Tablet
    Tablet
    Capsule
    Tablet
    Capsule
    Capsule
    Tablet
    Tablet
    Tablet/ capsule

    Liquid filled b,d


    Reproductive harm, teratogen, carcinogen j
    Delayed-release a
    Slow-release
    Teratogen b,j
    Extended-release
    Carcinogen, mutagen j
    Extended-release b
    Antineoplastic agent i
    Extended-release b
    Extended-release b
    Taste, teratogenic potential g, j
    Teratogen j

    Risperidone

    Keppra
    Lithobid
    CeeNU
    Kaletra
    Amitiza
    Alkeran
    Purinethol
    Lialda
    Pentasa
    Trexall, Rheumatrex
    Methergine
    Toprol XL
    Mifeprex
    MS Contin
    Cellcept
    Niaspan
    Adalat CC, Nifediac CC,
    Procardia XL
    Nimotop
    Trileptal
    Zenpep, Pancrease
    Protonix
    Paxil
    Trental
    Dibenzyline
    K-Dur
    Mayulane
    Inderal LA
    Mestinon ER
    Evista
    Copegus, Rebetol,
    Ribasphere
    Risperdal

    Note: orally disintegrating, do not swallow; dissolve


    in water only & dispense via dosing syringe or NG
    tube
    Taste e- liquid formulation available from pharmacy
    Extended-release b
    Antineoplastic agent i
    Film-coated b
    Slow-release
    Antineoplastic agent i
    Reproductive harm j
    Delayed-release
    Slow-release
    Antineoplastic agent i
    Oxytocic
    Slow-release b,f
    Oxytocic
    Extended-release b
    Teratogenic potential b,j
    Extended-release
    Extended-release

    Tablet

    Ritonavir

    Norvir

    Tablet

    Sevelamer

    Renagel

    Tablet

    Tacrolimus
    Tamsulosin
    Tetracycline
    Theophylline

    Prograf
    Flomax
    Sumycin
    Theophylline CR,
    Uniphyl
    Detrol LA
    Topamax
    Valcyte

    Capsule
    Capsule
    Capsule
    Tablet/ capsule

    Hazardous drug, change order to disintegrating


    tablet or liquid b,j
    Note: crushing tablets has resulted in decreased
    bioavailability of drug b
    Note: tablets expand in liquid if broken or
    crushedcan clog feeding tube; can administer
    sevelamer carbonate (Renvela) packets via feeding
    tube
    Immunosuppressive b,j
    Slow-release
    Teratogen j
    Extended-release Note: capsule contains beads that
    dissolve throughout GI tract b
    Extended-release b
    Bitter taste e
    Teratogenic and irritant potential b,g,j

    Indomethacin
    Isosorbide
    mononitrate h
    Lansoprazole

    Levetiracetam
    Lithium h
    Lomustine
    Lopinavir/ ritonavir
    Lubiprostone
    Melphalan
    Mercaptopurine
    Mesalamine
    Mesalamine
    Methotrexate
    Methylergonovine
    Metoprolol succinate
    Mifepristone
    Morphine h
    Mycophenolate
    Nicotinic acid
    Nifedipine h
    Nimodipine
    Oxcarbazepine
    Pancrelipase
    Pantoprazole
    Paroxetine
    Pentoxifylline
    Phenoxybenzamine
    Potassium
    Procarbazine
    Propranolol h
    Pyridostigmine
    Raloxifene
    Ribavirin

    Tolterodine h
    Topiramate
    Valganciclovir

    Capsule
    Tablet
    Tablet

    Active Ingredient

    Drug Product

    Dosage Form

    Reasons/ Comments

    Valproic acid
    Venlafaxine XR h
    Verapamil SR
    Vitamin A
    Ziprasidone
    Zonisamide

    Depakote, Depakote ER
    Effexor XR
    Calan SR
    A-25
    Geodon
    Zonegran

    Tablet/Capsule
    Capsule
    Tablet
    Capsule
    Capsule
    Capsule

    Teratogen b,j
    Extended-release b
    Slow-release b,f
    Liquid filled d
    Genotoxin, carcinogen, teratogen j
    Teratogen j

    a. Capsule may be opened and contents taken without chewing or crushing; soft food such as applesauce or
    pudding may facilitate administration. Contents may generally be given via a nasogastric tube providing all
    the contents are flushed down the tube
    b. Liquid or immediate tablet/capsule dosage forms of this medication are available; however, dose, frequency of
    administration and manufacturers may differ from that of the solid/slow-release form
    c. Antacids 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 is acceptable
    f. Tablet is scored and may be broken in half without affecting release characteristics
    g. Skin contact may enhance tumor production; avoid direct contact
    h. Various formulations are available (IR vs. ER,SR), please ensure formulation ordered by provider and product
    dispensed from pharmacy both match
    i. Hazardous agent- cytotoxic- crushing is only allowed in the pharmacys chemotherapy hood
    j. Hazardous agent- if crushing, use PPE (gloves, gown, safety glasses, fitted N95 respirator, as needed to
    prevent exposure). Use liquid formulation if available.
    References:
    1.

    Mitchell JF. Oral Dosage Forms That Should Not Be Crushed. August 2013. www.ismp.org (Accessed
    September 26, 2013)
    2. Miller D, Miller H. To crush or not to crush? What to consider before giving medications to a patient with a
    tube or who has trouble swallowing. Nursing 2000; 30:50-2.
    3. www.cdc.gov/NIOSH (June 2012). NIOSH List of Antineoplastic and Other Hazardous Drugs in Health Care
    Settings.
    4. SFGH Administrative Policy 16.36; Non-Cytotoxic Hazardous Drugs Management, Appendix A. (Updated
    9/2013)

    A. Logan, K Pang, K Slown 10/2013

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