Oral Dosage Forms That Should Not Be Crushed

Crushing pills can make them easier to give, but not all pills should be broken for the following reasons:

• Doing so with pills meant to release medication slowly can lead to a sudden large dose. For example, Metoprolol ER is an extended-release drug, crushing may cause rapid effect and drop in blood pressure.
• It can also interfere with pills designed to protect against stomach acids or irritation. For example, Aspirin EC and Enteric coated Pancrelipase are gastric irritants and should not be crushed, Depakene is a mucous membrane irritant and can damage the oral mucosa if crushed.
• Tablets meant to dissolve under the tongue or against the cheek might not work properly if crushed. For example, Prevacid Solutab instructions says orally disintegrating do not swallow.
• Some pills use special technologies that can be affected by crushing, changing how much medicine the body absorbs. For example, crushing the antiviral drug Ritonavir has resulted in decreased bioavailability of the drug. 
  
• Crushing pills with a bitter taste might not be pleasant for the person taking them. 
• And breaking apart pills that are irritating or dangerous can be harmful to the person doing the crushing. For example, Finasteride leaflet warns women who are, or may become pregnant should not handle crushed or broken tablets. Hydroxyurea tablets, if crushed, should be handled with gloves on to avoid serious skin toxicities. 
• If there's no other option but to crush hazardous pills (like those that can cause cancer), follow guidelines outlined by your healthcare facility, and instruct outpatients on the proper procedures. Hazardous pills typically come with instructions not to crush in their product information.

Below is a list of the 2016 "Oral Dosage Forms That Should Not Be Crushed" from the Institute for Safe Medication Practice (ISMP). Oral Dosage Forms That Should Not Be Crushed 2016 (lacounty.gov)

Currently, the ISMP no longer own, update, or review content on the List of Oral Dosage Forms That Should Not Be Crushed.  Oral Dosage Forms That Should Not Be Crushed | Institute For Safe Medication Practices (ismp.org)

Click the link for a video on "Why you shouldn't crush certain pills" https://www.youtube.com/watch?v=aHBKT9rpqhM

Thank you and we hope the information in this channel has been helpful in your clinical practice. 

The Clinical Nursing Channel Team