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