An article from Drug Dosing Systems ()
For determine which medicines cannot be crushed or cut, it is necessary to take into account that There are several ways to administer pharmaceutical specialties. Depending on the route of administration, the active principles are formulated in a different galenic form. Besides, the oral solid form is the most used presentation.
For some people it is especially difficult to swallow and many patients and caregivers fractionate and crush solid dosage forms. And when it comes to capsules, they proceed to open them and manage their contents. However, The decision to cut or crush a tablet or open a capsule should not be taken lightly.
What are the risks of modifying a dosage form?
- When modifying a pharmaceutical form the responsibility for any adverse effect It can fall on the person responsible for handling the medication
- we can commit dosing errors
- There is the possibility of increasing the side effects
- The medication can lose effectiveness
- It increases the toxic potential
At SDM we have prepared a list in which we indicate which medicines cannot be crushed or cut, but generally:
CUT
The presence of a score in the tablet does not mean that it can be divided and, if it can, it is recommended to use .
In the event that the medicine can be divided, it is always recommended to use a cutter
CRUSH
In general we should avoid crushing or opening the capsules of the following presentations:
- Delayed, coated, modified or prolonged release, sublingual, orodispersible, and gastro-resistant pharmaceutical forms
- If the active substance is unstable
- Effervescent or dragee forms
- With a narrow therapeutic margin
- Cytostatic and immunosuppressive
- When it contains irritating substances
- When its administration indication is to suck or chew
- When it contains liquid form. Soft capsules
What are the advantages of administration of crushed medication?
This system allows the patients with swallowing problems can swallow the medication more easily. On the other hand, in patients who intentionally do not adhere to their treatment, we can have control that the medication is ingested diluting it in liquids (water or juice) or semi-solids (jam, compote, yogurt…).
To develop the list of which drugs cannot be cut, crushed, or opened in their capsules, we have consulted the manufacturer’s recommendations, respecting their criteria. In our study we have found different authors who do accept the grinding of some drugs, against the manufacturer’s criteria. From SDM, the manufacturer’s recommendations have always prevailed.
The table about these medicines is structured as follows:
- A list of active ingredients has been drawn up in alphabetical order.
- Next is the trademark
- In the second column you will find the galenic form in abbreviated form
- The third column is the presentations
- The next three specify whether cutting, shredding, or opening is not recommended.
- The next column lists the alternatives and, in the last column, the observations
The table of these medications that cannot be cut or shredded can be downloaded at .