Medication Safety

Do Not Crush Medication List

What Medication Cannot Be Crushed?

There are many different ways to split tablets in half. One way is to purchase a tablet splitter from your local pharmacy . These tablet splitters are safe and easy to use. All you need to do is to place the tablet in the proper place and then when the splitter is closed, a steel blade cuts the tablet in halves. Some tablets are scored and have a line dividing the dose in half and may be able to be snapped in half using your fingers. Other alternatives used are splitting by hands (for scored tablets) or with scissors (for unscored tablets), or with a kitchen knife.

However, there are medications that should never be crushed of spitted. The institute for safe medication practice (ISMP) provides a list of oral dosage forms that should not be crushed, commonly referred to as the “Do Not Crush”. This list contains medications that should not be crushed because of their special pharmaceutical formulations or characteristics, such as oral dosage forms that are sustained-release in nature.

The ISMP do not crush list is provided in the table below:

Drug Product Active Ingredient(s) Dosage Form(s) Reasons/Comments
Abilify MyCite kit (aripiprazole) Tablet Drug-device combination
Absorica (ISOtretinoin) Capsule Mucous membrane irritant
Abstral (fentaNYL) Tablet Note: Sublingual tablet; do not suck, chew, or swallow whole.
AcipHex (rabeprazole) Tablet Slow-release
AcipHex Sprinkle (rabeprazole) Capsule Slow-release; Note: contents are intended to be sprinkled on food or liquid but should not be chewed or crushed.
Acticlate (doxycycline hyclate) Capsule; Tablet Film-coated; tablet is scored and may be split; Note: 150 mg tablets can be broken into two-thirds or one-third to provide a 100 mg and 50 mg strength, respectively
Actiq (fentaNYL) Lozenge Slow-release; Note: this lollipop delivery system requires the patient to slowly allow dissolution. If chewed and swallowed, may result in a lower peak concentration and bioavailability.
Actonel (risedronate) Tablet Irritant; Note: chewed, crushed, or sucked tablets may cause oropharyngeal ulceration.
Actoplus Met Xr (combination) Tablet Slow-release
Adalat CC (NIFEdipine) Tablet Slow-release
Adderall XR (amphetamine salts) Capsule Slow-release (a)
Adhansia XR (methylephenidate hydrochloride) Capsule Slow-release (a)
Adzenys XR-ODT (amphetamine) Tablet Slow-release; Sublingual form (g)
Aemcolo (rifamycin) Tablet Slow-release
Afeditab CR (NIFEdipine) Tablet Slow-release
Afinitor (everolimus) Tablet Mucous membrane irritant
Aggrenox (combination) Capsule Slow-release
Alecensa (alectinib) Capsule Antineoplastic
Alophen (bisacodyl) Tablet Enteric-coated
Altoprev (lovastatin) Tablet Slow-release
Alunbrig (brigantinib) Tablet Antineoplastic
Ambien CR (zolpidem) Tablet Slow-release
Amitiza (lubiprostone) Capsule
Amnesteem (ISOtretinoin) Capsule Mucous membrane irritant
Ampyra (dalfampridine) Tablet Slow-release; Note: formerly fampridine-SR
Amrix (cyclobenzaprine) Capsule Slow-release (a)
Aplenzin (buPROPion) Tablet Slow-release
Aptensio XR (methylphenidate) Capsule Slow-release (a)
Aptivus (tipranavir) Capsule Note: oil emulsion within spheres; taste
Arakoda (tafenoqunie succinate) Tablet
Aricept 23 mg (donepezil) Tablet Note: crushing the 23 mg tablet may significantly increase the rate of absorption; the 5 mg and 10 mg tablets are not affected
Arthrotec (combination) Tablet Enteric-coated
Arymo ER (morphine) Tablet Slow-release; Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose.
Asacol HD (mesalamine) Tablet Slow-release
Aspirin enteric-coated (aspirin) Caplet; Tablet Slow-release; Enteric-coated
Astagraf XL (tacrolimus) Capsule Slow-release
Atelvia (risedronate) Tablet Slow-release; Note: chewed, cut, or crushed tablets may cause oropharyngeal irritation
Augmentin XR (combination) Tablet Slow-release (b,h)
Austedo (deutetrabenazine) Tablet
Avodart (dutasteride) Capsule Mucous membrane irritation; 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
Azulfidine EN-Tabs (sulfaSALAzine) Tablet Slow-release (b)
Balcoltra (combination) Tablet
Balversa (erdafitinib) Tablet Antineoplastic
Bayer EC, Bayer Regular (aspirin) Caplet Enteric-coated
Belbuca (buprenorphine) Film, buccal Sublingual form (g); Note: chewing or swallowing may result in lower bioavailability.
Belviq XR (lorcaserin hydrochloride) Tablet Slow-release
Biaxin-XL (clarithromycin) Tablet Slow-release
Biltricide (praziquantel) Tablet Taste (h)
Binosto (alendronate) Tablet Effervescent tablet (f)
Bisac-Evac (bisacodyl) Tablet Enteric-coated (c)
Bisacodyl (combination) Tablet Enteric-coated (c)
Bisa-Lax (combination) Tablet Enteric-coated (c)
Boniva (ibandronate) Tablet Note: chewed, crushed, or sucked tablets may cause oropharyngeal irritation
Bonjesta (combination) Tablet Slow-release
Bosulif (bosutinib) Tablet Antineoplastic; Note: crushed or broken tablets should not be handled
Briviact (brivaracetam) Tablet Film-coated (b)
Budeprion SR (buPROPion) Tablet Slow-release
Bunavail (combination) Buccal film Note: chewing or swallowing may result in lower peak concentrations and bioavailability
Butrans (buprenorphine) Film Slow-release; Note: may expose to potentially fatal overdose
Cabometyx (cabozantinib) Tablet Film-coated
Calquence (acalabrutinib) Capsule Antineoplastic
Caprelsa (vandetanib) Tablet Irritant
Carbaglu (carglumic acid) Tablet Note: tablets should be dispersed completely in water
Carbatrol (carBAMazepine) Capsule Slow-release (a)
Cardene SR (niCARdipine) Capsule Slow-release
Cardizem (dilTIAZem) Tablet Note: although not in the package insert, the drug has a coating that is intended to release the drug over approximately 3 hours
Cardizem CD (dilTIAZem) Capsule Slow-release
Cardizem LA (dilTIAZem) Tablet Slow-release
Cardura XL (doxazosin) Tablet Slow-release
Cartia XT (dilTIAZem) Capsule Slow-release
Cassipa (combination) Film, sublingual Sublingual form (g)
Cefaclor ER —— Tablet Slow-release (b)
Ceftin (cefuroxime) Tablet Taste (b) (Note: use suspension for children)
CellCept (mycophenolate) Capsule; Tablet Teratogenic potential (i)
Cerdelga (eliglustat) Capsule Preferably taken with water
Cholbam (cholic acid) Capsule Note: capsules may be opened and the contents mixed with food/drink
Cipro XR (ciprofloxacin) Tablet Slow-release (b)
Claravis (ISOtretinoin) Capsule Mucous membrane irritant
Colestid (colestipol) Tablet Slow-release
Cometriq (cabozantinib) Capsule Antineoplastic
Concerta (methylphenidate) Tablet Slow-release
Contrave (combination) Tablet Slow-release
Conzip (traMADol) Capsule Slow-release; Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose.
Copiktra (develisib) Capsule Antineoplastic
Coreg CR (carvedilol) Capsule Slow-release (a) (Note: may add contents of capsule to chilled, not warm, applesauce and consume immediately)
Cotempla XR-ODT (methylphenidate) Tablet Slow-release; oral disintegrating tablet designed to disintegrate on the tongue.
Creon 5, 10, 20 (pancrelipase) Capsule Slow-release (a)
Cresemba (isavuconazium) Capsule
Crixivan (indinavir) Capsule Taste; Note: capsule may be opened and mixed with fruit puree (e.g., banana)
Cymbalta (DULoxetine) Capsule Slow-release
Cytoxan (cyclophosphamide) Tablet Note: drug may be crushed but company recommends using injection
Daurismo (glasdegib maleate) Tablet Antineoplastic
Delzicol (mesalamine) Capsule Slow-release (a)
Depakene (valproic acid) Capsule Slow-release; mucus membrane irritant (b)
Depakote, Depakote ER (divalproex) Tablet Slow-release
Detrol LA (tolterodine) Capsule Slow-release
Dexilant (dexlansoprazole) Capsule Slow-release (a)
Diacomit (stiripentol) Capsule (b)
Diclegis (combination) Tablet Slow-release
Dilatrate-SR (isosorbide dinitrate) Capsule Slow-release
Ditropan XL (oxybutynin) Tablet Slow-release
Doryx, Doryx MPC (doxycycline hyclate) Tablet Slow-release
Drisdol (ergocalciferol) Capsule Liquid filled (d)
Droxia (hydroxyurea) Capsule Note: exposure to the powder may cause serious skin toxicities; health care workers should wear gloves to administer
Duavee (combination) Tablet Antineoplastic
Duexis (combination) Tablet
Dulcolax (bisacodyl) Capsule; Tablet Enteric-coated (c); Liquid-filled
Durlaza (aspirin) Capsule Slow-release
Easprin (aspirin) Tablet Enteric-coated
EC-Naprosyn (naproxen) Tablet Enteric-coated (b)
Ecotrin Adult Low Strength (aspirin) Tablet Enteric-coated
Ecotrin Maximum Strength (aspirin) Tablet Enteric-coated
Ecotrin Regular Strength (aspirin) Tablet Enteric-coated
Edluar (zolpidem) Tablet Sublingual form (g)
Effer-K (potassium bicarbonate) Tablet Effervescent tablet (f)
Effervescent Potassium —— Tablet Effervescent tablet (f)
Effexor XR (venlafaxine) Capsule Slow-release (a)
Elepsia XR (levETIRAcetam) Tablet Slow-release (b)
Embeda (combination) Capsule Slow-release (a); Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose
Enablex (darifenacin) Tablet Slow-release
Entocort EC (budesonide) Capsule Enteric-coated (a)
Envarsus XR (tacrolimus) Tablet Slow-release
Equetro (carBAMazepine) Capsule Slow-release (a)
Ergomar (ergotamine) Tablet Sublingual form (g)
Erivedge (vismodegib) Capsule Note: package insert indicates potential teratogenic effects; material safety data sheet warns against skin contact; health care workers should take appropriate precautions
Erleada (apalutamide) Tablet Antineoplastic
Ery-Tab (erythromycin) Tablet Enteric-coated
Eryc (erythromycin) Capsule Enteric-coated pellets (a)
Erythromycin Base —– Tablet Enteric-coated
Erythromycin Stearate —— Tablet Enteric-coated
Erythromycin ethylsuccinate —— Tablet Taste (b)
Evekeo ODT (amphetamine sulphate) Tablet Sublingual form (g)
Evista (raloxifene) Tablet Taste; teratogenic potential (i)
Exalgo (HYDROmorphone) Tablet Slow-release (Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose)
Exjade (deferasirox) Tablet Note: do not give as whole tablet, tablets are meant to be given as oral suspension; see company insert
Ezallor (rosuvastatin calcium) Capsule (a)
Farydak (panobinostat) Capsule Irritant
Feldene (piroxicam) Capsule Mucous membrane irritant
Felodipine —— Tablet Slow-release
Fentora (fentaNYL) Tablet Note: buccal tablet; do not swallow whole
Fetzima (levomilnacipran) Capsule Slow-release
Fibricor (fenofibric acid) Tablet ——
Fleet Laxative (bisacodyl) Tablet Enteric-coated (c)
Flomax (tamsulosin) Capsule Slow-release
FluvoxaMINE ER —— Capsule Slow-release
Focalin XR (dexmethylphenidate) Capsule Slow-release (a)
Forfivo XL (buPROPion) Tablet Slow-release
Fortamet (metFORMIN) Tablet Slow-release
Fosamax (alendronate) Tablet Mucous membrane irritant
Fosamax Plus D (combination) Tablet Mucous membrane irritant
Galafold (migalastat hydrochloride) Capsule ——-
Gleevec (imatinib) Tablet Mucous membrane irritant; Note: may be dissolved in water or apple juice
Glucophage XR (metFORMIN) Tablet Slow-release
Glucotrol XL (glipiZIDE) Tablet Slow-release
Glumetza (metFORMIN) Tablet Slow-release
Gocovri (amantadine hydrochloride) Capsule Slow-release (a)
Gralise (gabapentin) Tablet Slow-release (b)
Guaifed, Guaifed-PD (combination) Capsule Slow-release
Guaifenex DM (combination) Tablet Slow-release (h)
Guaifenex GP (combination) Tablet Slow-release
Guaifenex PSE (combination) Tablet Slow-release (h)
GuaifFENesin/Pseudoephedrine —— Tablet Slow-release
GuaiMAX-D (combination) Tablet Slow-release
Halfprin 81 (aspirin) Tablet Enteric-coated
Hetlioz (tasimelteon) Capsule Note: not scored; no studies available from company
Horizant (gabapentin) Tablet Slow-release (b)
Hydrea (hydroxyurea) Capsule Note: exposure to the powder may cause serious skin toxicities; health care workers should wear gloves to administer
Hysingla ER (HYDROcodone) Tablet Slow-release; Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose
Ibrance (palbociclib) Capsule Antineoplastic
Iclusig (PONATinib) Tablet Antineoplastic
Idhifa (enasidenib) Tablet Antineoplastic
Imbruvica (ibrutinib) Capsule Antineoplastic; Note: not scored; no studies available from company
Imdur (isosorbide mononitrate) Tablet Slow-release (h); Note: 30mg tablet may not be split
Impavido (miltefosine) Capsule Note: not scored; no studies available from company
Inderal LA (propranolol) Capsule Slow-release
Inlyta (axitinib) Tablet Antineoplastic
InnoPran XL (propranolol) Capsule Slow-release
Intelence (etravirine) Tablet Note: tablet should be swallowed whole and not crushed; tablet may be dispersed in water
Intuniv (guanFACINE) Tablet Slow-release
Invega (paliperidone) Tablet Slow-release
Invokamet XR (combination) Tablet Slow-release
Iressa (gefitinib) Tablet Note: tablet may be dissolved in 4-8 ounces of water
Isradipine —— Tablet Slow-release
Isosorbide SR (isosorbide mononitrate) Tablet Slow-release
Jakafi (ruxolitinib) Tablet Note: see prescribing information for making a suspension
Jalyn (combination) Capsule Mucous membrane irritant; Note: women who are, or may become, pregnant, should not handle crushed or broken tablets (l)
Janumet, Janumet XR (combination) Tablet Slow-release
Jentadueto XR (combination) Tablet Slow-release
Jornay PM (methylphenidate hydrochloride) Capsule Slow-release (a)
Juxtapid (lomitapide) Capsule ——
Kadian (morphine) Capsule Slow-release (a) (Note: do not give via NG tubes; crushing, chewing or dissolving tablets can cause rapid release and absorption of a potentially fatal dose)
Kaletra (combination) Tablet Film-coated (b)
Kapspargo Sprinkle (metroprolol succinate) Capsule Slow-release (a)
Kapvay (cloNIDine) Tablet Slow-release
Kazano (combination) Tablet Note: not scored; no studies available from company
K-Dur (potassium chloride) Tablet Slow-release (b)
Keppra (levETIRAcetam) Tablet Taste (b) (Note: some extemporaneous formulas are pharmacy prepared)
Keppra XR (levETIRAcetam) Tablet Slow-release (b)
Khedezla (desvenlafaxine) Tablet Slow-release
Kisqali (ribociclib succinate) Tablet Antineoplastic
Kisqali Femara Co-Pack (combination) Tablet Antineoplastic
Klor-Con (potassium chloride) Tablet Slow-release (b)
Klor-Con M (potassium chloride) Tablet Slow-release (b,h)
K-Lyte, K-Lyte CL, K-Lyte DS (potassium) Tablet Effervescent tablet (f)
Kombiglyze XR (combination) Tablet Slow-release (Note: tablet matrix may remain in stool)
Korlym (mifepristone) Tablet Adverse reproductive effects
Krintafel (tafenoquine succinate) Tablet ——
K-Tab (potassium chloride) Tablet Slow-release (b)
LaMICtal XR (lamoTRIgine) Tablet Slow-release
Lenvima (lenvatinib) Capsule Note: may be dissolved in a small glass of liquid
Lescol XL (fluvastatin) Tablet Slow-release
Letairis (ambrisentan) Tablet ——
Levbid (hyoscyamine) Tablet Slow-release (h)
Levsinex Timecaps (hyoscyamine) Capsule Slow-release
Lialda (mesalamine) Tablet Slow-release
Linzess (linaclotide) Capsule (a)
Lithobid (lithium) Tablet Slow-release
Lorbrena (lorlatinib) Tablet Antineoplastic
Lovaza (combination) Capsule Note: contents of capsule may be erosive
Lynparza (olaparib) Capsule Antineoplastic
Lyrica CR (pregabalin) Tablet Slow-release
Mavenclad (cladribine) Tablet Cytotoxic
Maxifed DM, Maxifed DMX (combination) Tablet Slow-release (h)
Maxiphen DM (combination) Tablet Slow-release (h)
Medent-DM (combination) Tablet Slow-release
Mestinon ER (pyridostigmine) Tablet Slow-release (b)
Metadate CD (methylphenidate) Capsule Slow-release (a)
Metadate ER (methylphenidate) Tablet Slow-release
Methylin ER (methylphenidate) Tablet Slow-release
Micro K Extencaps (potassium chloride) Capsule Slow-release (a,b)
Minocin (minocycline) Capsule Mucous membrane irritant
Minolira (minocycline) Tablet Slow-release (h)
Miraplex ER (pramipexole) Tablet Slow-release
Miraphen PSE (combination) Tablet Slow-release
Morphabond (morphine) Tablet Slow-release (b); Note: crushing, chewing or dissolving tablets can cause rapid release and absorption of a potentially fatal dose
Motrin (ibuprofen) Tablet Taste (b,e)
Moxatag (amoxicillin) Tablet Slow-release (h)
MS Contin (morphine) Tablet Slow-release (b); Note: crushing, chewing or dissolving tablets can cause rapid release and absorption of a potentially fatal dose
Mucinex (guaiFENesin) Tablet Slow-release
Mucinex DM (combination) Tablet Slow-release
Mydayis (combination) Capsule Slow-release (a)
Myfortic (mycophenolic acid) Tablet Slow-release; Enteric-coated
Myorisan (ISOtretinoin) Capsule Mucous membrane irritant
Myrbetriq (mirabegron) Tablet Slow-release
Mytesi (crofelemer) Tablet Slow-release
Namenda XR (memantine) Capsule Slow-release (a,b)
Namzaric (combination) Capsule Slow-release (a)
Naprelan (naproxen) Tablet Slow-release
Nerlynx (neratinib maleate) Tablet Antineoplastic
Neurontin (gabapentin) Capsule; Tablet (b,h)
NexIUM (esomeprazole) Capsule Slow-release (a)
Niaspan (niacin) Tablet Slow-release
Nifediac CC (NIFEdipine) Tablet Slow-release
Nifedical XL (NIFEdipine) Tablet Slow-release
Ninlaro (ixazomib) Capsule Antineoplastic
Nitrostat (nitroglycerin) Tablet Sublingual form (g)
Norflex ER (orphenadrine) Tablet Slow-release
Norpace CR (disopyramide) Capsule Slow-release form within a special capsule
Northera (droxidopa) Capsule Note: no studies available from company
Norvir (ritonavir) Capsule; Tablet Note: crushing tablets has resulted in decreased bioavailability of drug (b)
Noxafil (posaconazole) Tablet Slow-release (b)
Nucynta ER (tapentadole) Tablet Slow-release; Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose
OFEV (nintedanib) Capsule Taste
Omtryg (omega-3-acid ethyl esters A) Capsule Note: contents of capsule may be erosive
Opana ER (oxyMORphone) Tablet Slow-release; Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose
Opsumit (macitentan) Tablet ——
Oravig (miconazole) Tablet, buccal Buccal form
Orenitram (treprostinil) Tablet Slow-release
Oseni (combination) Tablet ——
Osmolex ER (amantadine hydrochloride) Tablet Slow-release (b)
Otezla (apremilast) Tablet Film-coated
Oxaydo (oxyCODONE) Tablet Note: not amenable to crushing; may obstruct feeding tubes (b)
Oxtellar XR (OXcarbazepine) Tablet Slow-release
OxyCONTIN (oxyCODONE) Tablet Slow-release; Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose
Pancreaze (pancrelipase) Capsule Slow-release; Enteric-coated (a)
Paxil  (PARoxetine) Tablet Film-coated (b)
Paxil CR (PARoxetine) Tablet Slow-release
Pentasa (mesalamine) Capsule Slow-release (a)
Pertyze (pancrelipase) Capsule Slow-release (a)
Pexeva (PARoxetine) Tablet Film-coated (b)
Plaquenil (hydroxychloroquine) Tablet Film-coated
Pomalyst (pomalidomide) Capsule Antineoplastic
Pradaxa (dabigatran) Capsule Note: breaking, chewing, or emptying contents of the capsule can result in increased exposure
Prevacid (lansoprazole) Capsule Slow-release (a)
Prevacid SoluTab (lansoprazole) Tablet Note: see package insert for administration instructions via an oral syringe of NG tube
Prevpac (combination) Capsule; Tablet Slow-release
Prevymis (letermovir) Tablet ——
PriLOSEC (omeprazole) Capsule Slow-release (a,b)
Pristiq (desvenlafaxine) Tablet Slow-release
Procardia  (NIFEdipine) Capsule Note: pharmacokinetics may be altered if not taken whole
Procardia XL (NIFEdipine) Tablet Slow-release
Procysbi (cysteamine) Capsule Slow-release (a)
Propecia (finasteride) Tablet Note: women who are, or may become, pregnant, should not handle crushed or broken tablets
Proscar (finasteride) Tablet Note: women who are, or may become, pregnant, should not handle crushed or broken tablets
Protonix (pantoprazole) Tablet Slow-release (b)
PROzac Weekly (FLUoxetine) Tablet Enteric-coated
Pylera (combination) Capsule Mucous membrane irritant
Qtern (combination) Tablet ——
Qternmet XR (combination) Tablet Slow-release
Qudexy XR (topiramate) Capsule Slow-release (a)
Ranexa (ranolazine) Tablet Slow-release
Rapamune (sirolimus) Tablet Note: pharmacokinetic parameters may be affected (b)
Rayaldee (calcifediol) Capsule Slow-release
Rayos (predniSONE) Tablet Slow-release; Note: delayed release is dependent on an intact coating (b)
Razadyne ER (galantamine) Capsule Slow-release
Requip XL (rOPINIRole) Tablet Slow-release
Revlimid (lenalidomide) Capsule Note: Teratogenic potential; health care workers should avoid contact with capsule contents/body fluids
Reyataz (atazanavir) Capsule Note: an oral powder is available, see prescribing information for administration instructions
Ritalin LA (methylphenidate) Capsule Slow-release (a)
Roweepra (levETIRAcetam) Tablet Taste (b)
Roweepra ER (levETIRAcetam) Tablet Slow-release (b)
Rydapt (midostaurin) Capsule Antineoplastic
Rytary (combination) Capsule Slow-release (a)
Rythmol SR (propafenone) Capsule Slow-release
Sensipar (cinacalcet) Tablet Note: tablets are not scored and cutting may cause variable dosage accuracy
SEROquel XR (QUEtiapine) Tablet Slow-release
Siklos (hydroxyurea) Tablet Note: exposure to the powder may cause serious skin toxicities; health care workers should wear gloves to administer
Sinemet CR (levodopa/carbidopa) Tablet Slow-release (h)
SINUvent PE (combination) Tablet Slow-release (h)
Sirturo (bedaquiline) Tablet ——
Sitavig (acyclovir) Tablet Buccal form
Solodyn (minocycline) Tablet Slow-release
Somnote (chloral hydrate) Capsule Liquid filled
Sprycel (dasatinib) Tablet Film-coated (Note: active ingredients are surrounded by wax matrix to prevent healthcare exposure; women who are, or may become, pregnant should not handle crushed or broken tablet)
Stalevo (combination) Tablet Note: combining multiple tablets or portions of tablets may lead to an overdose of entacapone
Staxyn (verdenafil) Tablet Sublingual form (g)
Stivarga (regorafenib) Tablet Antineoplastic
Strattera (atomoxetine) Capsule Note: capsule contents can cause ocular irritation
Suboxone (combination) Film, buccal Sublingual form (g)
Sular (nisoldipine) Tablet Slow-release
Symax Duotab, Symax SR (hyoscyamine) Tablet Slow-release
Syndeko (copackaged) (combination) Tablet ——
Synjardy XR (combination) Tablet Slow-release
Tafinlar (dabrafenib) Capsule Antineoplastic
Tagrisso (osimertinib) Tablet Note: tablet may be dissolved in 2 ounces of water
Talzenna (talazoparib tosylate) Capsule Antineoplastic
Tasigna (nilotinib) Capsule Note: disruption of capsule may yield high blood levels causing enhanced toxicity (a)
Taztia XT (dilTIAZem) Capsule Slow-release (a)
Tecfidera (dimethyl fumarate) Capsule Slow-release
Tegretol-XR (carBAMazepine) Tablet Slow-release
Tekturna (aliskiren hemifumarate) Capsule Empty contents into a spoon for administration. Do not swallow the capsule. Do not chew or crush the contents of the capsule. (a)
Temodar (temozolomide) Capsule Mucous membrane irritant; Note: accidentally opened or damaged capsules require rigorous precautions to avoid inhalation or contact with the skin or mucous membranes (i)
Tessalon Perles (benzonatate) Capsule Note: swallow whole; local anesthesia of the oral mucosa; choking could occur
Theo-24 (theophylline) Capsule Slow-release; Note: contains beads that dissolve throughout the GI tract
Theochron (theophylline) Tablet Slow-release
Tiazac (dilTIAZem) Capsule Slow-release (a)
Tibsovo (ivosidenib) Tablet Antineoplastic
Tolsura (itraconazole) Capsule (b)
Topamax (topiramate) Capsule; Tablet Taste; Taste (a)
Topamax Sprinkle (topiramate) Capsule Taste (a)
Toprol XL (metoprolol succinate) Tablet Slow-release (h)
Touro CC-LD (combination) Tablet Slow-release (h)
Touro LA-LD (combination) Tablet Slow-release (h)
Toviaz (fesoterodine) Tablet Slow-release
Tracleer (bosentan) Tablet Note: women who are, or may become, pregnant, should not handle crushed or broken tablets
Trental (pentoxifylline) Tablet Slow-release
Treximet (combination) Tablet Note: unique drug matrix enhances rapid drug absorption
Trilipix (fenofibric acid) Capsule Slow-release
Trokendi XR (topiramate) Capsule Slow-release
Trulance (plecanatide) Tablet Note: see package insert for instructions on crushing administration
Uceris (budesonide) Tablet Slow-release; Note: film coating is designed to break down at or above pH of 7.0
Uniphyl (theophylline) Tablet Slow-release (h)
Uptravi (selexipag) Tablet Film-coated
Urocit-K (potassium citrate) Tablet Slow-release; Wax-coated; prevents upper GI release
Uroxatral (alfuzosin) Tablet Slow-release
Valcyte (valGANCiclovir) Tablet Teratogenic and irritant potential (b, i)
Vascepa (icosapent ethyl) Capsule ——
Venclexta (venetoclax) Tablet Film-coated, Antineoplastic
Verelan, Verelan PM (verapamil) Capsule Slow-release (a)
Verzenio (abemaciclib) Tablet Antineoplastic
VESIcare (solifenacin) Tablet Taste
Videx EC (didanosine) Capsule Slow-release; Enteric-coated
Viekira XR (combination) Tablet Slow-release
Vimovo (combination) Tablet Slow-release
Viokace (pancrelipase) Tablet Mucous membrane irritant
Viramune XR (nevirapine) Tablet Slow-release (b)
Vitrakvi (larotrectinib) Capsule Antineoplastic (b)
Voltaren XR (diclofenac) Tablet Slow-release
VoSpire ER (albuterol) Tablet Slow-release
Votrient (PAZOPanib) Tablet Note: crushing significantly increases the AUC and Tmax
Vyndamax (tafamidis) Capsule ——
Vyndagel (tafamidis meglumine) Capsule ——
Wellbutrin (buPROPion) Tablet ——
Wellbutrin SR, Wellbutrin XL (buPROPion) Tablet Slow-release
Xalkori (crizotinib) Capsule Antineoplastic
Xanax XR (ALPRAZolam) Tablet Slow-release (b)
Xartemis XR (combination) Tablet Slow-release (Note: crushing, chewing, or dissolving tablets can cause rapid release and absorption of a potentially fatal dose)
Xeljanz XR (tofacitinib) Tablet Slow-release
Ximino (minocycline) Capsule Slow-release
Xigduo XR (combination) Tablet Slow-release
Xospata (gilteritinib fumarate) Tablet Antineoplastic
Xtampza ER (oxyCODONE) Capsule Slow-release (a, b)
Xtandi (enzalutamide) Capsule Antineoplastic
Yonsa (abiraterone acetate) Tablet Antineoplastic
Yosprala (combination) Tablet Slow-release
Zegerid (combination) Capsule Slow-release (b)
Zejula (niraparib tosylate) Capsule Antineoplastic
Zelboraf (vemurafenib) Tablet Antineoplastic
Zenatane (ISOtretinoin) Capsule Mucous membrane irritant
Zenpep (pancrelipase) Capsule Slow-release (a)
Zohydro ER (HYDROcodone) Capsule Slow-release; Note: crushing, chewing, or dissolving capsules can cause rapid release and absorption of a potentially fatal dose
Zolinza (vorinostat) Capsule Note: irritant; avoid contact with skin or mucous membranes; avoid contact with crushed or broken tablets
Zortress (everolimus) Tablet Note: crushed powder may cause mucous membrane irritation
Zubsolv (combination) Tablet Sublingual form (g)
Zuplenz (ondansetron) Film, oral Sublingual form (g)
Zyban (buPROPion) Tablet Slow-release
Zydelig (idelalisib) Tablet Antineoplastic; Note: not scored; film-coated
Zytiga (abiraterone) Tablet Antineoplastic
Zyflo CR (zileuton) Tablet Slow-release

a: Capsule may be opened and the contents taken without chewing or crushing; soft food such as applesauce  or pudding may facilitate administration; contents may generally be administered via NG tube using an appropriate fluid provided entire contents are washed down the tube.

b: Liquid dosage forms of the product are available; however, dose, frequency of administration, and manufacturers may differ from that of the solid dosage form.

c: Antacids and/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 NG tube should be acceptable.

f: Effervescent tablets must be dissolved in the amount of diluent recommended by the manufacturer.

g: Tablets are made to disintegrate under the tongue.

h: Tablet is scored and may be broken in half without affecting release characteristics.

i: Skin contact may enhance tumor production; avoid direct contact.

For More Information Visit : What Are The 5 R’s For Medication Safety?

Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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