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Oral Medications That Should Not Be Crushed - March 2023 Update

Although crushing pills can make taking pills easier, and may even be necessary for some (e.g., those with a feeding tube), it is important to be mindful of which solid oral medications should not be crushed before consumption as it may alter their intended effects due to their specific formulation. These include:

• Extended-release, controlled-release, prolonged-action, and sustained-release formulations
• Enteric-coated or protective medications
• Sublingual or buccal absorbent medications or those meant to have a local effect in the mouth (e.g. lozenges)
• Medications that are unappealing to the taste, irritate the oral cavity, or contain substances that may discolor the teeth or oral mucosa (may be given through nasogastric tubes)
• Carcinogenic and/or teratogenic medications that require special handling to minimize health risks
• Medications created with specific technology to prevent misuse and abuse.

Below is a list of medications that, in most cases, should not be crushed. However, it is important to note that this list is not exhaustive and should only be used as a general guide.

The name of the medications is listed alphabetically (by brand name). If you are unsure about whether a medication can safely be crushed, be sure to talk to your doctor or pharmacist before doing so.

This list is updated/reviewed monthly or as information becomes available.

Last Updated 2/23/2023

What Are The Reasons These Medications Shouldn't Be Crushed?

There are a number of reasons why medications on the above list should not be crushed, which include:

• Crushing extended-release medications can lead to a rapid release of a large dose of the drug at once, potentially causing harm
• Crushing delayed-release medications can disrupt the protective mechanism designed to shield the drug from gastric acids or prevent gastric mucosal irritation
• Crushing sublingual or buccal tabs can impact their effectiveness.
• Crushing pills based on certain technologies (such as amorphous solid dispersion or nanocrystals) can change the drug's bioavailability.
• Bitter-tasting medications can be unpleasant to consume if crushed, and crushing medications that are irritating or hazardous can pose a risk to the person handling the drugs.
• If a hazardous medication (such as a carcinogenic substance) must be crushed, it's important to follow USP Chapter <800> standards in healthcare settings or advise outpatients on proper procedures. The product information for these hazardous medications explicitly states not to crush.
• A list of hazardous medications is available on the NIOSH website

If you have a question about any drug on this list or have a suggestion for an addition, please contact one of our pharmacists.

Where Does Our Information Come From?

Guidance regarding medications that should not be crushed comes from various sources, including:

• The FDA-approved prescribing information for the individual drugs 
• NIOSH (National Institute for Occupational Safety & Health)
• Drug Compendia (e.g., UpToDate, Elsvier Clinical Key, Micromedex)
• Personal communication with the drug manufacturer
• Clinical studies (e.g., To crush or not to crush: A brief review of novel tablets and capsules prepared from nanocrystal and amorphous solid dispersion technologies)

If you need a specific reference for a drug contained on the list and it isn't noted, please contact us directly and we'll be sure to provide that information for you.