Can You Crush Concerta (Methylphenidate Extended Release)?
Concerta tablets should be swallowed whole and not be altered.
My son cannot swallow his 18mg Concerta medication. The doctor said to crush it up and put it in Sprite. I want to know if this is safe. It specifically says on the bottle not to chew or crush.
Sep 22, 2022- Concerta tablets should always be swallowed whole because crushing or cutting them releases the entire dose at once instead of gradually, which can cause side effects and shorten how long the medicine works.
- If you have trouble swallowing Concerta pills, talk to your doctor about switching to a different form of methylphenidate, such as a liquid suspension or chewable tablet.
Answer
Concerta (methylphenidate extended-release) should not be crushed, cut, or split.
Doing so will destroy the extended-release properties of the drug, resulting in the entire dose being delivered at once. This is known as "dose dumping" and can increase the risk of side effects as well as shorten the duration of action of the drug.
Per the prescribing information for Concerta:
"Do not chew, crush, or divide the tablets. Swallow CONCERTA tablets whole with water or other liquids. Tell your doctor if you or your child cannot swallow CONCERTA whole. A different medicine may need to be prescribed."
Concerta Release Mechanism
Concerta (methylphenidate extended-release) tablets utilize what is known as an osmotic 'biphasic' release mechanism.
After taking a dose by mouth, there is an initial release of methylphenidate, with maximum concentrations occurring after one hour. After this initial release of the drug, there is a gradual release of more drug, increasing concentrations over the next 5 to 9 hours.
The prescribing information details exactly how the drug is delivered by the specially designed tablet:
"In an aqueous environment, such as the gastrointestinal tract, the drug overcoat dissolves within one hour, providing an initial dose of methylphenidate. Water permeates through the membrane into the tablet core. As the osmotically active polymer excipients expand, methylphenidate is released through the orifice [drilled in the tablet]. The membrane controls the rate at which water enters the tablet core, which in turn controls drug delivery."
This biphasic release allows the drug to take effect quickly and lengthens the duration of action while avoiding the significant fluctuations in drug concentration that can happen with immediate-release products.
Below is a chart illustrating the 'biphasic' release of Concerta (taken once daily) compared to immediate-release methylphenidate (taken three times daily):
Source: Concerta Prescribing Information
Why You Shouldn't Crush Concerta
As mentioned above, crushing Concerta will destroy the release mechanism.
Not only will the entire dose be released at once, increasing the risk of side effects, but it will also have a significantly shortened duration of action (around 3 to 6 hours versus 10-12 for intact Concerta).
Possible side effects from Concerta include:
- Insomnia
- Agitation
- Anxiety
- Increased blood pressure
- Increased heart rate
- Headache
- GI upset
- Decrease in appetite
Be sure to clarify with the doctor how they want your son to take his medication. If Concerta cannot be swallowed, it may make sense to switch to a different product.
There are extended-release methylphenidate suspensions and chew tabs available (Quillivant XR) which may be viable alternatives.
Final Words
Thanks for contacting us! I hope this answer helped show why Concerta should not be cut or crushed. If you have trouble swallowing pills, there are other forms of methylphenidate available that can be cut/crushed. There are liquid versions available as well.
References & sources
Glossary — Terms in This Answer
- Extended-release
- A medication formulation designed to slowly release the drug over many hours instead of all at once.
- Dose dumping
- When an entire dose of medication is suddenly released and absorbed into the body at one time instead of gradually.
- Methylphenidate
- The active ingredient in Concerta; a stimulant medication used to treat attention and focus problems.
- Biphasic release
- A two-stage drug release system where medication is released in two separate phases at different times.
- Osmotic
- A process that uses water movement across a membrane to control how fast a medication is released from a tablet.
- Gastrointestinal tract
- The digestive system, including the stomach and intestines, where swallowed medications are absorbed.
- Polymer excipients
- Inactive ingredients in a medication that expand or change in the body to help control drug release.
- Immediate-release
- A medication formulation that quickly releases its full dose, usually taken multiple times per day.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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