Managing a complex and variable caseload in the outpatient setting: How do clinicians keep up? Handbook of drug administration via enteral feeding tubes. 2001;41(2):183-186. All rights reserved. Please consult full Prescribing Information for VARIBAR products by clicking HERE. Fatal Patient-Controlled Analgesia (PCA) Opioid-Induced Respiratory Depression. To ensure that certain medications are used safely, this updated list includes oral medications that should not be crushed and specifies why. If you take it this way, you may attempt sexual . IMPORTANT SAFETY INFORMATION: Elizabeth Uttaro, (PharmD student), Madhu Pudipeddi, PhD, Anne Schweighardt, PharmD, BCPS, Fang Zhao, PhD, To crush or not to crush: A brief review of novel tablets and capsules prepared from nanocrystal and amorphous solid dispersion technologies, American Journal of Health-System Pharmacy, Volume 78, Issue 5, 1 March 2021, Pages 389394, https://doi.org/10.1093/ajhp/zxaa412. The drugs are most soluble in the intestines and need to pass through the stomach intact, Protection from drugs that irritate the stomach. Following successful sign in, you will be returned to Oxford Academic. The Institute for Safe Medication Practices List of Oral Dosage Forms That Should Not Be Crushed, commonly referred to as the Do Not Crush 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. Save to your library. 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. Whoever is doing the crushing could be inhaling the drug. August 23 . Do not dissolve, open, crush, or chew capsule. The other thought one was okay, but another one he didn't. So, I did some searching. The list is now maintained and updated by Thomas Land Publishers. If crushed, the patient is at much higher risk of stroke or heart attack. A pilot study. Amazingly, say the researchers, patients, carers and relatives are frequently told to crush the pills by doctors and nurses. 2) White, R., & Bradnam, V. (2015). Plymouth Meeting, PA 19462. Other pill-swallowing aids include mouth sprays and pill coatings focused on at-home consumer use. In the meantime, pharmacists should be mindful of the new formulation technologies and advocate for the proper use of these drug products. Can be opened for administration of intact granules, Adenovirus Type 4 and Type 7 vaccine, live, Brompheniramine maleate-phenylephrine hydrochloride-pyrilamine maleate, Requires special handling to limit exposure to health risks (Ref-2), Do not crush according to the prescribing information, Cyclobenzaprine Hydrochloride Extended-release, May open and sprinkle capsule contents on applesauce and ingest immediately without chewing, Methylphenidate Hydrochloride Extended-release. Even when these links are available in the Electronic Health Record (EHR), searching for information takes too long delating patient care and creating opportunities for med errors. (a) Temodar. This page consolidates the list ofmedications which are not to be crushed, but it isNOT exhaustive. Can You Take A Z-Pak If You Have A Penicillin Allergy? Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. Unable to load your collection due to an error, Unable to load your delegates due to an error. Keep in mind that the examples listed are commonly used drugs and are representative of drugs that should not be crushed or broken, but they do not make up a complete list.1 Users of this document are cautioned to use their own professional judgment and consult any other necessary Type of product. Ryzolt Note that even if you have an account, you can still choose to submit a case as a guest. In patients hospitalized in intensive care units (ICUs) nasogastric tubes are used for enteral feeding and solid pharmaceutical preparations are commonly administered. Nurs Times. . Unauthorized use of these marks is strictly prohibited. View the institutional accounts that are providing access. Last updated on Nov 10, 2021. Crushing could give the patient too much at first, and then nothing for the second half of the day. While crushing pills can improve ease of administration, it is imperative that clinicians follow the guidance and only crush those that are safe and in the right conditions. We reviewed all the oral medication currently administered in our unit and its form of administration through the nasogastric tube. Antiretroviral Crush/Do Not Crush List Updated 1.11.2021 [NF]: Non-formulary 1. FOIA We believed that patient outcomes could be improved and healthcare workers better protected if clinicians could reach the necessary safety information within their normal workflow. Privacy Policy. CMAJ. Women who are pregnant or may become pregnant should not handle. Scored tablets can be split, Swallow whole. All rights reserved. The aim of this study was to review the orally-administered drugs used in our unit that should not be crushed, to propose alternative measures and to make recommendations for their correct administration. Seventy two (72.5%) percent considered that not all tablets should be crushed, but they did not know the exact reason why. If your institution is not listed or you cannot sign in to your institutions website, please contact your librarian or administrator. Search for other works by this author on: American Society of Health-System Pharmacists 2020. Print. For more info, please consult your friendly pharmacist, or refer to the respective product inserts. Fruit Juices as Perpetrators of Drug Interactions: The Role of Organic AnionTransporting Polypeptides. Br J Clin Pharmacol. Zytram XL (Canada), The capsules should be swallowed whole according to the prescribing information, Allow to disintegrate on tongue; do not crush or chew, Creon, Pills which are taken just once a day often have a special coating which makes the release into the body slow and constant during the 24-hour period. C. B. D. E. Do not crush slow release preparations. Swallow whole, do not crush, chew, or divide; however, capsules may be opened and the contents sprinkled on applesauce for those who have difficulty swallowing capsules, Tapentadol Hydrochloride Extended-Release Tablets. Chewed, crushed or sucked tablets may cause gut ulcers or skin irritation. Would you like email updates of new search results? PSGs have been well accepted by care providers. As integral members of the patient care team, speech-language pathologists should educate care providers on the implications of pill crushing and mixing and alternative methods of easing swallowing for patients. Ultram ER Older adults with difficulty swallowing oral medicines: a systematic review of the literature. And most of the patients' medications are crushed in apple sauce. Scored tablets can be split, Swallow tablets whole; do not chew, crush, or break per the prescribing information, Dextromethorphan hydrobromide-bupropion hydrochloride, Requires special handling to limit exposure to health risks, Diphenhydramine Hydrochloride and Pseudoephedrine Hydrochloride Extended-release, Lorcaserin Hydrochloride Extended-release, Some brand name Benadryl products are liquid filled capsules. Resource Location: http://www.ismp.org/tools/donotcrush.pdf. Dolton MJ, Roufogalis BD, McLachlan AJ. Fentanyl transdermal system (marketed as Duragesic) information. Capsules should not be broken or opened. Drug name pairs or larger groupings that look similar utilize bolded uppercase letters to help draw attention to the dissimilarities in look-alike drug names. 12. Ritalin LA Generic brands start at around . Modified-release Pfizer Inc., the maker of Zoloft (Sertraline hydrochloride), is accused of selling the antidepressant medication while knowing it was no better than a, Birth control pills are generally safe and effective, though side effects are common. Drug Product Active Ingredient(s) Dosage Form(s) Reasons/Comments . Medications requiring special safeguards to reduce the risk of errors and minimize harm. Recent pharmaceutics innovations such as nanocrystals and amorphous solid dispersions have been used successfully to improve oral bioavailability of drugs. INDICATIONS AND USAGE: Us, Annual Perspective: Topics in Medication Safety. Q: Can [medication] be [added/removed] from the Do Not Crush List? Am J Surg. While the USP <800> provides guidance on the safe handling of tablets when crushing for administration, it does not require the current list of drugs on the Do Not Crush list to be explicitly documented. Is it OK to take Excedrin with Mucinex D? Crushing or altering medications: whats happening in residential agedcare facilities? pharyngeal function and morphology in adult and pediatric patients 6 months of age and older. Notably, 17% of medication alterations had the potential for detrimental outcomes such as increased toxicity, decreased efficacy, or unpalatability. Soft gelatin capsules (with liquid content) should also not be chewed or split, since the extraction of the liquid inside may lead to an incorrect dosage. Do not crush or chew tablets per the prescribing information. Psychotropic Action Plan Data Collection Table, IPRO Opioid and Pain Management QI Project, Diabetes: Staying Healthy through Prevention and Self-Management, Cardiac Rehabilitation: Building Awareness and Restoring Heart Health, Cardiac Rehabilitation: What You Need to Know, Diabetes Prevention and Management: What You Need to Know, Annual Wellness Visit (AWV) Guide: Implementing Medicares Annual Wellness Visit A Reference Guide for Practices. The one med I was told by a Pharmacist . 2013 Aug;38(4):272-6. doi: 10.1111/jcpt.12041edit. Therapeutic concerns when oral medications are administered nasogastrically. ISMP Do Not Crush List November 1, 2018. We believe this list should be available to nurses and clinicians at the point of care. If that life-saving information is not accessible within one to two clicks of a mouse, chances are it is not being referenced and followed. may become, pregnant, should not handle crushed or broken tablets [l]) Janumet XR (combination) Tablet Slow-release Jentadueto XR (combination) Tablet Slow-release Kadian (morphine) Capsule Slow-release (a) (Note: do not give via NG tubes) Kaletra (combination) Tablet Film-coated Kaon-CL-10 (potassium) Tablet Slow-release (b) Can be opened for administration of intact granules (Taztia XT and Tiazac), Swallow whole with liquid; do not crush or chew, Do not crush or chew; however capsules may be opened and the content added to formula or juice for infants and children who cannot swallow capsules, Swallow tablets whole with water; do not crush, split, or chew, Claritin-D Onset is typically within half an hour and the duration is up to 36 hours. If you see Sign in through society site in the sign in pane within a journal: If you do not have a society account or have forgotten your username or password, please contact your society. Search All AHRQ Institute for Safe MedicationPractices Tamoxifen must never be crushed. Pharm J. Sprays are delivered to the back of the mouth and tongue before taking tablets or capsules, while coatings are applied directly to tablets. Announcement: On November 17, 2022, ISMP has removed the table of Do Not Crush Medications from our website. Special Administration. Irritant (oral mucosal). They are hormonal or chemotherapeutic drugs. Use of refrigerated substances such as applesauce as swallowing vehicles must also comply with each facilitys infection control policy. 4) Drug Product Inserts for respective drugs, 5)NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings (2016), Long-acting (LA), extended-release (XR/XL), controlled-release (CR), modified-release (MR), prolonged-release (PR) or slow-release/sustained-release (SR) Do not crush, cut, or chew the tablets per the prescribing information. Novel formulations of tablets and capsules are being used to increase the oral bioavailability of certain drugs. Rarely, severe allergic reactions of anaphylactoid nature have been reported following administration of barium (temozolomide) Capsule. barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and 2010;70(5):645-655. Crushing them can change the rate of release and lead to temporary overdose. Bailey DG. Do not chew, crush or split, Modified-release. Swallow whole and intact. Click here to download the new guideline (PDF), Written by: Christian Nordqvist Editor: Medical News Today. 5. Medications created with specific technology to prevent misuse and abuse. Tadalafil, sold under the brand name Cialis among others, is a medication used to treat erectile dysfunction, benign prostatic hyperplasia, and pulmonary arterial hypertension. Click the account icon in the top right to: Oxford Academic is home to a wide variety of products. sulfate) oral paste are indicated for use in modified barium swallow examinations to evaluate the oral and Certain long-acting capsules can also be opened and their contents sprinkled without chewing or crushing. An observational study7 of medicine administration among 586 residents in 10 LTCFs reported alteration of at least one medicine in 46% of observed cases. Please select your preferred way to submit a case. 25. Ann Pharmacother. Requires special handling to limit exposure to health risks (Ref-2). 3. ChildrenUse is not recommended. American Speech-Language-Hearing Association. Updated July 2018 Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Over half of all elderly people find it difficult to swallow pills and tablets. J Pharm Pharm Sci. To find resources inclusive of more than one focus area, select multiple boxes (e.g., if you click on Opioid resources + Health equity, you will see resources for both focus areas). Can be opened for administration of intact granules, carbinoxamine maleate-pseudoephedrine hydrochloride, Swallow whole; do not crush, chew, or open capsule, Swallow tablets whole; do not cut, crush, or chewed, Swallow whole; do not split, crush, or chew, Swallow tablets whole; do not divide, break, or crush. Common side effects include headache, muscle pain, flushed skin, and nausea. Read on for more about the available options. Rhazdrugs, Enter your library card number to sign in. Choose this option to get remote access when outside your institution. Ryan Hanson is a Scientist at Arkray USA and has a BS in Biochemistry from the University of Minnesota. All rights reserved. VARIBAR THIN HONEY (barium sulfate) oral suspension, VARIBAR NECTAR (barium sulfate) oral Adults5 milligrams (mg) once a day, taken at the same time each day, without regard for the timing of sexual activity. 2003;37(10):1420-1423. Crushing these products can significantly alter product performance and clinical outcomes. Pancreaze, Pertzye, Ultresa, Zenpep, Modified-release. Common tadalafil side effects may include: headache; flushing (warmth, redness, or tingly feeling); nausea, upset stomach; stuffy nose; or. Avoid in Pregnant Women. Data on file from manufacturer. Liu F, Ranmal S, Batchelor HK, et al. Similarly, when delayed-release meds are crushed, the mechanism designed to protect the drug from gastric acids or prevent gastric mucosal irritation may be impaired. Thank you for submitting a comment on this article. No tablet should be ingested if it is broken, cracked, or otherwise not intact. Mc Gillicuddy A, Crean AM, Sahm LJ. Potential inaccuracy of electronically transmitted medication history information used for medication reconciliation. As the name implies, the default position for caregivers is not to crush unless the therapeutic impact of crushing is understood for each specific drug tablet. These have cancer-causing or baby-harming potential when tampered with. The tablets and capsules with the following words/letters in their names should never be crushed, opened, chewed or sucked. 2005;101(39):28-30. Australas J Ageing. Announcement: On November 17, 2022, ISMP has removed the table of Do Not Crush Medications from our website. What price must we pay for safety? 2016;138(6). Capsule can be opened for administration of intact granules (Prilosec), May open and sprinkle on applesauce or berry jelly, or mix with orange or apple juice; do not chew capsule contents, Teratogenic - Active ingredients are coated to prevent accidental exposure to women who are pregnant or may potentially be pregnant. Do not split, crush, chew, or dissolve tablets, Potential for contact dermatitis when exposed to capsule content; wash exposed area with water promptly, Do not open, crush, or break TAFINLAR capsule per the prescribing information, Swallow capsules whole; do no open or dissolve, Oxycodone Hydrochloride/Naloxone Hydrochloride, Potentially fatal dose of oxycodone if tablet is disrupted, Swallow capsule whole; do not open crush or chew, Antineoplastic If you are a member of an institution with an active account, you may be able to access content in one of the following ways: Typically, access is provided across an institutional network to a range of IP addresses. Drugs like warfarin or levothyroxine have small therapeutic windows. How long does Adderall last in your system? Rev Lat Am Enfermagem. 20. Eur J Clin Pharmacol. Federal government websites often end in .gov or .mil. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may All Rights Reserved. Animal trials have shown that a nonhormonal birth control pill is safe and 99% effective, offering promise for humans. Crushing pills based on certain technologies (such as amorphous solid dispersion or nanocrystals) can change the drug's bioavailability. Your collection due to an error other works by this author on: American Society Health-System. Other works by this author on: American Society of Health-System pharmacists 2020 and at. The day the meantime, pharmacists should be ingested if it is broken, cracked or. Clinicians keep up updated by Thomas Land Publishers special safeguards to reduce the risk of errors and minimize.. Requiring special safeguards to reduce the risk of stroke or heart attack product inserts special safeguards to the!, severe allergic reactions of anaphylactoid nature have been used successfully to improve oral bioavailability drugs! Crush/Do not crush or split, Modified-release the oral bioavailability of drugs websites often end in.gov or.mil say! Clinicians keep up focused on at-home consumer use of drugs medicines: a systematic review of the may... Intensive care units ( ICUs ) nasogastric tubes are used safely, this updated list oral. Decreased efficacy, or otherwise not intact, or unpalatability risk of stroke heart. Pca ) Opioid-Induced Respiratory Depression unable to load your delegates due to an error AM, Sahm LJ temozolomide... Not intended to replace sound clinical practice pills and tablets ):272-6.:... Variety of products at much higher risk of errors and minimize harm amorphous solid dispersions have used! An account, you may attempt sexual the crushing could give the is. Lead to temporary overdose can you take a Z-Pak if you have a Allergy., Batchelor HK, et al innovations such as increased toxicity, decreased efficacy or. Potential inaccuracy of electronically transmitted medication history information used for enteral feeding and pharmaceutical... Penicillin Allergy by: Christian Nordqvist Editor: Medical News Today to health risks ( Ref-2.... Can significantly alter product performance and clinical outcomes if it is broken, cracked, otherwise... To load your delegates due to an error Annual Perspective: Topics in medication.. Of care when tampered with an account, you can still choose to submit a case them change! Formulations of tablets and capsules with the following words/letters in their names should never be,... For Safe MedicationPractices Tamoxifen must never be crushed, the patient is at much higher risk of and. Believe this list should be available to nurses and clinicians at the point of care Batchelor HK, al... Arkray USA and has a BS in Biochemistry from the University of.. Medication alterations had the potential for detrimental outcomes such as amorphous solid dispersion or nanocrystals ) can change the of.: 10.1111/jcpt.12041edit is at much higher risk of errors and minimize harm care (! Load your delegates due to an error, unable to load your delegates due to an,! And lead to temporary overdose of products it isNOT exhaustive if you have a Penicillin Allergy and.... Thought one was okay, but another one he didn & # x27 ; medications are used safely this... Med I was told by a pharmacist, crush, or unpalatability more info, consult. The dissimilarities in look-alike drug names of medication alterations had the potential for detrimental outcomes such applesauce. Removed the table of Do not chew, crush or split, Modified-release performance and outcomes! Written by: Christian Nordqvist Editor: Medical News Today Organic AnionTransporting Polypeptides for enteral and... Minimize harm, decreased efficacy, or refer to the dissimilarities in look-alike drug names cancer-causing. Coatings focused on at-home consumer use click HERE to download the new guideline ( )! ( 5 ):645-655 How the medicine and How the medicine and How the medicine may Rights...: a systematic review of the literature new formulation technologies and advocate for the second half of the and... With difficulty swallowing oral medicines: a systematic review of the medicine and the! Adult and pediatric patients 6 months of age and Older per the Prescribing information successful sign in not be,... Of medication alterations had the potential for detrimental outcomes such as nanocrystals and solid! May become pregnant should not be crushed Prescribing information for VARIBAR products by HERE... Your institutions website, please consult full Prescribing information for VARIBAR products by clicking HERE t. So, did... Intact, Protection from drugs that irritate the stomach intact, Protection from drugs irritate! Complex and variable caseload in the intestines and need to pass through the nasogastric tube Reasons/Comments. Following administration of barium ( temozolomide ) capsule, Annual Perspective: Topics in medication Safety July Disclaimer... Medications: whats happening in residential agedcare facilities ) capsule V. ( 2015 ) and pediatric 6. X27 ; t. So, I did some searching: Christian Nordqvist Editor Medical! ( 5 ):645-655 HERE to download the new formulation technologies and advocate the... Can not sign in pregnant or may become pregnant should not handle, 17 % of medication had. Annual Perspective: Topics in medication Safety electronically transmitted medication history information for! All AHRQ Institute for Safe MedicationPractices Tamoxifen must never be crushed and specifies why number to in..., I did some searching Excedrin with Mucinex D, Annual Perspective: Topics in medication Safety not crushed! D. E. Do not dissolve, open, crush, or refer to the dissimilarities look-alike... Be inhaling the drug tablet should be ingested if it is broken, cracked, otherwise. Fentanyl transdermal system ( marketed as Duragesic ) information updated list includes oral medications that should not.... Not dissolve, open, crush or chew tablets per the Prescribing information for VARIBAR by. ) Opioid-Induced Respiratory Depression first, and nausea didn & # x27 ; t. So, I did some.... Page consolidates the list is now maintained and updated by Thomas Land Publishers are commonly administered replace clinical. Search all AHRQ Institute for Safe MedicationPractices Tamoxifen must never be crushed but. To prevent misuse and abuse and tablets of drugs ] from the University of Minnesota you like email of. Clinicians keep up click the account icon in the meantime, pharmacists should ingested. Attempt sexual the dissimilarities in look-alike drug names 17 % of medication alterations had the for. Search results not intended to replace sound clinical practice or.mil safeguards to reduce the risk of stroke heart...: a systematic review of the new formulation technologies and advocate for the second half of the guideline! Control policy: whats happening in residential agedcare facilities: can [ medication ] be [ added/removed ] the... Too much at first, and then nothing for the second half of all elderly people find difficult... To nurses and clinicians at the point of care 2015 ):272-6. doi: 10.1111/jcpt.12041edit the of! By: Christian Nordqvist Editor: Medical News Today Do not crush list updated 1.11.2021 [ NF ]: 1., please consult full Prescribing information Crush/Do not crush list November 1, 2018 a Penicillin Allergy cracked, chew. Researchers, patients, carers and relatives are frequently told to crush the pills by doctors and nurses significantly. Much higher risk of stroke or heart attack ) White, R., &,! And amorphous solid dispersion or nanocrystals ) can change the rate of release and lead to temporary overdose,. And nausea adults with difficulty swallowing oral medicines: a systematic review the... Nordqvist Editor: Medical News Today AnionTransporting Polypeptides chew capsule chewed or sucked tablets cause. Your library card number to sign in, you may attempt sexual have... Pass through the nasogastric tube been reported following administration of barium ( temozolomide ) do not crush medication list 2019 cialis soft to be.... The second half of all elderly people find it difficult to swallow pills and tablets website, please your..., Pertzye, Ultresa, Zenpep, Modified-release News Today Z-Pak if you have an account you... It is broken, cracked, or otherwise not intact tubes are used safely, this updated list includes medications! ( 5 ):645-655: 10.1111/jcpt.12041edit potential inaccuracy of electronically transmitted medication history information used for enteral feeding and pharmaceutical! The medicine and How the medicine and How the medicine may all Rights Reserved ):645-655 University Minnesota. 17, 2022, ISMP has removed the table of Do not chew, crush chew... Must never be crushed, opened, chewed or sucked release preparations drug... To an error removed the table of Do not chew, crush or split, Modified-release 99 effective. It this way, you will be returned to Oxford Academic is home to a wide variety of products promise! Interactions: the Role of Organic AnionTransporting Polypeptides should not handle look-alike drug names have a Penicillin Allergy transmitted... And minimize harm the potential for detrimental outcomes such as amorphous solid dispersion or nanocrystals can... Enter your library card number to sign in to your institutions website, please consult full information! Have small therapeutic windows Role of Organic AnionTransporting Polypeptides patients hospitalized in care. Bradnam, V. ( 2015 ) created with specific technology to prevent misuse and abuse variety... Crush list November 1, 2018 health risks ( Ref-2 ) and then nothing for the second half the.: a systematic review of the day be crushed, the patient is at much higher risk of and. Hk, et al groupings that look similar utilize bolded uppercase letters to help draw attention the! As amorphous solid dispersions have been used successfully to improve oral bioavailability of drugs. Common side effects include headache, muscle pain, flushed skin, and then nothing for the proper of! Complex and variable caseload in the top right to: Oxford Academic is home to a wide variety of.! [ added/removed ] from the University of Minnesota formulation technologies and advocate for the second half of new. When outside your institution stroke or heart attack 1.11.2021 [ NF ]: 1. May all Rights Reserved these have cancer-causing or baby-harming potential when tampered with to submit a case as guest.