PDF of Ask a Pharmacist 0413

Which medicines can be split or crushed for administration?

Cancer patients may have difficulty swallowing oral tablets, or may require a dose that necessitates splitting a tablet. In general, any tablet that is labeled extended-release (XR or ER) or sustained-release (SR) should not be crushed or split. This is because crushing or splitting will damage the tablet’s infrastructure, causing dumping of what would otherwise have been spread out over a longer time period.

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Some tablets have an enteric coating (EC) that prevents the drug inside from being destroyed by stomach acid. Crushing or splitting these tablets will release the drug into the stomach, where it may be broken down and not absorbed. There are also oral medications (including many oral chemotherapies) that should not be split or crushed because they can irritate mucus membranes, or because they can cause harm to the caregiver.

As a general rule, most oral chemotherapies should not be split or crushed unless noted otherwise. The Institute for Safe Medication Practices (ISMP) maintains a list of many drugs that cannot be crushed (view it here: Oral Dosage Forms That Should Not Be Crushed). The list is not exhaustive, so it is best to review a patient’s medications with a pharmacist prior to recommending splitting or crushing.