Do Not Crush List

 DO NOT CRUSH IF:

  • Long-acting (LA), extended-release (XR/XL), controlled-release (CR), modified-release (MR), prolonged-release (PR) or slow-release/sustained-release (SR)
    [Formulated to release drug over extended period of time, and crushing them can result in dose dumping effects -> Increased risk of toxicity]

  • Enteric Coated (EC), or capsules containing EC granules/pellets [Formulated to pass through stomach intact, so as to prevent destruction by gastric acid, gastric irritation, or delay onset of action]

  • Sublingual/buccal medications [Formulated to dissolve quickly in oral mucosa fluid for rapid absorption]

  • Extremely bitter [Poor palatability]

  • Causes oral mucosa irritation

  • Teratogenic/Cytotoxic

Start by keying drug name right here!

DISCLAIMER

This page consolidates the list of medications which are not to be crushed, but it is NOT exhaustive. By default, do not crush also means that the drug is NOT to be halved, unless stated otherwise. Medications not to be crushed solely because of poor palatability have been excluded. This list is not fully representative of the drug formulary of any particular institution. For more info, please consult your friendly pharmacist, or refer to the respective product inserts.

References
1) Institute for Safe Medication Practices (ISMP) – “Do Not Crush” List (2016)
2) White, R., & Bradnam, V. (2015). Handbook of drug administration via enteral feeding tubes. London: Pharmaceutical Press.
3) Pharmacist’s Letter – Meds That Should Not Be Crushed (Aug 2014)
4) Drug Product Inserts for respective drugs

5) NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings (2016)

Last updated 17 Feb 2021