Do Not Crush drug list

[Punarbhava]

http://www.ismp.org/tools/donotcrush.pdf

Thought I'd post this list for those who have decided to liquid titrate (crushing tablets or opening capsules, disolving in liquid and then measuring out the required dose).

Note: Most Extended-Release Medications are on this Do Not Crush List.

Also, please take the time to read the warnings and recommendations that are outlined below the list.

 

Unfortunately this list is no longer available.  See this post here.
 

---

Administrator's note: This list from a UK medical group contains information about crushing and making liquids of many drugs: http://stockportccg.org/wp-content/uploads/2012/01/34838_Med_Admin_Dysphagia.pdf

Also see How to make a liquid from tablets or capsules

 

Edited November 30, 2022 by manymoretodays
updated

[Altostrata]

Thanks, Pun. This is from what appears to be a reputable non-profit organization of pharmacists and other medical professionals, the Institute for Safe Medication Practices (ISMP).

 

There are some good tips here, for example:

 

Cymbalta

Slow-release (a); Note: may add contents of capsule to apple juice or applesauce but NOT chocolate

[Punarbhava]

Thanks, Pun. This is from what appears to be a reputable non-profit organization of pharmacists and other medical professionals, the Institute for Safe Medication Practices (ISMP).

 

There are some good tips here, for example:

 

Cymbalta

Slow-release (a); Note: may add contents of capsule to apple juice or applesauce but NOT chocolate

 

Sur,

 

I've had this article in my research files for a few years now but thought it was really important info and thus, decided to post it.

 

Yes, so many important tips as well.

 

BTW, do you think it may be beneficial to create a link to this post in the Tapering thread, so those who are tapering will be aware and thus, more informed, of what is covered in this report?

 

Not all psyche drugs come in liquid form and thus, many must crush or open capsules and create their own liquid suspensions in order to taper slowly.

 

Also, I know from being on different forums that some people do not seem to tolerate the pharma liquid preparations as well as the pills or capsules, not to mention some don't like the liquid versions because some brands are too thick and sticky. Consequently, they land up reverting back to creating their own liquid suspensions.

 

I've also read of some people not transitioning well from pills to pharma liquid versions of the drug. Perhaps the liquid versions contain some type of ingredient that some may be allergic or sensitive to? Gosh, I wish I could recall this but can't ATM.

 

Anyway, I'm just sharing what others have reported over the years. I have no personal experience with liquid versions of meds but rather, created my own liquid suspension.

 

Pun

Edited May 6, 2011 by surviving
removed extra line breaks

[Altostrata]

Yep, it's already been linked to!

 

I would caution folks, though -- if your drug is not on this list, it does not mean you can crush it and put it in water. Sometimes the active ingredient reacts badly with H2O.

 

To find out if there are any studies done about the stability of the drug in water, I would Google

 

[drug name] solubility

 

or

 

[drug name] liquid

 

to see if anyone is reporting success with making it into a liquid.

 

Sometimes pharmacists will look this up for you, if they're not too busy.

 

As for people not transitioning well to liquid forms -- I think this is based on the problem with variation between brand name drugs and generics and even different generics manufacturers. No one knows how sensitive you are until you try it.

[meistersinger]

Yep, it's already been linked to!

 

I would caution folks, though -- if your drug is not on this list, it does not mean you can crush it and put it in water. Sometimes the active ingredient reacts badly with H2O.

 

To find out if there are any studies done about the stability of the drug in water, I would Google

 

[drug name] solubility

 

or

 

[drug name] liquid

 

to see if anyone is reporting success with making it into a liquid.

 

Sometimes pharmacists will look this up for you, if they're not too busy.

 

As for people not transitioning well to liquid forms -- I think this is based on the problem with variation between brand name drugs and generics and even different generics manufacturers. No one knows how sensitive you are until you try it.

 

Alto,

 

I just discovered that Viibryd is soluable. I thought I saw a method on this board on how to create a liquid form of the drug. What equipment do i need (i'm on general assistance) to do this?

[Altostrata]

See tips for making a homemade liquid solution here: Making a Celexa solution yourself

[manymoretodays]

Sadly, the ISMP is no longer doing the "Do Not Crush Drug List", and the following announcement is on their site:

Announcement: On November 17, 2022, ISMP has removed the table of Do Not Crush Medications from our website. This is because ISMP does not own, update, or review new or existing content on the List of Oral Dosage Forms That Should Not Be Crushed. ISMP encourages that organizations maintain, update, and periodically review a list of oral dosage forms that may require alteration through evaluation of package inserts, drug manufacturer inquiries, tertiary drug information resources, and primary literature.

The List of Oral Dosage Forms That Should Not Be Crushed was originally compiled and updated by John Mitchell, PharmD. The list is now maintained and updated by Thomas Land Publishers. Any inquiries regarding the List of Oral Dosage Forms That Should Not Be Crushed should be directed to, and an email is given there, which can be found at the ISMP site(mod note:  I am not able to post it direct)

https://www.ismp.org/recommendations/do-not-crush

 

Edited November 30, 2022 by manymoretodays
removed email

[manymoretodays]

In addition, here is what Drugs.com has to say:

Which tablets should never be crushed?

 

(added to first post in topic, mmt)