Oral medication that should NOT be crushed or opened

The tablets and capsules with the following words/letters in their names should never be crushed, opened, chewed or sucked.   

• CR/Chrono         Controlled Release
• CRT                   Controlled Release
• EC/EN                Enteric Coated
• LA                       Long Acting
• MR/Retard        Modified Release
• SA                       Sustained Action
• SR/Dur/Dural     Sustained Release
• XL                      Extended Release

The list below details some common examples of tablets and capsules where advice on crushing or opening should be sought and an alternative formulation, such as a liquid medicine, should be used.

Modified release medicines

Frequently identifiable by two letters such as m/r, LA, SA, CR, XL or SR at the end of the name. Words such as "Retard" or "Slow" in the title sometimes used instead.

Medicine designed to be released over prolonged period. Mechanism for slowing absorption may be damaged if the tablet is crushed. Disruption of a modified release coating may result in the patient experiencing a period of time where the systemic drug concentration is too high, causing toxicity or an overdose, followed by period where the drug concentration is too low to be therapeutically active.

• Verapamil m/r
• Propranolol m/r
• Felodipine m/r
• Diclofenac m/r

Enteric coated medicines

Usually identifiable by the two letters EN or EC at the end of the name. Medicine designed not to be released in the stomach. Disruption of the enteric coating may increase the likelihood of stomach irritation or damage, reduced potency of the drug due to acid degradation of the active ingredient, or release of the drug at the wrong site of action.

• Diclofenac e/c
• Naproxen e/c
• Sulfasalazine e/c

Film or sugar coated medicines

Disruption of the film or sugar coating on drugs may result in rapid degradation of the active ingredient, poor tasting medicines which may be more difficult to swallow.  They may also cause skin irritation in patients or carers.

• Quinine sulphate
• Ibuprofen

Hormonal cytoxic or steroidal medicines

Risk assessment form requires completion if drug is to be crushed prior to administration. If the tablet is crushed, the drug may go into the air and the dose inadvertently received by the administrating nurse or carer.

• Tamoxifen
• Methotrexate

(Wright, 2005)

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