Crushing Guide For Oral Medication In Residents With ...

[Pages:14]Updated July 2018

Guide for Crushing Oral Medication for Residents with Swallowing Difficulties in Residential Aged Care

Medicine

Funded brand

Form Administration if swallowing difficulties

ACICLOVIR

ALENDRONATE, ALENDRONATE with COLECALCIFEROL ALLOPURINOL

Lovir

Tablet

Fosamax Fosamax Plus

Tablet

Allopurinol-Apotex Tablet

DB-Allopurinol

Tablet

Soluble, dispersible4 Swallow whole or disperse in at least 50mL of water3 Do not divide, crush, chew or disperse3,4 Mucous membrane irritant1,4 Alternate bisphosphonate available as injection3

Scored, may be halved3

Scored, may be halved3

ALUMINIUM HYDROXIDE

Alu-Tab

AMIODARONE

Cordarone-X

Tablet Tablet

Film coated. Can crush; mix powder with 5-10mL water, and give immediately.4

If aspiration risk, may crush and mix with yoghurt (if appropriate).4 May crush4

AMITRIPTYLINE AMLODIPINE AMOXICILLIN AMOXICILLIN/ CLAVULANIC ACID

ARIPIPRAZOLE

ANASTRAZOLE ASCORBIC ACID

ArrowAmitriptyline Apo-Amlodipine

Apo-Amoxi Augmentin

Abilify Aripiprazole Sandoz Rolin Cvite

Tablet Tablet Capsule Tablet

Tablet

Tablet Tablet

Film coated3 No information

May be crushed but use immediately, it is very light-sensitive4 Do not halve3 Alternative route available3 Oral liquid form available3 Film coated3 Can crush, but use immediately (clavulanic acid is sensitive to moisture)4 Alternative route available3 Oral liquid form available3 Swallow whole3 Do not crush or chew6 Swallow whole3

Film coated3 Do not halve3 No information

ASPIRIN EC

ASPIRIN (dispersible)

Ethics Aspirin EC Ethics Aspirin

Tablet Tablet

Enteric coated, swallow whole;7 do not divide, crush, chew or disperse4,7 Soluble, dispersible tablet available7 Soluble, dispersible; dissolve in water before taking7

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may affect the patient. Please check with a pharmacist for further advice if necessary. Document number: 010-03-09-004 Review date: April 2021 Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand

Updated July 2018

Medicine ATENOLOL ATORVASTATIN

AZATHIOPRINE

BACLOFEN BENDROFLUAZIDE

BETAHISTINE BEZAFIBRATE BEZAFIBRATE SR BISACODYL EC

BISOPROLOL BROMOCRIPTINE BUMETANIDE BUSPIRONE CALCITRIOL CALCIUM CARBONATE CALCIUM CARBONATE EFFERVESCENT CANDESARTAN CARBAMAZEPINE

CARBAMAZEPINE CR

CARBIMAZOLE

Funded brand Mylan Atenolol

Form Tablet

Administration if swallowing difficulties Film coated, may be halved3

Lorstat Imuran

Pacifen ArrowBendrofluazide

Tablet Tablet

Tablet Tablet

Film coated; 20mg, 40mg and 80mg may be halved but the divided portion should be swallowed whole, not chewed3 Film coated3 Do not break, crush or chew3,4 May disperse in 5-10mL water, in a closed system such as an oral dispenser. Will disperse within 5 minutes4 Follow guidelines for handling cytotoxic medicines if dispersing3 No information

Do not halve3

Vergo 16 Bezalip Bezalip Retard Lax-Tab

Tablet Tablet Tablet Tablet

Bosvate

Tablet

Apo-Bromocriptine Tablet

Burinex

Tablet

Orion Buspirone

Tablet

No information

Film coated tablet, swallow whole3

Sustained release, film coated3 Do not divide, crush, chew or disperse4 Enteric sugar coated; swallow whole3 Do not divide, crush, chew or disperse4 Alternative route available, suppositories available3 Can be halved, but the divided portion should be swallowed whole and not chewed3 No information

May be crushed4

Can be divided into equal doses3

Calcitriol-AFT Arrow-Calcium Calsource

Capsule Tablet Tablet

No information No information Dissolve in water7

Candestar Tegretol Tegretol CR Neo-Mercazole

Tablet No information

Tablet Tablet Tablet

May disperse in water4

Alternative route available, oral liquid form available7 Controlled release, film coated3 Do not divide, crush, chew or disperse4 May be halved3 May be crushed4

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may affect the patient. Please check with a pharmacist for further advice if necessary. Document number: 010-03-09-004 Review date: April 2021 Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand

Updated July 2018

Medicine CARVEDILOL CEFACLOR CELIPROLOL CETIRIZINE CICLOSPORIN CILAZAPRIL

CILAZAPRIL/ HYDROCHLOROTHIAZIDE CIPROFLOXACIN

CITALOPRAM CLINDAMYCIN CLOMIPRAMINE CLONAZEPAM CLONIDINE

CLOPIDOGREL CLOZAPINE

CODEINE PHOSPHATE

Funded brand

Form Administration if swallowing difficulties

Carvedilol Sandoz Ranbaxy-Cefaclor Celol Zista Neoral

Apo-Cilazapril

Tablet Capsule Tablet Tablet Capsule

Tablet

May be dispersed, will disperse within 5 min with shaking4 Alternative route available, oral liquid form available3 Film coated3 No information Film coated; may be halved3

Swallow whole,3 do not crush, chew or open4 Alternative route available, oal liquid form available3 Film coated3 May be divided3

Zapril

Apo-Cilazapril/ Hydrochlorothiazide

Cipflox

Tablet

Film coated; do not chew, swallow whole with glass of water3

Tablet

Film coated3 The 500mg strength may be halved3 Alternative route available, oral liquid form available3

PSM Citalopram

Tablet

Clindamycin ABM Capsule

Apo-Clomipramine Tablet

Paxam

Tablet

Clonidine BNM Catapres

Tablet

Arrow - Clopid Clozaril Clopine

Tablet Tablet

Codeine phosphate Tablet PSM

Film coated3 No information Swallow whole with a large glass of water3 Oesophageal irritant3 Film coated; do not halve3

May be crushed4 may be halved3 Alternative route available, oral liquid form available3 Alternative route available ,transdermal patch available3 May be dispersed in water4 May be halved3 Alternative route available, oral liquid form available3 Film coated3 Insoluble in water3 No information

May be crushed, but poorly soluble4 May be halved3 Oral liquid form available (Clopine only)3 No information

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may affect the patient. Please check with a pharmacist for further advice if necessary. Document number: 010-03-09-004 Review date: April 2021 Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand

Updated July 2018

Medicine COLCHICINE COLECALCIFEROL

CO-TRIMOXAZOLE CYCLIZINE CYCLOPHOSPHAMIDE

DABIGATRAN

DEXAMETHASONE DIAZEPAM DICLOFENAC EC

DICLOFENAC SR

DIGOXIN

DIHYDROCODEINE TARTRATE LA DILTIAZEM DILTIAZEM CD

DIPYRIDAMOLE SR DOCUSATE & SENNA DOCUSATE SODIUM DOMPERIDONE DONEPEZIL

Funded brand Colgout Vit.D3

Trisul Nauzene Cycloblastin

Pradaxa

Dexmethsone Arrow-Diazepam Diclofenac Sandoz

Apo-Diclo SR

Lanoxin Lanoxin PG DHC Continus Dilzem Apo-Diltiazem CD

Form Tablet Capsule Tablet Tablet Tablet Capsule Tablet Tablet Tablet Tablet

Tablet

Tablet Tablet Capsule

Administration if swallowing difficulties

May be dispersed in water4

Soft gelatin capsule3 No stability data about withdrawal of capsule contents4.6 Alternative route available, oral liquid form available3 Can be divided into equal doses3 Alternative route available3 Do not divide, crush, chew or disperse4 Cytotoxic, occupational health and safety risk to staff2 Do not crush, chew or open4 Bioavailability increases by 75% when pellets are taken without the capsule shell1 Disperse and give within 1-5min, with or soon after food4 Can be divided into equal doses. Alternative route available, suppositories available3 Enteric coated; do not crush, divide or chew3,4 Alternative route available, suppositories available, dispersible tablet available3 Slow release. Swallow whole, do not divide, crush, chew or disperse3 Alternative route available, suppositories available3 May be crushed4 Alternative route available oral liquid form available3 Long- acting; swallow whole3 Do not divide, crush, chew or disperse3

Film-coated;3 may be crushed4

Controlled delivery; do not crush or chew 3

Pytazen SR Laxsol Coloxyl Prokinex Donepezil-Rex

Tablet Tablet Tablet Tablet Tablet

Sustained release; swallow whole3 Do not divide, crush, chew or disperse3 Film coated, sugar free7 Do not divide, crush, chew or disperse7 May be crushed4 Do not disperse (takes longer than 5min)4 No information

Film coated3 No information

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may affect the patient. Please check with a pharmacist for further advice if necessary. Document number: 010-03-09-004 Review date: April 2021 Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand

Updated July 2018

Medicine DOTHIEPIN (DOSULEPIN) DOXAZOSIN DOXEPIN DOXYCYCLINE

ENALAPRIL

Funded Brand Dopress

Apo-Doxazosin Anten Doxine Doxy-50 Doxylin-100 Ethics Enalapril

Form Tablet Capsule

Administration if swallowing difficulties

Film coated3 No information No information

Tablet No information

Capsule Tablet

Tablet

No information

Film coated3 Crushing may cause oesophageal irritation3 Do not crush; contents are irritant to mucous membranes and may cause oesophageal ulceration if crushed. May disperse (tablets will disperse within 2-5 min)4 Do not divide3

ENTACAPONE ERYTHROMYCIN

ESCITALOPRAM

EZETIMIBE FEBUXOSTAT FELODIPINE ER FERROUS FUMARATE

FERROUS FUMARATE with FOLIC ACID

FERROUS SULPHATE (long acting)

FERROUS SULPHATE with FOLIC ACID (long acting) FINASTERIDE

Entapone E-Mycin

Tablet Tablet

Apo-Escitalopram Tablet

Ezetimibe-Sandoz Adenuric Plendil ER Ferro-tab

Tablet Tablet Tablet Tablet

Ferro-F-tabs

Tablet

Ferrograd

Tablet

Ferrograd F

Tablet

Ricit

Tablet

Film coated3 No information Film coated3,4 Alternative route available oral liquid form available3 Film coated3 Disperses rapidly in water4 Crushed tablets have unpleasant taste4 No information

Film-coated, immediate release3

Extended release3 Do not divide, crush, chew or disperse3,4 Swallow whole7 Alternative route available, oral liquid form available7 Film coated;4 do not divide, crush, chew or disperse4 Alternative route available, oral liquid form available7 Film coated, modified release4 Do not divide, crush, chew or disperse4 Alternative route available, oral liquid form available7 Film coated, modified release4 Do not divide, crush, chew or disperse4 Alternative route available, oral liquid form available7 Film coated3 Women of child-bearing potential should not crush or handle broken tablets3

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may affect the patient. Please check with a pharmacist for further advice if necessary. Document number: 010-03-09-004 Review date: April 2021 Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand

Updated July 2018

Medicine FLECAINIDE ACETATE FLECAINIDE ACETATE CR FLUCLOXACILLIN

FLUCONAZOLE

FLUDROCORTISONE ACETATE FLUOXETINE FLUOXETINE (dispersible)

FOLIC ACID FUROSEMIDE (FRUSEMIDE) GABAPENTIN

GLICLAZIDE GLIPIZIDE HALOPERIDOL HEXAMINE HYDROXYCHLOROQUINE

Funded brand Tambocor Tambocor CR Staphlex

Mylan

Florinef Arrow-Fluoxetine Arrow-Fluoxetine

Apo-Folic acid Diurin 40 Urex Forte Apo-Gabapentin

Arrow-Gabapentin Neurontin Nupentin Glizide Minidiab Serenace

Hiprex Plaquenil

Form Tablet Capsule Capsule

Capsule

Tablet Capsule Tablet

Tablet Tablet

Capsule

Tablet Tablet Tablet Tablet Tablet

Administration if swallowing difficulties

Disperse in water, and give immediately; will disperse in less than 1 minute4 Controlled release3

Do not crush, chew or open; contents have a bitter taste4 Alternative route available, oral liquid form available3 Swallow the capsules whole with a glass of water3 Alternative route available, oral liquid form available3 May be dispersed in water; will disperse within 1 minute, give immediately after dispersing4 Swallow whole; soluble, dispersible tablet available3 Soluble, dispersible3 May be swallowed whole, or broken in half for a 10mg dose, or dispersed in 100mL of water before drinking immediately3 No information

Oral liquid available3

May disperse; halve prior to dispersing, will disperse within 5 min4 Capsule contents have an unpleasant taste. May open capsule and mix contents with apple sauce or orange juice. Give immediately (gabapentin hydrolyses rapidly)4 Swallow whole3 Do not divide, crush, chew or disperse4 May open and mix contents with orange juice or apple sauce4

May be halved3

Disperse in water; will disperse in 1 minute, give immediately after dispersing4 May crush but slow to disperse4 Alternative route available, oral liquid form available3 May crush but slow to disperse (longer than 5min)4 Film coated tablets3 May crush but slow to disperse (longer than 5 min)4

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may affect the patient. Please check with a pharmacist for further advice if necessary. Document number: 010-03-09-004 Review date: April 2021 Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand

Updated July 2018

Medicine

HYDROXYUREA (HYDROXYCARBAMIDE)

Funded brand Hydrea

HYOSCINE BUTYL BROMIDE Buscopan

Form Administration if swallowing difficulties

Capsule Tablet

May open and empty contents into a glass of water and take immediately3,4 Avoid inhaling powder,3

exposure causes skin toxicities; wear gloves to administer1 Sugar coated;3 can be crushed4 Injectable form available3

IBUPROFEN

IBUPROFEN SR IMIPRAMINE INDAPAMIDE ISOSORBIDE MONONITRATE ISOSORBIDE MONONITRATE SR

IVERMECTIN LABETALOL LAMOTRIGINE

LANSOPRAZOLE LEFLUNOMIDE

LETROZOLE LEVETIRACETAM

Ibuprofen Relieve

Brufen SR Tofranil

Dapa-Tabs Ismo 20 Duride

Ismo 40 Retard Stromectol Hybloc Arrow-Lamotrigine Lamictal Logem Motrig Lanzol Relief Apo-Leflunomide

Letrole Letromyl Everet

Tablet Tablet Tablet Tablet Tablet Tablet

Tablet Tablet Tablet

Capsule

Tablet Tablet

Film coated; swallow whole, do not chew, break, crush or suck ? may cause oral discomfort and throat irritation3 Oral liquid form available3 Sustained release3

Sugar coated3 Can crush4 but slow to disperse (longer than 5 min)4 Film coated; do not halve3 May be crushed4 Do not chew, may be divided along the score line3 Sustained release; swallow whole3,4 Do not crush, chew or disperse4 May be divided (but each portion swallowed whole)3.4 Immediate release preparations available3 Slow release; swallow whole3 Immediate release preparations available3 No information

Film coated3 No information Chewable, soluble, dispersible3,4 May be chewed, dispersed in a small amount of water, or swallowed whole3,4

Swallow whole, with a full glass of water, do not chew3 Film coated4 Swallow whole, do not divide3 May disperse using a closed system such as an oral dispenser; will disperse within 5 min of shaking4 Film coated; swallow whole do not halve3

Film coated; do not halve3

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may affect the patient. Please check with a pharmacist for further advice if necessary. Document number: 010-03-09-004 Review date: April 2021 Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand

Updated July 2018

Medicine LEVODOPA/CARBIDOPA LEVODOPA/CARBIDOPA CR

Funded brand Sinemet Sinemet CR

LEVODOPA/BENSERAZIDE (dispersible) LEVODOPA/BENSERAZIDE (long acting)

LEVODOPA/BESERAZIDE

Madopar Rapid Madopar

Madopar HBS

LEVOMEPROMAZINE MALEATE

LISINOPRIL

Nozinan Ethics Lisinopril

Form Tablet Tablet Tablet Capsule Capsule

Tablet Tablet

Administration if swallowing difficulties

May disperse in water and use immediately4 Do not divide3 Controlled release3 Do not divide, crush, chew or disperse3 Immediate release preparations available3 Soluble dispersible tablet3 Disperse in 10mL water before taking4 Swallow whole, do not crush, chew or disperse3,4 Soluble or dispersible tablet available3 Modified release; swallow whole, do not crush, chew, disperse or open capsules3,4 Immediate release and dispersible preparations available3 Film coated3 Injectable form available3 No information

LITHIUM CARBONATE LITHIUM CARBONATE

LITHIUM CARBONATE (long acting) LOPERAMIDE

Lithium Carbonate (Douglas) Lithicarb FC

Priadel

Diamide Relief Nodia

Capsule Tablet

Tablet Capsule Tablet

No information

Film coated3,4 Scored, can be halved3 May be dispersed in cold water4 Do not crush, chew or swallow with warm liquid3 Modified release3 Scored, may be halved3 Do not, crush, chew or swallow with hot liquid3 No information

Scored tablet, but do not halve, swallow whole3

LORATADINE

Lorafix

Tablet No information

LORAZEPAM

Ativan

Tablet

Disperse in water4

LOSARTAN

Losartan Actavis

Tablet

Film coated;3 do not halve3

LOSARTAN AND HYDROCHLORTHIAZIDE

Arrow-Losartan & Hydrochlorothiazide

Tablet

Film coated3 No information

MEBEVERINE

Colofac

MEDROXYPROGESTERONE Provera

MELATONIN (long acting)

Circadin

Tablet Tablet Tablet

Sugar coated3 Swallow whole with a full glass of water3 Do not chew, has a very bitter taste3 Slow to disperse4 Will disperse within 1-2 minutes4 Gloves and mask should be worn, women of child-bearing potential should not crush or handle broken tablets4

Prolonged release; swallow whole3

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may affect the patient. Please check with a pharmacist for further advice if necessary. Document number: 010-03-09-004 Review date: April 2021 Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand

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