![]() ![]() Hydrocodone bitartrate 10-mg/chlorpheniramine 8-mg (Tussicaps) is FDA-approved as a Schedule III controlled substance as an antitussive/antihistamine combination.8 Adult dosage is one capsule every 12 hours. A patch may be worn for up to seven days. Granisetron 3.1mg/24-hour transdermal patch (Sancuso) is FDA-approved for preventing nausea and vomiting in adults receiving moderate or high-chemotherapy regimens for up to five consecutive days.7 To dose the patch, apply it to a clean, dry area of intact healthy skin on the upper outer arm 24 to 48 hours before chemotherapy, and remove it at least 24 hours after chemotherapy has been completed. ![]() Kaufman, PharmD, BSc, RPh, is a freelance medical writer based in New York City.Ĭinryze, a C1 esterase inhibitor (human), is FDA-approved as a new orphan drug for routine prophylaxis against angioedema in patients with hereditary angioedema (HAE).5 The drug is administered intravenously (IV) and can be administered every three to four days for routine HAE attack prevention, which can spontaneously occur during stress, surgery, or infection, and lead to rapid swelling of the hands, feet, limbs, face, intestinal tract, or airway.6 If there is ever any doubt about the best way to administer a particular product or whether it can be halved or crushed, ask your pharmacist.3 TH Hospital Pharmacy publishes a wall chart that includes many of these types of formulations, along with their do’s and don’ts. Additionally, both sublingual and effervescent medications should not be crushed because it will decrease the medication’s effectiveness. If this type of medication is crushed, the patient would be subject to its unpleasant taste, which could significantly impair medication adherence. Other medications have objectionable tastes and are sugar-coated to improve tolerability. By enteric-coating tablets or capsule beads, the drug’s release can be delayed until it reaches the small intestine. Enteric-coated tablets, which are formulated because certain drugs can be irritating to the stomach or are degraded by stomach acid.Some of the more common prefixes or suffixes for sustained-release, controlled-release, or controlled-delivery products include: 12-hour, 24-hour, CC, CD, CR, ER, LA, Retard, SA, Slo-, SR, XL, XR, or XT. Sustained-release tablets, which can be composed of multiple layers for different drug release times, as can beads within capsules.Generally, meds that should not be crushed fall into one of these categories: But beware of certain caveats, as not all medications are suitable for crushing. In these cases, crushing of medication for powdered delivery (to be mixed with food or beverages) should be considered. Some patients have difficulty swallowing tablets or capsules some dislike the taste. You should always consult your hospital pharmacist for information on this modality of drug administration. In some cases, after careful consideration of compatibility, stability, and drug absorption changes, an injectable formulation of a product may be used. If an oral solution or suspension is not available, the hospital pharmacy should be consulted to determine if a liquid formulation of the product can be extemporaneously prepared. A recent review in the American Journal of Health-System Pharmacy provides more details about administering medications in patients with enteral feeding tubes.2 Oral solutions can be used when commercially available and medically appropriate. The majority of extended-release products should not be crushed or chewed, although there are some newer slow-release tablet formulations available that are scored and can be divided or halved (e.g., Toprol XL).Ī common reason for crushing a tablet or capsule is for use by a hospitalized patient with an enteral feeding tube. These medications should not be chewed, either, usually due to their specific formulations and their pharmacokinetic properties.1 Most of the no-crush medications are sustained-release, oral-dosage formulas. There are multiple reasons for crushing tablets or capsule contents before administering medications, but there are numerous medications that should not be crushed.
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