When may it be appropriate to consider crushing, opening or splitting tablets?
If a decision is taken that the most appropriate way to address an individual patient’s needs is to crush, open, or split tablets, full consideration must be given to any of the cytotoxic, teratogenic, stability, irritancy and bitterness issues listed previously.
Useful information on whether this form of manipulation is appropriate for a drug product can be found in the Handbook of Drug Administration via Enteral Feeding Tubes33 and at the website created by Colchester Medicines Information at Colchester Hospital University NHS Foundation Trust81. However, while these sources provide guidance on whether a dosage form can be manipulated, there is no data to indicate how this manipulation may affect the bioavailability of the product, or if the manipulated product remains bioequivalent with the original dosage form. This should be borne in mind when considering a product’s clinical effect or stability. It is also advisable to check whether a product has subsequently become licensed (eg. as a liquid) since these guidelines were developed.
Find alternatives to
solid dose medications
- Handbook of extemporaneous preparation. Edited by Mark Jackson and Andrew Lowey.
- The NEWT Guidelines
- Consensus guideline on the medication management of adults with swallowing difficulties.
- NEEMMC guidelines for tablet crushing in patients with swallowing difficulties. Colchester Hospital University NHS Foundation Trust, NHS North East Essex.
- Specials Toolkit. Royal Pharmaceutical Society