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Cutting, Crushing, or Splitting Medications

Hello, and thanks for stopping by the Corner.

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In this issue, I would like to outline some of the considerations that should be taken into account before a medication is to be cut, crushed, or split.

Although not often, there may be times when someone may be looking to change a medication before it is administered. This could range from trying to avoid having to swallow a large tablet or capsule, to splitting tablets in an effort to save money. Medications come in a variety of dosage forms with tablets and capsules being the most common. While some of these products may be able to be cut, crushed, or split, there are certain formulations that can cause unwanted effects if they are manipulated. Products may be available as “immediate-release”, which means absorption will begin to occur when the medication dissolves within the digestive system. On the other hand, there are products that are modified-release indicating absorption may be delayed or prolonged due to the formulation. These products are often referred to a “controlled-release” or “CR”, “delayed-release” or “DR”, “long-acting” or “LA”, or “sustained-release” or “SR”.

Typically, if a product is immediate-release, contains only one active ingredient, and does not have coating, it is acceptable to cut, crush, or split if needed. Some tablets are even scored which would help in the process of splitting. Certain immediate-release capsule formulations may also be able to be opened and sprinkled on applesauce or other soft foods. For products that are coated, irregularly shaped, or contain more than one active ingredient, manipulation of the product is typically discouraged. Specifically when it comes to splitting, if these products are altered it could lead to uneven or variable dosing.

Generally speaking, most modified-release products should not be cut, crushed, or split. There are various reasons for this, but most common is the fact that it will alter the effects in the body. Changing these dosage forms could result in things like dose dumping, altered absorption, or irritation along the gastrointestinal tract. For example, if a long-acting product were to be cut or crushed it could result in dose dumping, leading to severe adverse effects due to most or all of the medication being absorbed at one time.

If a patient decides they want to cut, crush, split, or otherwise modify a medication before administration, it is always a good idea to check with a pharmacist.

Medications are formulated in different ways, and in fact even the same medication may be available in both immediate- and modified-release options. There are also products that could be considered hazardous if they were to be cut, crushed, or split as exposure to the residue may carry risks. A pharmacist will be able to analyze a product to see if it can safely be manipulated and make recommendations.

Stay safe and stay well.  See you next month.

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