Do Not Crush List: These Common Medications Should Always Stay Intact

Do you get anxiety at the thought of having to swallow a medication whole? Turns out, you’re not alone. Many people are unable to swallow medications, particularly tablets and capsules.

The inability to swallow medications is often related to age or certain medical conditions. Others don’t like it because the size, taste, or idea of a pill makes them feel nervous. Whatever the reason, it’s important that you find a way to take your medication regularly so you can receive its full benefits.

Crushing, splitting, or chewing medications can make it easier to take certain treatments. It can also be necessary for certain people who eat their meals through a feeding tube. But it’s not the best solution for every medication. Here, we’ll discuss popular medications that are on the “do not crush” list.

Why can’t certain medications be crushed, split, or chewed?

Crushing, splitting, or chewing certain medications can increase the odds of experiencing side effects. It could also make your medication less effective. Read on to learn about the types of medications that should always stay intact.

Modified-release dosage forms

Many medications are known as immediate-release (IR) medications. This means they work quickly, but they often need to be taken multiple times per day. Modified-release dosage forms extend or delay a medication’s release so it lasts longer. This allows you to take the medication less often. It can also make your medication more effective by allowing for better absorption.

However, you shouldn’t crush, split, or chew these types of medications. This could cause the medication to release all at once and at higher amounts than intended. Look for the following phrases on your prescription label that can clue you in to whether your medication contains a modified-release dosage form:

• Delayed-release (DR)

• Extended-release (ER, XR)

• Modified-release (MR)

• Sustained-release (SR)

• Controlled-release (CR)

Special coatings

Even if your medication doesn’t mention one of the dosage forms above, it may still have a special exterior coating. These coatings are often used to prevent mouth, throat, or stomach irritation. They can also hide unpleasant tastes.

An enteric-coating (EC) is one specific coating that not only protects the stomach but prevents medications from dissolving too early. This ensures they reach the small intestine for better absorption. Crushing, splitting, or chewing enteric-coated pills could result in irritation or a less effective treatment.

Hazardous medications

Hazardous medications typically include those that are used to treat cancer. It also includes medications that may cause harm to an unborn baby.

The real concern is for people who crush, chew, or open these medications. The powders created when these medications are opened or changed can be unsafe to people who are exposed to them. Only trained healthcare professionals should alter hazardous medications.

Dissolvable dosage forms

Medications that are meant to dissolve in the mouth or under the tongue shouldn’t be altered either. These designs are sometimes used to improve drug absorption, facilitating their entry into your bloodstream. Other medications use a dissolving tablet solely for the sake of convenience. In either case, due to their design, crushing, splitting, or chewing them could make them less effective.

Special technologies

Medications with “amorphous solid dispersion” or nanocrystal technology inside of them shouldn’t be crushed, cut, or chewed either. Medications with this complicated technology need to stay intact so they effectively be absorbed into your bloodstream. Your pharmacist can tell you if your medication has this technology.

Capsules

Capsules typically have powder, pellets, or liquid inside of them. Softgels are another type of capsule made of soft gelatin. These can’t be crushed or chewed because the contents inside can spill out and make it difficult to get a correct dose.

Although some capsules can be opened and sprinkled onto soft foods, this isn’t the case for all capsules. Your pharmacist can tell you if you can safely open your capsules.

EXPERT PICKS: WHAT TO READ NEXT

• What to know about long-lasting drugs: You shouldn’t crush or chew medications that are designed to work over time. Here’s what else to know about extended- and sustained-release medications.

• What to know about what’s in your medication: Your prescription’s active ingredient is only one portion of your pill. It’s important to know what else is in your medication — especially if you have any allergies or dietary restrictions.

• What to know about specialty pharmacies: There are a few differences between community and specialty pharmacies. Keep these tips in mind for accessing your specialty medication delivery.

Do not crush list of medications

It can be hard to keep track of all the different medications that shouldn’t be crushed. Below is a list of the most common medications that shouldn’t be crushed, cut, or chewed.

Medications that have modified-release dosage forms or a special coating:

• Acetaminophen ER (Tylenol 8HR)

• Aspirin EC (Ecotrin)

• Bisacodyl (Dulcolax)

• Alprazolam ER (Xanax XR)

• Bupropion ER (Aplenzin, Forfivo XL, Wellbutrin SR/XL)

• Oxycodone ER (OxyContin, Xtampza ER)

• Morphine sulfate ER (MS Contin)

• Amoxicillin / clavulanate ER (Augmentin XR)

• Ciprofloxacin ER (Cipro XR)

• Zolpidem ER (Ambien CR)

Medications that have modified-release dosage forms but the capsules can be opened:

• Omeprazole (Prilosec, Prilosec OTC)

• Lansoprazole (Prevacid)

• Dexmethylphenidate ER (Focalin XR)

• Dextroamphetamine / amphetamine ER (Adderall XR)

• Methylphenidate ER (Metadate CD, Ritalin LA)

• Carvedilol ER (Coreg CR)

• Diltiazem ER (Taztia XT, Tiazac)

• Verapamil (Verelan, Verelan PM)

Hazardous medications:

• Abiraterone (Zytiga)

• Anastrozole (Arimidex)

• Capecitabine (Xeloda)

• Cyclophosphamide (Cytoxan)

• Imatinib (Gleevec)

• Lenalidomide (Revlimid)

• Methotrexate

• Osimertinib (Tagrisso)

• Tamoxifen (Soltamox)

Medications that have special technologies to help them dissolve:

• Etravirine (Intelence)

• Glecaprevir / pibrentasvir (Mavyret)

• Lopinavir / ritonavir (Kaletra)

• Aprepitant (Emend)

• Fenofibrate (TriCor)

• Itraconazole (Sporanox)

Medications that can irritate the mouth, stomach, or skin:

• Benzonatate (Tessalon Perles)

• Ferrous gluconate (Fergon)

• Ferrous sulfate (Feosol, Feratab)

• Diclofenac / misoprostol (Arthrotec)

• Piroxicam (Feldene)

• Alendronate (Fosamax)

• Ibandronate (Boniva)

• Risedronate (Actonel, Atelvia)

Medications that can leave a bad taste in the mouth:

• Cefuroxime

• Ciprofloxacin

• Erythromycin (E.E.S.)

• Docusate sodium (Colace)

• Ibuprofen (Advil, Motrin)

• Trazodone

Good to know: This list isn’t comprehensive. What’s more, many medications are available as both immediate-release and extended-release products. Your pharmacist can tell you if any of your medications are on the full “do not crush” list.

How do you know if medication can be crushed, split, or chewed?

Many prescription labels will tell you if your specific product can’t be crushed, split, or chewed. This is often the fastest way to tell. But if your pill is scored (has a line down the middle), that’s another clue it’s OK to cut the medication in half.

That being said, the safest course of action is to ask your pharmacist to review your medication list. They can tell you if it's safe to make any modifications.

What can you do to make taking medication easier?

If your medication can’t be altered, don’t fret. Many medications come in different dosage forms. Liquids, chewable or dissolvable tablets, and suppositories may all be acceptable alternatives to consider. Injections are another option. You can even ask your healthcare team if you can switch from a tablet to a capsule (if they’re easier for you to swallow).

If an alternative dosage form isn’t available, you can try the following strategies to make swallowing your pill easier:

• Take your medication with a full glass of water.

• Try tipping your head forward or turning it to the left or right.

• Try the pop-bottle method. Place the tablet on your tongue, close your lips around the opening of a plastic water bottle, and tilt your head back and suck water from the bottle while swallowing both the water and the pill.

• Try a pill coating device, spray, or gel.

Tips for splitting or opening medications safely

If your medication is acceptable to cut, consider investing in a high-quality tablet cutter. This is because it’s not a good idea to use a knife to split your medications. Doing so may cause the tablet to break apart unevenly and you won’t get an accurate dose. You also risk injuring yourself. A tablet cutter helps ensure you get a nice, even split.

If you’re able to crush your medication, it’s recommended to use a dedicated tablet crusher for safety purposes. Your pharmacist may then direct you to mix the crushed tablet with water, applesauce, or another food or beverage. The best food or drink pairing will depend on your specific medication.

Speaking of applesauce — many capsules can be opened up and sprinkled on soft foods as well. You can swallow the contents of the capsule alongside the soft food without the need to chew. Again, it’s a good idea to check in with your pharmacist to make sure your favorite soft food is compatible with your medication and that your capsule can safely be opened.

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Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Reviewed by:

Ashlyn Clark, PharmD Candidate

Ashlyn has worked at several Rite Aid locations in northeastern Pennsylvania since April 2021.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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