Key takeaways:
Many medications are on the “do not crush” list. That’s because crushing, splitting, or chewing certain pills can raise the risk of side effects or reduce how well the treatment works.
Medications on the “do not crush” list include those with extended-release dosage forms or special coatings, hazardous medications, and medications that can irritate the mouth and throat.
The best way to know if it’s safe to crush or split your medication is to check with your pharmacist. They can also recommend alternative options if your pill is on the “do not crush” list.
Does the thought of swallowing a pill make you anxious? If so, you’re not alone. Many people have trouble swallowing medications, particularly tablets and capsules.
Trouble swallowing pills can be related to age, certain medical conditions, or even a pill’s size or taste. Crushing, splitting, or chewing a pill can sometimes make it easier to take. These methods may also be necessary if you receive medications through a feeding tube.
But not every medication can be safely altered. Crushing or cutting certain pills can change how they work and, in some cases, increase the risk of side effects. Here, we’ll cover common medications on the “do not crush” list to help you avoid these issues.
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Why crushing or chewing certain pills can be risky
Crushing, splitting, or chewing pills isn’t a safe option for certain medications. The risks of crushing certain pills depend on what type of pill it is. Examples of riskier pills to crush include:
Delayed- or extended-release pills: These medications are designed to release the active ingredient over time. Crushing or splitting them can result in the medication being released all at once or in higher amounts than intended. Not only can this increase the risk of side effects, it can lead to a harmful overdose in some situations. You can often identify these medications by the following abbreviations in the name:
Delayed-release (DR)
Extended-release (ER, XR, XL)
Modified-release (MR)
Sustained-release (SR)
Controlled-release (CR)
Enteric-coated pills: These pills have a coating that controls when and where they dissolve in the body. This coating can help protect your stomach or improve the absorption of a medication. Crushing or splitting enteric-coated pills can cause stomach damage or irritation. It can also prevent your body from absorbing the medication properly. Often, these medications will have the abbreviation “EC” after the name to indicate enteric coating.
Hazardous medications: If you crush or split a pill that contains a hazardous ingredient, you raise the risk of harmful exposure to yourself and other people.
Sublingual or orally disintegrating pills: These pills are designed to dissolve in the mouth or under the tongue. Crushing them can change how the pill works and how well you absorb the medication from it. This could prevent you from getting your proper dose or stop it from working as quickly as it should.
Special technology formulations: Many newer medications use special technologies, such as amorphous solid dispersion or nanocrystal technology. Cutting or crushing these medications can interfere with how they’re released and absorbed, which could result in you receiving too much or too little medication.
Irritants: Some medications may taste bad or irritate the mouth and throat if you crush or chew them. In some cases this may just be bothersome. But in other cases, it can be harmful or even life-threatening.
Keep in mind that these are general guidelines. There are usually some exceptions. For example, it’s safe to open some capsules and sprinkle them onto food or drinks, even though they’re extended-release medications. Examples include:
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)
Do not crush list of medications
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)
Alprazolam ER (Xanax XR)
Amoxicillin / clavulanate ER (Augmentin XR)
Aspirin EC (Ecotrin)
Bisacodyl (Dulcolax)
Bupropion ER (Aplenzin, Forfivo XL, Wellbutrin SR/XL)
Carbamazepine ER (Tegretol XR)
Ciprofloxacin ER (Cipro XR)
Clarithromycin (Biaxin XL)
Methylphenidate ER (Concerta, Relexxii)
Morphine sulfate ER (MS Contin)
Oxycodone ER (OxyContin, Xtampza ER)
Paroxetine ER (Paxil CR)
Zolpidem ER (Ambien CR)
Hazardous medications:
Abiraterone (Zytiga)
Anastrozole (Arimidex)
Apremilast (Otezla)
Capecitabine
Cyclophosphamide (Cytoxan)
Imatinib (Gleevec)
Lenalidomide (Revlimid)
Methotrexate
Osimertinib (Tagrisso)
Tamoxifen (Soltamox)
Medications that have special technologies to help them dissolve:
Aprepitant (Emend)
Etravirine (Intelence)
Fenofibrate
Itraconazole (Sporanox)
Kaletra (lopinavir / ritonavir)
Mavyret (glecaprevir / pibrentasvir)
Ritonavir (Norvir)
Suvorexant (Belsomra)
Medications that can irritate the mouth, stomach, or skin:
Alendronate (Fosamax)
Benzonatate (Tessalon)
Bisacodyl
Diclofenac / misoprostol (Arthrotec)
Dutasteride (Avodart)
Ferrous gluconate (Fergon)
Ferrous sulfate (Feosol, Feratab)
Ibandronate
Isotretinoin (Absorica, Amnesteem)
Piroxicam (Feldene)
Risedronate (Actonel, Atelvia)
Valproic acid
Medications that can leave a bad taste in the mouth:
Cefuroxime
Docusate sodium (Colace)
Erythromycin (E.E.S.)
Ibuprofen (Advil, Motrin)
Levetiracetam (Keppra)
Topiramate (Topamax)
Good to know: This isn’t a comprehensive list. Check with your pharmacist or prescriber if you have questions about whether it’s OK to chew, cut, or crush a medication you’re taking.
How do you know if medication can be crushed, split, or chewed?
Many prescription labels will tell you if it’s OK (or not) to crush, split, or chew your medication. This is often the fastest way to tell. If a tablet 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. They can tell you if it’s safe to crush or split any of your pills.
Tips for splitting or opening medications safely
If your medication is acceptable to cut, consider investing in a high-quality tablet cutter. Using a knife isn’t recommended. It may cause the tablet to break apart unevenly, which means you won’t get an accurate dose. You also risk the knife slipping and causing an injury. A tablet cutter helps ensure you safely 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.
What can you do to make taking medication easier?
If your medication can’t be altered, don’t fret. Many pills also come in different dosage forms that are easier to swallow, such as a liquid or chewable tablet. A compounding pharmacy may also be able to make a liquid or chewable version if one isn’t commercially available.
If an alternative dosage form isn’t an option, try the following strategies to make swallowing your pill easier:
Take your medication with a full glass of water.
If it’s OK to take your medication with food, try placing it in a spoonful of pudding or applesauce.
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.
Frequently asked questions
The manufacturer recommends swallowing gabapentin (Neurontin) capsules whole with water. If you have trouble swallowing capsules, gabapentin also comes as an oral solution (liquid) that may be a better option for you. But if you administer medications through a feeding tube, it’s typically fine to open a gabapentin capsule and mix the contents with a small amount of water before administering through the tube.
Most Mucinex tablets are extended-release formulas or coated caplets, so you shouldn’t crush or chew them. But many products also come in a liquid form that’s easier to swallow.
The manufacturer doesn’t state whether losartan (Cozaar) can be crushed or split. But it isn’t an extended-release formula or a coated tablet. So it’s generally considered safe to crush it if needed. There’s also a liquid form of losartan (Arbli) that’s another option if you have trouble swallowing pills.
The manufacturer recommends swallowing gabapentin (Neurontin) capsules whole with water. If you have trouble swallowing capsules, gabapentin also comes as an oral solution (liquid) that may be a better option for you. But if you administer medications through a feeding tube, it’s typically fine to open a gabapentin capsule and mix the contents with a small amount of water before administering through the tube.
Most Mucinex tablets are extended-release formulas or coated caplets, so you shouldn’t crush or chew them. But many products also come in a liquid form that’s easier to swallow.
The manufacturer doesn’t state whether losartan (Cozaar) can be crushed or split. But it isn’t an extended-release formula or a coated tablet. So it’s generally considered safe to crush it if needed. There’s also a liquid form of losartan (Arbli) that’s another option if you have trouble swallowing pills.
The bottom line
Many medications are on the “do not crush” list. That’s because crushing, splitting, or chewing certain medications can change how they’re absorbed and raise the risk of side effects or redue how well the treatment works.
Medications on the “do not crush” list include those with extended-release dosage forms or special coatings, such as morphine sulfate ER (MS Contin), amoxicillin / clavulanate ER (Augmentin XR), or aspirin EC (Ecotrin). Hazardous medications, such as capecitabine and abiraterone (Zytiga), and medications that can irritate the mouth and throat, such as benzonatate (Tessalon) shouldn’t be crushed or split either.
The best way to know if it’s safe to crush or split your medication is to check with your pharmacist. They can also recommend alternative options if your pill is on the “do not crush” list.
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References
Blaszczyk, A., et al. (2023). Crushed tablet administration for patients with dysphagia and enteral feeding: Challenges and considerations. Drugs & Aging.
Centers for Disease Control and Prevention. (2019). Hazardous drug exposures in healthcare.
Chincholkar, M. (2020). Gabapentinoids: Pharmacokinetics, pharmacodynamics and considerations for clinical practice. British Journal of Pain.
DailyMed. (n.d.). Search results for: mucinex.
Maderuelo, C., et al. (2019). Enteric coating of oral solid dosage forms as a tool to improve drug bioavailability. European Journal of Pharmaceutical Sciences.
Pharmacist’s Letter. (2023). Meds that should not be crushed.
Radhakrishnan, C., et al. (2021). A difficult pill to swallow: An investigation of the factors associated with medication swallowing difficulties. Patient Preference and Adherence.
RemedyRepack Inc. (2026). Gabapentin- gabapentin capsule [package insert].
Schiele, J. T., et al. (2014). Two techniques to make swallowing pills easier. Annals of Family Medicine.
Sefidani Forough, A., et al. (2018). A spoonful of sugar helps the medicine go down? A review of strategies for making pills easier to swallow. Patient Preference and Adherence.
Uttaro, E., et al. (2021). To crush or not to crush: A brief review of novel tablets and capsules prepared from nanocrystal and amorphous solid dispersion technologies. American Journal of Health-System Pharmacy.
