Crushing pills can improve ease of administration, but some shouldn’t be crushed. Crushing extended release meds can result in administration of a large dose all at once. Crushing delayed-release meds can alter the mechanism designed to protect the drug from gastric acids or prevent gastric mucosal irritation. Crushing sublingual or buccal tabs can alter effectiveness. Crushing pills based on certain technologies (i.e., amorphous solid dispersion or nanocrystals) can alter bioavailability. Crushing bitter-tasting meds can be unpleasant for the patient. Crushing irritating or hazardous meds can be harmful to the individual crushing the meds. (If hazardous meds [e.g., carcinogenic] must be crushed, follow USP Chapter <800> standards in healthcare settings or advising outpatients on proper procedures. Hazardous meds below explicitly state not to crush in the product information. The NIOSH hazardous meds list is at: https://www.cdc.gov/niosh/docs/2025-103/pdfs/2025-103.pdf?id=10.26616/NIOSHPUB2025103.
This table has some commonly prescribed medications that should not be crushed; many more may not be listed. Brand names are representative and may not be all-inclusive. Contact the pharmacy for clarification on medication products or dosage forms that are not listed.
Modified-release: Indicates extended-release or delayed-release formulation.
| Medications That Should Not be Crushed1-2 | |||
|---|---|---|---|
| Generic Name | Brand Name | Dosage Form | Comments |
| Acamprosate | Campral | Tablet | – Modified-release |
| Acetaminophen | Tylenol Arthritis Pain Extended-Release (US) | Tablet | – Modified-release |
| Acoramidis | Attruby | Tablet | – Other |
| Adagrasib | Krazati (US) | Tablet | – Other |
| Alendronate | Fosamax | Tablet | – Irritant (oropharyngeal) |
| Alfuzosin | Uroxatral (US) | Tablet | – Modified-release |
| Alprazolam | Xanax XR (US) | Tablet | – Modified-release |
| Ambrisentan | Letairis (US) | Tablet | – Teratogenic |
| Amoxicillin/Clavulanate | Augmentin XR (US) | Tablet | – Modified-release – Scored tablets can be split |
| Apremilast | Otezla (US) | Tablet | – Antineoplastic |
| Aprepitant | Emend (US) | Capsule | – Nanocrystal |
| Asciminib | Scemblix | Tablet | – Other |
| Aspirin | Ecotrin | Tablet | – Modified-release – Irritant (gastric) |
| Aspirin/Dipyridamole | Aggrenox | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Atogepant | Qulipta | Tablet | – Special Technology |
| Atomoxetine | Strattera | Capsule | – Irritant (ocular) |
| Avacopan | Tavneos | Capsule | – Special Technology |
| Avapritinib | Ayvakit | Tablet | – Other |
| Axitinib | Inlyta | Tablet | – Antineoplastic |
| Belladonna Alkaloids | Donnatal Extentabs (US) | Tablet | – Modified-release |
| Belumosudil | Rezurock | Tablet | – Other |
| Benzonatate | Tessalon Perles (US) | Capsule | – Local anesthetic effect could increase the risk of choking |
| Bexagliflozin | Brenzavvy (US) | Tablet | – Modified-release |
| Bisacodyl | Dulcolax | Capsule, Tablet | – Modified-release – Irritant (gastric) |
| Bosutinib | Bosulif | Tablet | – Antineoplastic |
| Brivaracetam | Briviact (US) | Tablet | – Bad taste |
| Budesonide | Entocort EC (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Budesonide | Uceris (US) | Tablet | – Modified-release |
| Buprenorphine | Belbuca (US) | Film | – Sublingual dosage form |
| Bupropion | Aplenzin (US), Budeprion SR (US), Wellbutrin SR, XL, Zyban | Tablet | – Modified-release |
| Cabozantinib | Cabometyx, Cometriq (US) | Capsule, Tablet | – Antineoplastic |
| Capivasertib | Truqap | Tablet | – Other |
| Capmatinib | Tabrecta | Tablet | – Other |
| Carbamazepine | Carbatrol (US), Equetro (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Carbamazepine | Tegretol XR (US) | Tablet | – Modified-release |
| Carvedilol | Coreg CR (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Cefuroxime | Ceftin | Tablet | – Bad taste |
| Chlorpheniramine Maleate | Chlor-Trimeton Allergy 12 Hour (US) | Tablet | – Modified-release |
| Ciprofloxacin | Cipro | Tablet | – Bad taste |
| Ciprofloxacin | Cipro XR (US), Cipro XL (Canada) | Tablet | – Modified-release |
| Clarithromycin | Biaxin XL | Tablet | – Modified-release |
| Clonidine | Kapvay (US) | Tablet | – Modified-release |
| Colestipol | Colestid | Tablet | – Modified-release |
| Cyclobenzaprine | Amrix (US) | Capsule | – Modified-release |
| Cyclophosphamide | Cytoxan (US), Generics | Capsule, Tablet | – Antineoplastic |
| Dabigatran | Pradaxa | Capsule | – Intact product must be taken to avoid increased exposure |
| Dalfampridine | Ampyra (US) | Tablet | – Modified-release |
| Darifenacin | Enablex | Tablet | – Modified-release |
| Dasatinib | Sprycel | Tablet | – Antineoplastic – Teratogenic |
| Deferasirox | Exjade | Tablet | – Tablet is for oral suspension |
| Desvenlafaxine | Pristiq | Tablet | – Modified-release |
| Deutetrabenazine | Austedo XR | Tablet | – Modified-release |
| Dexlansoprazole | Dexilant | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Dexmethylphenidate | Focalin XR (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Dextroamphetamine | Dexedrine | Capsule | – Modified-release |
| Dextroamphetamine/Amphetamine | Adderall XR | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Diclofenac | Voltaren XR (US) | Tablet | – Modified-release – Irritant (gastric) |
| Diclofenac/Misoprostol | Arthrotec | Tablet | – Modified-release – Irritant (gastric) – Teratogenic |
| Didanosine | Videx EC | Capsule | – Modified-release |
| Diflunisal | Generics | Tablet | – Irritant (gastric) |
| Diltiazem | Cardizem CD, Cartia XT (US), Dilacor XR (US), Dilt-XR (US), Taztia XT (US), Tiazac | Capsule | – Modified-release – Can be opened for administration of intact granules (Taztia XT and Tiazac) |
| Diltiazem | Cardizem LA (US) | Tablet | – Modified-release |
| Dimethyl Fumarate | Tecfidera | Capsule | – Modified-release |
| Disopyramide | Norpace CR (US) | Capsule | – Modified-release |
| Divalproex | Depakote Sprinkle (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Divalproex | Depakote (US), Depakote ER (US) | Tablet | – Modified-release |
| Docusate Sodium | Colace | Capsule | – Bad taste |
| Donepezil | Aricept (23 mg strength only) | Tablet | – Intact product must be taken to avoid increased rate of absorption |
| Doxazosin | Cardura XL (US) | Tablet | – Modified-release |
| Doxycycline | Doryx (US) | Capsule, Tablet | – Modified-release – Scored tablets can be split |
| Drospirenone/Estetrol | Nextstellis | Tablet | – Other |
| Duloxetine | Cymbalta | Capsule | – Modified-release |
| Dutasteride | Avodart, Jalyn | Capsule | – Teratogenic – Irritant (mucous membrane) |
| Elacestrant | Orserdu | Tablet | – Other |
| Elbasvir/Grazoprevir | Zepatier (US) | Tablet | – Amorphous solid dispersion |
| Elexacaftor/Tezacaftor/Ivacaftor | Trikafta | Tablet | – Amorphous solid dispersion |
| Ensartinib | Ensacove (US) | Capsule | – Other |
| Enzalutamide | Xtandi | Capsule | – Antineoplastic |
| Ergotamine | Ergomar (US) | Tablet | – For sublingual administration |
| Erythromycin | Erythromycin delayed-release | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Erythromycin | E.E.S. | Tablet | – Bad taste |
| Erythromycin | Ery-Tab (US) | Tablet | – Modified-release |
| Esomeprazole | Nexium | Capsule (US) | – Modified-release – Capsule can be opened for administration of intact granules |
| Eszopiclone | Lunesta (US) | Tablet | – Bad taste |
| Etravirine | Intelence | Tablet | – Amorphous solid dispersion – Tablet may be dispersed in water – Scored tablets can be split |
| Everolimus | Afinitor Zortress (US) | Tablet | – Amorphous solid dispersion – Irritant (mucous membrane) – Teratogenic |
| Felodipine | Plendil | Tablet | – Modified-release |
| Fenofibrate | TriCor (US) | Tablet | – Nanocrystal |
| Fentanyl | Abstral | Tablet | – Sublingual dosage form |
| Fentanyl | Actiq (US) | Lozenge | – Lozenge should be sucked, not chewed |
| Fentanyl | Fentora | Tablet | – Buccal dosage form |
| Ferrous Gluconate | Fergon (US) | Tablet | – Modified-release – Irritant (gastric) |
| Ferrous Sulfate | Feosol (US), Feratab (US) | Tablet | – Modified-release – Irritant (gastric) |
| Fesoterodine | Toviaz | Tablet | – Modified-release |
| Fexofenadine/Pseudoephedrine | Allegra-D | Tablet | – Modified-release |
| Fezolinetant | Veozah | Tablet | – Other |
| Finasteride | Propecia, Proscar | Tablet | – Teratogenic |
| Fluoxetine | Prozac Weekly (US) | Capsule | – Modified-release |
| Fluvastatin | Lescol XL | Tablet | – Modified-release |
| Fluvoxamine | Luvox CR (US) | Capsule | – Modified-release |
| Futibatinib | Lytgobi (US) | Tablet | – Other |
| Gabapentin | Gralise (US), Horizant (US) | Tablet | Modified-release |
| Galantamine/Benzgalantamine | Razadyne ER (US), Zunveyl (US) | Capsule, Tablet | – Modified-release |
| Gepirone | Exxua (US) | Tablet | – Modified-release |
| Glecaprevir/Pibrentasvir | Mavyret (US) | Tablet | – Amorphous solid dispersion |
| Glipizide | Glucotrol XL (US) | Tablet | – Modified-release |
| Guaifenesin | Mucinex (US) | Tablet | – Modified-release |
| Guaifenesin/Dextromethorphan | Mucinex DM (US) | Tablet | – Modified-release |
| Guaifenesin/Pseudoephedrine | Mucinex D (US) | Tablet | – Modified-release – Scored tablets can be split |
| Guanfacine | Intuniv (US) | Tablet | – Modified-release |
| Hydromorphone | Exalgo (US) | Tablet | – Modified-release |
| Hydroxyurea | Droxia (US), Hydrea, Siklos (US) | Capsule, Tablet | – Irritant (cytotoxic) – Teratogenic |
| Hyoscyamine | Levbid (US) | Capsule, Tablet | – Modified-release – Scored tablets can be split |
| Ibandronate | Boniva (US) | Tablet | – Irritant (oropharyngeal) |
| Ibuprofen | Advil, Motrin | Tablet | – Bad taste |
| Imatinib | Gleevec | Tablet | – Antineoplastic – Irritant (mucous membrane) – Scored tablets can be split |
| Inavolisib | Itovebi (US) | Tablet | – Other |
| Indinavir | Crixivan | Capsule | – “Bad taste – Can be opened for administration of intact granules |
| Indomethacin | Indocin SR (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Iptacopan | Fabhalta | Capsule | – Other |
| Isavuconazonium Sulfate | Cresemba | Capsule | – High risk of instability or reduced absorption |
| Isosorbide Dinitrate | Dilatrate-SR (US) | Capsule | – Modified-release |
| Isosorbide Dinitrate | Isordil Sublingual (US) | Tablet | – Sublingual dosage form |
| Isosorbide Mononitrate | Imdur | Tablet | – Modified-release – Scored tablets can be split |
| Isotretinoin | Absorica (US), Amnesteem (US) | Capsule | – Irritant (esophageal) – Teratogenic |
| Itraconazole | Sporanox | Capsule | – Amorphous solid dispersion |
| Ivacaftor | Kalydeco | Tablet | – Amorphous solid dispersion |
| Ivosidenib | Tibsovo (US) | Tablet | – Amorphous solid dispersion |
| Lamotrigine | Lamictal XR (US) | Tablet | – Modified-release |
| Lansoprazole | Prevacid | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Lansoprazole | Prevacid SoluTab (US) | Tablet | – Should be dissolved in the mouth, not chewed |
| Lazertinib | Lazcluze | Tablet | – Other |
| Lenacapavir | Sunlenca | Tablet | – Other |
| Lenalidomide | Revlimid | Capsule | – Teratogenic |
| Lenvatinib | Lenvima | Capsule | – Hazardous/Teratogenic |
| Levetiracetam | Keppra | Tablet | – Bad taste |
| Levetiracetam | Keppra XR (US) | Tablet | – Modified-release |
| Levodopa/Carbidopa | Sinemet CR | Tablet | – Modified-release – Scored tablets can be split |
| Levomilnacipran | Fetzima | Capsule | – Modified-release |
| Lithium Carbonate | Lithobid (US) | Tablet | – Modified-release |
| Lopinavir/Ritonavir | Kaletra | Tablet | – Amorphous solid dispersion – Reduced bioavailability with crushing8 |
| Loratadine/Pseudoephedrine | Claritin-D (US) | Tablet | – Modified-release |
| Lovastatin | Altoprev (US) | Tablet | – Modified-release |
| Lubiprostone | Amitiza (US) | Capsule | – Stability is compromised |
| Lumacaftor/Ivacaftor | Orkambi | Tablet | – Amorphous solid dispersion |
| Mavorixafor | Xolremdi | Capsule | – Other |
| Memantine | Namenda XR | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Mesalamine | Apriso, Asacol HD, Lialda, Pentasa | Capsule Tablet | – Modified-release – Capsules can be opened for administration of intact granules (Delzicol, Pentasa [US]) |
| Metformin | Fortamet (US), Glucophage XR (US), Glumetza | Tablet | – Modified-release |
| Methylphenidate | Metadate CD (US), Ritalin LA (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Methylphenidate | Concerta | Tablet | – Modified-release |
| Metoprolol Succinate | Toprol-XL (US) | Tablet | – Modified-release – Scored tablets can be split |
| Metronidazole | Flagyl ER (US) | Tablet | – Modified-release |
| Miltefosine | Impavido | Capsule | – Hazardous/Teratogenic |
| Minocycline | Emrosi, Solodyn (US) | Tablet | – Modified-release |
| Mirabegron | Myrbetriq | Tablet | – Modified-release |
| Momelotinib | Ojjaara | Tablet | – Other |
| Morphine Sulfate | Avinza, Kadian | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Morphine Sulfate | MS Contin | Tablet | – Modified-release |
| Mycophenolate | CellCept | Capsule, Tablet | – Teratogenic |
| Mycophenolic Acid | Myfortic | Tablet | – Modified-release – Teratogenic |
| Naproxen | EC Naprosyn (US), Naprelan | Tablet | – Modified-release |
| Nevirapine | Viramune XR | Tablet | – Modified-release |
| Niacin | Niaspan | Tablet | – Modified-release |
| Nicardipine | Cardene SR (US) | Capsule | – Modified-release |
| Nifedipine | Adalat CC (US), Procardia XL (US) | Tablet | – Modified-release |
| Nilotinib | Tasigna, Danziten | Capsule | – Antineoplastic – Modified-release – Can be opened for administration of intact granules |
| Nirmatrelvir/Ritonavir | Paxlovid | Tablet | – Other |
| Nirogacestat | Ogsiveo (US) | Tablet | – Other |
| Nisoldipine | Sular (US) | Tablet | – Modified-release |
| Nitroglycerin | Nitrostat | Tablet | – Sublingual dosage form |
| Olaparib | Lynparza | Tablet | – Amorphous solid dispersion |
| Omaveloxolone | Skyclarys | Capsule | – Other |
| Omeprazole | Prilosec (US), Prilosec OTC (US) | Capsule, Tablet | – Modified-release – Capsule can be opened for administration of intact granules (Prilosec) |
| Opicapone | Ongentys (US) | Capsule | – Other |
| Orphenadrine | Norflex ER (US) | Tablet | – Modified-release |
| Oxybutynin | Ditropan XL | Tablet | – Modified-release |
| Oxycodone | OxyContin (US), Xtampza ER (US) | Capsule, Tablet | – Modified-release |
| Oxymorphone | Opana ER (US) | Tablet | – Modified-release |
| Paliperidone | Invega | Tablet | – Modified-release |
| Pancreatic Enzymes | Creon, Pancreaze (US), Pertzye (US), Zenpep (US) | Capsule | – Modified-release – Irritant (oral mucosal) – Can be opened for administration of intact granules |
| Pantoprazole | Protonix (US) | Tablet | – Modified-release |
| Paroxetine | Paxil CR | Tablet | – Modified-release |
| Pazopanib | Votrient | Tablet | – Antineoplastic |
| Pentoxifylline | Trental (US) | Tablet | – Modified-release |
| Piroxicam | Feldene (US) | Capsule | – Irritant (oropharyngeal) |
| Pirtobrutinib | Jaypirca (US) | Tablet | – Hazardous/Teratogenic |
| Pomalidomide | Pomalyst | Capsule | – Antineoplastic – Teratogenic |
| Posaconazole | Noxafil DR (US) | Tablet | – Amorphous oral dispersion – Modified-release |
| Potassium Chloride | Micro-K (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Potassium Chloride | Klor-Con, K-Tab | Tablet | – Modified-release |
| Pralsetinib | Gavreto | Capsule | – Other |
| Praziquantel | Biltricide | Tablet | – Bad taste – Scored tablets can be split |
| Propafenone | Rythmol SR (US) | Capsule | – Modified-release |
| Propranolol | Inderal LA | Capsule | – Modified-release |
| Pseudoephedrine | Sudafed 12 Hour, 24 Hour (US) | Tablet | – Modified-release |
| Pseudoephedrine/Brompheniramine | LoHist 12D (US) | Tablet | – Modified-release |
| Pseudoephedrine/Fexofenadine | Allegra D | Tablet | – Modified-release |
| Pseudoephedrine/Desloratadine | Clarinex D (US) | Tablet | – Modified-release |
| Pyridostigmine | Mestinon Timespan (US) | Tablet | – Modified-release |
| Quetiapine | Seroquel XR | Tablet | – Modified-release |
| Quizartinib | Vanflyta | Tablet | – Other |
| Rabeprazole | Aciphex (US), Aciphex Sprinkle (US) | Capsule, Tablet | – Modified-release |
| Raloxifene | Evista | Tablet | – Bad taste – Teratogenic |
| Ranolazine | Ranexa (US) | Tablet | – Modified-release |
| Regorafenib | Stivarga | Tablet | – Amorphous solid dispersion – Antineoplastic |
| Repotrectinib | Augtyro (US) | Capsule | – Other |
| Ripretinib | Qinlock | Tablet | – Special Technology |
| Risedronate | Actonel | Tablet | – Irritant (oropharyngeal) |
| Risedronate | Atelvia (US) | Tablet | – Modified-release – Irritant (oropharyngeal) |
| Risperidone | Risperdal M | Tablet | – Must be allowed to dissolve on the tongue |
| Ritlecitinib | Litfulo | Capsule | Other |
| Ritonavir | Norvir | Tablet | – Amorphous solid dispersion |
| Ropinirole | Requip XL (US) | Tablet | – Modified-release |
| Selumetinib | Koselugo | Capsule | – Special Technology |
| Sirolimus | Rapamune | Tablet | – Nanocrystal |
| Solifenacin | Vesicare | Tablet | – Bad taste |
| Sotagliflozin | Inpefa | Tablet | – Other |
| Sulfasalazine | Azulfidine EN-Tabs (US) | Tablet | – Modified-release |
| Suvorexant | Belsomra (US) | Tablet | – Amorphous solid dispersion |
| Suzetrigine | Journavx (US) | Tablet | – Other |
| Tacrolimus | Astagraf XL (US) Prograf | Capsule | – Amorphous solid dispersion |
| Tamsulosin | Flomax (US) | Capsule | – Modified-release |
| Tapentadol | Nucynta ER | Tablet | – Modified-release |
| Temozolomide | Temodar (US) | Capsule | – Irritant (cytotoxic) |
| Tezacaftor/Ivacaftor | Symdeko | Tablet | – Amorphous solid dispersion |
| Theophylline | Theo-24 (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Theophylline | Uniphyl, Generics | Tablet | – Modified-release |
| Tipranavir | Aptivus | Capsule | Bad taste |
| Tolterodine | Detrol LA | Capsule | – Modified-release |
| Topiramate | Topamax | Capsule, Tablet | – Bad taste – Capsules can be opened for administration of intact granules |
| Topiramate | Qudexy XR (US), Trokendi XR (US) | Capsule | – Modified-release – Can be opened for administration of intact granules (Qudexy XR) |
| Tramadol | ConZip (US), Ryzolt (US), Ultram ER (US) | Capsule, Tablet | – Modified-release |
| Trazodone | Desyrel, Generics | Tablet | – Bad taste – Scored tablets can be split |
| Trazodone | Oleptro | Tablet | – Modified-release – Scored tablets can be split |
| Tucatinib | Tukysa | Tablet | – Special Technology |
| Vadadustat | Vafseo (US) | Tablet | – Other |
| Valganciclovir | Valcyte | Tablet | – Irritant – Teratogenic, carcinogenic |
| Valproic Acid | Depakene | Capsule | – Irritant (oropharyngeal) |
| Vandetanib | Caprelsa | Tablet | – Antineoplastic – Irritant |
| Vemurafenib | Zelboraf | Tablet | – Amorphous solid dispersion |
| Venetoclax | Venclexta | Tablet | – Amorphous solid dispersion |
| Venlafaxine | Effexor XR | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Verapamil | Verelan, Verelan PM (US) | Capsule | – Modified-release – Can be opened for administration of intact granules |
| Verapamil | Calan SR (US), Covera-HS (US), Isoptin SR | Tablet | – Modified-release – Scored tablets can be split |
| Vimseltinib | Romvimza (US) | Capsule | – Other |
| Vismodegib | Erivedge | Capsule | Teratogenic |
| Voclosporin | Lupkynis | Capsule | – Other |
| Vorasidenib | Voranigo | Tablet | – Other |
| Vorinostat | Zolinza | Capsule | – Irritant (skin and mucous membrane) |
| Xanomeline/Trospium | Cobenfy (US) | Capsule | – Other |
| Zileuton | Zyflo CR (US) | Tablet | – Modified-release |
| Zolpidem | Ambien CR (US) | Tablet | – Modified-release |
| Zolpidem | Intermezzo (US) | Tablet | – Sublingual dosage form |
References:
- Clinical Reference. Medications That Should Not Be Crushed. Pharmacist’s Letter. May 2026 [subscription required to view] https://pharmacist.therapeuticresearch.com
- Drug Label Information, DailyMed. https://dailymed.nlm.nih.gov/dailymed/
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