Updated February 2021

Guide for Crushing Oral Medication for Residents with Swallowing Difficulties
in Residential Aged Care

Medicine Funded brand Form Administration if swallowing difficulties

4
ACICLOVIR Lovir Tablet Soluble, dispersible
3
Swallow whole or disperse in at least 50mL of water
3,4
ALENDRONATE, Fosamax Tablet Do not divide, crush, chew or disperse
1,4
ALENDRONATE with Fosamax Plus Mucous membrane irritant
3
COLECALCIFEROL Alternate bisphosphonate available as injection
3
ALLOPURINOL Allopurinol-Apotex Tablet Scored, may be halved

3
DP-Allopurinol Tablet Scored, may be halved

ALUMINIUM HYDROXIDE Alu-Tab Tablet Film coated. Can crush; mix powder with 5-10mL water,
4
and give immediately.
If aspiration risk, may crush and mix with yoghurt (if
4
appropriate).
3
AMIODARONE Aratac Tablet Scored, uncoated tablet.
May disperse tablet; disperses within 5min. If it does
4
not disperse within 5 min, may crush
4
Tablets have a bitter taste, may be given with fruit juice
3
AMITRIPTYLINE Arrow- Tablet Film coated
Amitriptyline No information
AMLODIPINE Apo-Amlodipine Tablet May be crushed but use immediately, it is very light-
4
sensitive
3
Do not halve
Vasorex No information
3
AMOXICILLIN Alphamox Capsule Alternative route available
3
Apo-Amoxi Oral liquid form available
3
AMOXICILLIN/ Augmentin Tablet Film coated
CLAVULANIC ACID Can crush, but use immediately (clavulanic acid is
4
Curam Duo 500/125 sensitive to moisture)
3
Alternative route available; oral liquid form available
3
ARIPIPRAZOLE Aripiprazole Tablet Swallow whole
Sandoz
3
ANASTRAZOLE Rolin Tablet Film coated
3
Do not halve
ASCORBIC ACID Cvite Tablet No information
7
ASPIRIN EC Ethics Aspirin EC Tablet Enteric coated, swallow whole; do not divide, crush,
4,7
chew or disperse
7
Soluble, dispersible tablet available
7
ASPIRIN Ethics Aspirin Tablet Soluble, dispersible; dissolve in water before taking
(dispersible)
Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

3
ATENOLOL Mylan Atenolol Tablet Film coated, may be halved

ATORVASTATIN Lorstat Tablet Film coated; 20mg, 40mg and 80mg may be halved but
the divided portion should be swallowed whole, not
3
chewed
3
AZATHIOPRINE Azamun Tablet Film coated
3,4
Swallow whole, do not divide or chew
BACLOFEN Pacifen Tablet No information

3
BENDROFLUAZIDE Arrow- Tablet Do not halve
Bendrofluazide

BETAHISTINE Vergo 16 Tablet No information

3
BEZAFIBRATE Bezalip Tablet Film coated tablet, swallow whole

3
BEZAFIBRATE SR Bezalip Retard Tablet Sustained release, film coated
4
Do not divide, crush, chew or disperse
3
BISACODYL EC Lax-Tab Tablet Enteric sugar coated; swallow whole
4
Do not divide, crush, chew or disperse
3
Alternative route available, suppositories available
BISOPROLOL Bosvate Tablet Can be halved, but the divided portion should be
3
swallowed whole and not chewed
3
Bisoprolol Mylan Film coated tablet
3
Swallow whole, do not chew
BROMOCRIPTINE Apo-Bromocriptine Tablet No information

4
BUMETANIDE Burinex Tablet May be crushed

3
BUSPIRONE Orion Buspirone Tablet Can be divided into equal doses

CALCITRIOL Calcitriol-AFT Capsule No information

CALCIUM CARBONATE Arrow-Calcium Tablet No information

4
Calci-Tab 500 May be crushed
7
CALCIUM CARBONATE Calcium Sandoz Tablet Effervescent tablet, dissolve in water
EFFERVESCENT

CANDESARTAN Candestar Tablet No information

4
CARBAMAZEPINE Tegretol Tablet May disperse in water
7
Alternative route available, oral liquid form available
3
CARBAMAZEPINE CR Tegretol CR Tablet Controlled release, film coated
4
Do not divide, crush, chew or disperse
3
May be halved
4
CARBIMAZOLE Neo-Mercazole Tablet May be crushed

CARVEDILOL Carvedilol Sandoz Tablet May be dispersed, will disperse within 5 min with
4
shaking
Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

CEFACLOR Ranbaxy-Cefaclor Capsule Alternative route available,

3
oral liquid form available
3
CELIPROLOL Celol Tablet Film coated
No information
3
CETIRIZINE Zista Tablet Film coated; may be halved

3 4
CICLOSPORIN Neoral Capsule Swallow whole, do not crush, chew or open
3
Alternative route available, oal liquid form available
3
CILAZAPRIL Zapril Tablet Film coated
3
May be divided
CILAZAPRIL/ Apo-Cilazapril/ Tablet Film coated; do not chew, swallow whole with glass of
3
HYDROCHLOROTHIAZIDE Hydrochloro- water
thiazide
3
CIPROFLOXACIN Cipflox Tablet Film coated
3
The 500mg strength may be halved
3
Alternative route available, oral liquid form available
3
CITALOPRAM PSM Citalopram Tablet Film coated
No information
CLINDAMYCIN Dalacin C Capsule Can disperse capsule contents in water, but has an
4
unpleasant taste; can mix with food to mask taste
3
CLOMIPRAMINE Apo-Clomipramine Tablet Film coated; do not halve

4 3
CLONAZEPAM Paxam Tablet May be crushed may be halved
3
Alternative route available, oral liquid form available
, 3
CLONIDINE Clonidine BNM Tablet Alternative route available transdermal patch available

4
Catapres May be dispersed in water
3
May be halved
3
Alternative route available, oral liquid form available
3
CLOPIDOGREL Clopidogrel – Tablet Film coated
Multichem No information

CLOZAPINE Clozaril Tablet No information

4 3
Clopine May be crushed, but poorly soluble May be halved
3
Oral liquid form available (Clopine only)
CODEINE PHOSPHATE Codeine phosphate Tablet No information
PSM
4
COLCHICINE Colgout Tablet May be dispersed in water

3
COLECALCIFEROL Vit.D3 Capsule Soft gelatin capsule
No stability data about withdrawal of capsule
4.6
contents
3
CO-TRIMOXAZOLE Trisul Tablet Alternative route available, oral liquid form available
3
CYCLIZINE Nausicalm Tablet Can be divided into equal doses
3
Alternative route available
Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

4
CYCLOPHOSPHAMIDE Cycloblastin Tablet Do not divide, crush, chew or disperse Cytotoxic,
2
occupational health and safety risk to staff
4
DABIGATRAN Pradaxa Capsule Do not crush, chew or open Bioavailability increases by
1
75% when pellets are taken without the capsule shell
DEXAMETHASONE Dexmethsone Tablet Disperse and give within 1-5min, with or soon after
4
food
.
DIAZEPAM Arrow-Diazepam Tablet Can be divided into equal doses Alternative route
3
available, suppositories available
3,4
DICLOFENAC EC Diclofenac Sandoz Tablet Enteric coated; do not crush, divide or chew
Alternative route available, suppositories available,
3
dispersible tablet available
DICLOFENAC SR Apo-Diclo SR Tablet Slow release. Swallow whole, do not divide, crush, chew
3
or disperse
3
Alternative route available, suppositories available
4
DIGOXIN Lanoxin Tablet May be crushed
3
Alternative route available oral liquid form available
Lanoxin PG
3
DIHYDROCODEINE DHC Continus Tablet Long- acting; swallow whole
3
TARTRATE LA Do not divide, crush, chew or disperse
3 4
DILTIAZEM Dilzem Tablet Film-coated; may be crushed
3
DILTIAZEM CD Apo-Diltiazem CD Capsule Controlled delivery; do not crush or chew

3
DIPYRIDAMOLE SR Pytazen SR Tablet Sustained release; swallow whole
3
Do not divide, crush, chew or disperse
7
DOCUSATE & SENNA Laxsol Tablet Film coated, sugar free
No information
4
DOCUSATE SODIUM Coloxyl Tablet May be crushed
4
Do not disperse (takes longer than 5min)
DOMPERIDONE Domperidone Tablet No information
(Pharmacy Health)
3
DONEPEZIL Donepezil-Rex Tablet Film coated
No information
DOXAZOSIN Apo-Doxazosin Tablet No information

3
DOXYCYCLINE Doxine Tablet Film coated
3
Crushing may cause oesophageal irritation
ENALAPRIL Acetec Tablet No information

3
ENTACAPONE Entapone Tablet Film coated
No information
3,4
ERYTHROMYCIN E-Mycin Tablet Film coated
3
Alternative route available oral liquid form available
3
ESCITALOPRAM Apo-Escitalopram Tablet Film coated
4
Disperses rapidly in water
4
Crushed tablets have unpleasant taste

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded Brand Form Administration if swallowing difficulties

EZETIMIBE Ezetimibe-Sandoz Tablet No information

4
FAMOTIDINE Pepzan Tablet Disperse tablet in 5-10mL water and given immediately
4
May crush tablet if not dispersed within 3-5 min
3
FEBUXOSTAT Adenuric Tablet Film-coated, immediate release
3
FELODIPINE ER Felo 5 ER Tablet Extended release
3
Do not divide, crush or chew
7
FERROUS FUMARATE Ferro-tab Tablet Swallow whole
7
Alternative route available, oral liquid form available
4 4
FERROUS FUMARATE with Ferro-F-tabs Tablet Film coated; do not divide, crush, chew or disperse
7
FOLIC ACID Alternative route available, oral liquid form available
4
FERROUS SULPHATE Ferrograd Tablet Film coated, modified release
4
(long acting) Do not divide, crush, chew or disperse
7
Alternative route available, oral liquid form available
4
FERROUS FUMARATE with Ferro F Tablet Film coated
4
FOLIC ACID Swallow whole with a full glass of water
(long acting)
3
FINASTERIDE Ricit Tablet Film coated
Women of child-bearing potential should not crush or
3
handle broken tablets
FLUCLOXACILLIN Staphlex Capsule Do not crush, chew or open; contents have a bitter
4
taste
3
Alternative route available, oral liquid form available
3
FLUCONAZOLE Mylan Capsule Swallow the capsules whole with a glass of water
3
Alternative route available, oral liquid form available
FLUDROCORTISONE Florinef Tablet May be dispersed in water; will disperse within 1
4
ACETATE minute, give immediately after dispersing
3
FLUOXETINE Fluox Capsule Swallow whole; soluble, dispersible tablet available
3
FLUOXETINE Fluox Tablet Soluble, dispersible
(dispersible) May be swallowed whole, or broken in half for a 10mg
dose, or dispersed in 100mL of water before drinking
3
immediately
FOLIC ACID Apo-Folic acid Tablet No information

3
FUROSEMIDE Apo-Furosemide Tablet Oral liquid available
(FRUSEMIDE)
Urex Forte May disperse; halve prior to dispersing, will disperse
4
within 5 min
GABAPENTIN Apo-Gabapentin Capsule Capsule contents have an unpleasant taste. May open
capsule and mix contents with apple sauce or orange
4
juice. Give immediately (gabapentin hydrolyses rapidly)
3
GLICLAZIDE Glizide Tablet May be halved

GLIPIZIDE Minidiab Tablet Disperse in water; will disperse in 1 minute, give

4
immediately after dispersing

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

4
HALOPERIDOL Serenace Tablet May crush but slow to disperse
3
Alternative route available, oral liquid form available
4
HEXAMINE Hiprex Tablet May crush but slow to disperse (longer than 5min)
3
HYDROXYCHLOROQUINE Plaquenil Tablet Film coated tablets
4
May crush but slow to disperse (longer than 5 min)
HYDROXYUREA Devatis Capsule The contents of the capsules may be emptied into a
3
(HYDROXYCARBAMIDE) glass of water and taken immediately.
Wear gloves, do not inhale the powder, wash hands
3
before and after handling
3 4
HYOSCINE BUTYL BROMIDE Buscopan Tablet Sugar coated; can be crushed
3
Injectable form available

IBUPROFEN Ibuprofen Relieve Tablet Film coated; swallow whole, do not chew, break, crush
or suck – may cause oral discomfort and throat
3
irritation
3
Oral liquid form available
3
IBUPROFEN SR Brufen SR Tablet Sustained release
7
Swallow whole with plenty of fluids
3
Ibuprofen SR BNM Sustained release
3
Swallow whole with plenty of fluids
Do not chew, break, crush or suck tablets to avoid oral
3
discomfort and throat irritation
3
IMIPRAMINE Tofranil Tablet Sugar coated
4 4
Can crush but slow to disperse (longer than 5 min)
3
INDAPAMIDE Dapa-Tabs Tablet Film coated; do not halve
4
May be crushed
3
ISOSORBIDE MONONITRATE Ismo 20 Tablet Do not chew, may be divided along the score line

3,4
ISOSORBIDE MONONITRATE Duride Tablet Sustained release; swallow whole
4
SR Do not crush, chew or disperse
3.4
May be divided (but each portion swallowed whole)
3
Immediate release preparations available
3
Ismo 40 Retard Slow release; swallow whole
3
Immediate release preparations available

IVERMECTIN Stromectol Tablet No information

3,4
LAMOTRIGINE Logem Tablet Chewable, soluble, dispersible
May be chewed, dispersed in a small amount of water,
3,4
Lamictal or swallowed whole

3
LANSOPRAZOLE Lanzol Relief Capsule Swallow whole, with a full glass of water, do not chew

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

3
LEFLUNOMIDE Arava Tablet Film coated
3
Swallow whole, do not divide
May disperse using a closed system such as an oral
4
dispenser; will disperse within 5 min of shaking
Warning: Do not handle dispersed tablets if pregnant or
4
intending to become pregnant
3
LETROZOLE Letrole Tablet Film coated; swallow whole do not halve
Letromyl
3
LEVETIRACETAM Everet Tablet Film coated; do not halve
7
Oral liquid available
4
LEVODOPA/CARBIDOPA Sinemet Tablet May disperse in water and use immediately
3
Do not divide
3
LEVODOPA/CARBIDOPA CR Sinemet CR Tablet Controlled release
3
Do not divide, crush, chew or disperse
3
Immediate release preparations available
3
LEVODOPA/BENSERAZIDE Madopar Rapid Tablet Soluble dispersible tablet
4
(dispersible) Disperse in 10mL water before taking
3,4
LEVODOPA/BENSERAZIDE Madopar Capsule Swallow whole, do not crush, chew or disperse
3
(long acting) Soluble or dispersible tablet available
LEVODOPA/BESERAZIDE Madopar HBS Capsule Modified release; swallow whole, do not crush, chew,
3,4
disperse or open capsules
Immediate release and dispersible preparations
3
available
3
LEVOMEPROMAZINE Nozinan Tablet Film coated
3
MALEATE Injectable form available
LISINOPRIL Ethics Lisinopril Tablet No information

LITHIUM CARBONATE Lithium Carbonate Capsule No information

(Douglas)
3
LITHIUM CARBONATE Priadel Tablet Modified release
3
(long acting) Scored, may be halved
3
Do not, crush, chew or swallow with hot liquid
LOPERAMIDE Diamide Relief Capsule No information

3
Nodia Tablet Scored tablet, but do not halve, swallow whole

LORATADINE Lorafix Tablet No information

4
LORAZEPAM Ativan Tablet Disperse in water

3 3
LOSARTAN Losartan Actavis Tablet Film coated; do not halve

3
LOSARTAN AND Arrow-Losartan & Tablet Film coated
HYDROCHLORTHIAZIDE Hydrochlorothiazide No information

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

3
MEBEVERINE Colofac Tablet Sugar coated
3
Swallow whole with a full glass of water Do not chew,
3
has a very bitter taste
4
Slow to disperse
4
MEDROXYPROGESTERONE Provera Tablet Will disperse within 1-2 minutes
Gloves and mask should be worn, women of child-
bearing potential should not crush or handle broken
4
tablets
3
MELATONIN Circadin Tablet Prolonged release; swallow whole
(long acting)
7
MESALAZINE Pentasa Tablet Prolonged-release; do not divide, crush or chew
(long acting) May disperse in 50mL of cold water; stir and drink
3
immediately
3
Alternative route available, suppositories available
3
MESALAZINE EC Asacol Tablet Enteric coated; do not divide, crush, chew or disperse
3
Alternative route available, suppositories available
Asamax

3
METFORMIN Metformin Apotex Tablet Film coated
No information
3
METHADONE Methatabs Tablet Alternative route available
3
Oral liquid form available
3
METHOTREXATE Trexate Tablet Do not divide, crush, chew or disperse
Cytotoxic; crushing causes occupational health and
3
safety risk
3
METHYLPREDNISOLONE Medrol Tablet Do not halve

3
METOCLOPRAMIDE Metoclopramide Tablet Film coated; may be divided
3
Actavis Alternative route available

3
METOPROLOL SUCCINATE Betaloc CR Tablet Controlled release
3
CR May be halved, but must not be chewed, crushed or
6
dispersed
METOPROLOL TARTRATE Apo-Metoprolol Tablet No information
3
METOPROLOL TARTRATE Slow-Lopresor Tablet Slow release; do not divide, crush, chew or disperse
(long acting)
METRONIDAZOLE Metrogyl Tablet Tablet may be dispersed, will disperse within 5min (has
an unpleasant taste, give with or immediately after
4
food)
3
Alternative route available
3
Oral liquid form available
MIDODRINE Gutron Tablet No information
3
MIRTAZAPINE Apo-Mirtazapine Tablet Film coated; do not chew
4
May be crushed
4
MOCLOBEMIDE Aurorix Film coated
May crush tablet; tablets are slow to disperse (longer
4
than 5min)

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

3
MORPHINE SULPHATE Sevredol Tablet Film coated, do not chew but may halve
2
Crushing will cause unacceptable taste
3
Alternative route available; oral liquid form available
3
MORPHINE SULPHATE m-Eslon Capsule Modified release
(long acting) May be opened, and microgranules given with soft food
or liquids. Do not chew or crush granules, this will cause
3
rapid release of morphine and toxic concentrations
3
MORPHINE SULPHATE Arrow-Morphine Tablet Long acting; swallow whole, do not chew
(long acting) LA

MULTIVITAMINS Mvite Tablet No information

MULTIVITAMIN RENAL Clinicians Renal Capsule No information

Vit
3
NAPROXEN Noflam Tablet Can be halved and the halves swallowed whole

3,4
NAPROXEN SR Naprosyn SR Tablet Slow release; do not divide, crush, chew or disperse
3
Immediate release formulation available
3
NEFOPAM Acupan Tablet Film coated
3
NIFEDIPINE Adalat Tablet Controlled release
3,4
(long acting) Do not divide, crush, chew or disperse;
Adalat oros

Nyefax Retard

NITROFURANTOIN Nifuran Tablet No information

3
NORFLOXACIN Arrow-Norfloxacin Tablet Film coated
No information
3
NORTRIPTYLINE Norpress Tablet Film coated
No information
3
OLANZAPINE Zypine Tablet Film coated; swallow whole, do not halve
3
Dispersible tablets available

3
OLANZAPINE Zypine ODT Tablet Orodispersible
(dispersible) Do not halve, place in mouth whole to disperse in saliva,
3
followed by a glass of water

OMEPRAZOLE Omeprazole Capsule May open capsule and contents swallowed with liquid
Activis or mixed in fruit juice, yoghurt or water, dispersed for
30minutes before drinking. The pellets must not be
3
crushed or chewed
3
Alternative route available
7
Oral liquid form available

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

3
ONDANSETRON Onrex Tablet Film coated
No information
3
ONDANSETRON Ondansetron Tablet Orally disintegrating
(dispersible) ODT-DRLA Do not halve; place on top of tongue to disperse, then
3
swallow
4
ORPHENADRINE CITRATE Norflex Tablet May be crushed
3
OXAZEPAM Ox-Pam Tablet Swallow whole with water

OXYBUTYNIN Apo-Oxybutynin Tablet No information

7
Oral liquid available
3
OXYCODONE OxyNorm Capsule Swallow whole, do not open, chew or crush
3
Alternative route available
3
Oral liquid form available
3
OXYCODONE Oxycodone Tablet Controlled release; swallow whole
3
(long acting) Sandoz Do not open, chew or crush
3
Alternative route available
3
Oral liquid form available
3
PANTOPRAZOLE EC Panzop Relief Tablet Enteric coated; swallow whole, do not chew
3
Do not divide, crush, or disperse tablet
3
PARACETAMOL Paracetamol Tablet Alternative route available; suppositories available
3
(Pharmacare) Oral liquid form available

3
PARACETAMOL & CODEINE Relieve Tablet May be divided

3
PAROXETINE Loxamine Tablet Film coated; swallow whole

4 4
PERHEXILINE Pexsig Tablet May crush; slow to disperse, longer than 5min
3
PHENYTOIN Dilantin Capsule Swallow whole with at least half a glass of water
Alternative route available, oral liquid form available
2
(but check bioequivalence)
7
PHOSPHATE Phosphate- Tablet Effervescent; can be dissolved in water
Sandoz
4
PIZOTIFEN Sandomigran Tablet May crush; slow to disperse, longer than 5min

POTASSIUM CHLORIDE Span-K Tablet Sustained release; do not divide, crush, chew or
3,4
(long acting) disperse
3
Soluble or dispersible tablet available
7 3,4
POTASSIUM CHLORIDE/ Chlorvescent Tablet Effervescent, soluble, dispersible
4
POTASSIUM BICARBONATE/ Dissolve in at least half a glass of water
POTASSIUM CARBONATE
PREDNISONE Apo-Prednisone Tablet No information
7
Prednisolone syrup available
3
PREGABALIN Pregabalin-Pfizer Capsule Swallow whole with a full glass of water
6e
Do not open capsules
3
PROCHLORPERAZINE Nausafix Tablet Alternative route available
7
Buccal tablets available

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Funded brand Form Administration if swallowing difficulties

3
PROMETHAZINE Allersoothe Tablet Film coated
3 7
Alternative route available Oral liquid available
3
PROPRANOLOL Apo-propranolol Tablet Do not halve

3
PROPRANOLOL Cardinol LA Capsule Long acting; do not divide, crush, chew or disperse
(long acting)
4
PYRIDOSTIGMINE Mestinon Tablet Can crush, slow to disperse, longer than 5 min
4
PYRIDOXINE Apo-Pyridoxine Tablet May be crushed, or dispersed in water

Vitamin B6 25
3
QUETIAPINE Quetapel Tablet Film coated; do not halve

QUINAPRIL Arrow-Quinapril Tablet Film coated; swallow whole with a full glass of water, do
3
not chew
QUINAPRIL/ Accuretic Tablet Film coated; swallow whole with a full glass of water, do
3
HYDROCHLOROTHIAZIDE not chew
QUININE SULPHATE Q 300 Tablet Film coated, swallow whole with a full glass of water, do
3
not crush or chew
3 1
RALOXIFENE Evista Tablet Film coated tablets have unpleasant taste
1
Avoid contact with skin; teratogenic potential
RISEDRONATE Risedronate Tablet Film coated, swallow whole with a glass of water and
3
Sandoz remain upright for 30min after swallowing
Do not chew or suck; potential for oropharyngeal
3
irritation
3
RISPERIDONE Risperidone Tablet Film coated; do not halve
3
(Actavis) Alternative route available, oral liquid form available

3
RIVAROXABAN Xarelto Tablet Film coated tablet
Tablets may be crushed and mixed with water or apple
3
sauce immediately prior to use
3
ROPINIROLE Ropin Tablet Film coated
No information
3
ROXITHROMYCIN Arrow- Tablet Film coated; swallow whole
7
Roxithromycin Dispersible tablet available
(Teva)

ROXITHROMYCIN Rulide-D Tablet Dispersible tablet. Disperse in a small amount of water

7
(dispersible) (may take 30-40 seconds)
Give immediately after dispersion, the suspension
4
develops a bitter taste over time
SERTRALINE Setrona Tablet May be crushed but has a bitter taste and slight
4
anaesthetic effect
4
Disperse tablets within 1-5min with agitation
3
SIMVASTATIN Simvastatin Mylan Tablet Film coated
No information
SODIUM BICARBONATE Sodibic Capsule May open and disperse contents in 10mL water, give
4
immediately
Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Brand name Form Administration if swallowing difficulties

3,4 3
SODIUM VALPROATE Epilim Crushable Tablet May be crushed but do not halve
3
Alternative route available, oral liquid form available
3
SODIUM VALPROATE EC Epilim Tablet Enteric coated
4
Do not divide, crush, chew or disperse
3
Alternative route available, oral liquid form available
SOTALOL Mylan Tablet No information

3
SOLIFENACIN Mylan Tablet Film coated; swallow whole
4
Crushed tablets may be irritant to eyes
4
SPIRONOLACTONE Spiractin Tablet May be dispersed in water, will disperse within 2-5 min

4
SULFASALAZINE Salazopyrin Tablet May be crushed

3,4
SULFASALAZINE EC Salazopyrin EN Tablet Enteric coated; do not divide, crush, chew or disperse
2,3
Immediate release tablet available
3
SUMATRIPTAN Apo-Sumatriptan Tablet Film coated; swallow whole with water, do not halve
3 3
Alternative route available injectable form available

3
TAMSULOSIN Tamsulosin-Rex Capsule Modified release; swallow whole, do not crush or chew
(long acting)
TAMOXIFEN Tamoxifen Sandoz Tablet Disperse tablet in 5-10mL of water, using a closed
4
system such as an oral dispenser
4
Hazardous, take precautions when dispersing
Women of child-bearing potential should not crush or
4
handle broken tablets
3
TEMAZEPAM Normison Tablet Do not halve
4
Tablet difficult to disperse
3
TENOXICAM Tilcotil Tablet Film coated, do not chew but can divide

3
TERAZOSIN Apo-Terazosin Tablet Do not halve

3
TERBINAFINE Deolate Tablet Scored

3,4
THEOPHYLLINE SR Nuelin-SR Tablet Slow release; do not divide, crush, chew or disperse
7
THIAMINE Max Health Tablet Uncoated
No information

3
THYROXINE Eltroxin Tablet Swallow whole with a full glass of water, do not halve
(Levothyroxine)
3
Mercury Pharma Swallow whole

Synthroid May be crushed and suspended in 5-10mL water, or

sprinkled on small amount of food (eg apple sauce), and
3
given immediately
TICAGRELOR Brilinta Tablet Film coated; can crush, mix with water, stir and drink
3
immediately
3
TOLCAPONE Tasmar Tablet Film coated; swallow whole, has bitter taste

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand
 Updated February 2021

Medicine Brand name Form Administration if swallowing difficulties

3
TOLTERODINE Arrow-Tolterodine Tablet Film coated
No information
3
TRAMADOL Arrow-Tramadol Capsule Swallow whole with water

TRAMADOL SR Tramal SR Tablet Sustained release; do not divide, crush, chew or

3,4
disperse
3
TRANEXAMIC ACID Mercury Pharma Tablet Film coated
No information
3
TRIAZOLAM Hypam Tablet Do not halve

3
TRIMETHOPRIM TMP Tablet Swallow whole with water
3
VENLAFAXINE Enlafax XR Capsule Extended release; do not crush, chew or disperse

3 4
VERAPAMIL Isoptin Tablet Film coated, may be crushed
4
VERAPAMIL SR Isoptin SR Tablet Sustained release; do not crush
3
Immediate release tablets available
VITAMIN B COMPLEX Bplex Tablet No information

4
WARFARIN Coumadin Tablet May be crushed
4
Marevan May be dispersed, will disperse within 5min
4
ZINC SULPHATE Zincaps Capsule May open and disperse contents in water

3
ZOPICLONE Zopiclone Actavis Tablet Film coated; may be halved

References
1. Mitchell JF. ISMP (Institute for Safe Medication Practices) Oral Dosage Forms That Should Not Be Crushed January 2014
http://www.ismp.org/tools/donotcrush.pdf (Accessed 21-07-14)
2. 8.1 Draft guidelines for modification of oral formulations. (Adapted from ‘Guidelines for medication management in residential
aged care facilities; Australian Pharmaceutical Advisory Council November 2002’ and ‘Australian Pharmaceutical Formulary and
th th
Handbook 18 edition and 19 edition’.)
3. Medsafe Data Sheets and Consumer Medicines Information www.medsafe.govt.nz (Accessed October 2017)
4. Society of Hospital Pharmacists of Australia. Don’t rush to crush handbook. First edition; Dec 2011; ISBN 978-0-987-1103-3-6
5. The Drugsite Trust. Docusate. www.drugs.com/mtm/docusate.html (Accessed 11-08-14)
6. Direct correspondence with manufacturer
7. New Zealand Formulary www.nzf.org.nz

Disclaimer: This document is considered to be a guide only and is not intended to replace sound clinical practice. Occupational health and safety risks
in crushing medicines can be significant. Crushing tablets may have repercussions on the licensed status of the medicine and how the medicine may
affect the patient. Please check with a pharmacist for further advice if necessary.
Document number: 010-03-09-004 Review date: April 2021
Developed and maintained by Bernadette Rehman, Clinical Pharmacist, Residential Aged Care, Waitemata District Health Board, New Zealand and
Angela Lambie, Quality Use of Medicines Pharmacist, Waitemata District Health Board, New Zealand