What tablets can't you crush?

RE: What tablets can't you crush?

Andrea Tarr — Wed, 03 Apr 2019 11:58:39 GMT

Recommendations on whether or not to give with food should be in the SPC/data sheet. For example grapiprant (Galliprant) "Administer on an empty stomach (e.g. in the morning) and at least one hour before the next meal" Giving a grapiprant tablet with food reduces its absorption, so that the maximum serum concentration is delayed by 1.5 hours and the total amount of drug absorbed is reduced. I don't know of a list. It would be possible to create one - but a big project.

If a product needs to be modified, identify any potential problems with stability, safety, or palatability that a might arise as a result (e.g. because of cytotoxicity, teratogenicity, irritancy or bitterness). If a tablet is sugar- or film- coated, check why, before crushing it. The Colchester NHS Medicines Information service has published a helpful guide on crushing tablets. Click here to get to it. Proper data on the bioavailability of such manipulated forms is lacking, so patients having reformulated medicines should be carefully monitored. Generally, modified-release tablets should not be crushed or split and modified-release capsules should not be opened.

Extract from Veterinary Prescriber "Good veterinary dispensing practice"

RE: What tablets can't you crush?

David Mills — Mon, 01 Apr 2019 17:16:09 GMT

[quote user="Thomas Johnson"]

[quote user="David Mills"]There are other considerations, related to the owner, such as with methimazole or carbimazole, but this isn't related to efficacy AFAIK.[/quote]

I thought that Vidalta shouldn't be crushed because it only worked as a prolonged release formulation if swallowed whole, whereas if it is crushed the whole dose is absorbed straight away.

[/quote]

Yes, but whether this affects efficacy is unknown. Some people recommend giving it BID if crushing (which somewhat removes the convenience of SID). Cat will stabilise on methimazole SID so I can't see how getting the hit of carbimazole all in one go should be any different?

Though why anyone now uses tablets with thyronorm liquid being launched at an aggressive price point, escapes me.

RE: What tablets can't you crush?

Thomas Johnson — Mon, 01 Apr 2019 15:12:43 GMT

[quote user="David Mills"]There are other considerations, related to the owner, such as with methimazole or carbimazole, but this isn't related to efficacy AFAIK.[/quote]

I thought that Vidalta shouldn't be crushed because it only worked as a prolonged release formulation if swallowed whole, whereas if it is crushed the whole dose is absorbed straight away.

RE: What tablets can't you crush?

Lucy Fleming — Mon, 01 Apr 2019 10:31:57 GMT

[quote user="Beats"]I was looking to split these to 5mg and make up in cheap gelatin capsules[/quote]

Summit do a compounded 5mg omeprazole tablet if you wanted to make your life easier than splitting capsules.

[quote user="Beats"] it's hardly the most hazardous drug in the world[/quote] It's not the nicest either - at least if you are pregnant. The datasheet for the liquid formulation states that "women of child-bearing age" should wear gloves when handling the drug or waste from treated cats, and pregnant women shouldn't administer it or change trays, clean up vomit etc.

RE: What tablets can't you crush?

Beats — Sun, 31 Mar 2019 19:56:36 GMT

[quote user="David Mills"]Some are in gastro-resistant form so shouldn't be split - I think omeprazole is like that[/quote]

You can get omeprazole in tablet form as well (eg MUPS). You can halve that and then crush the 5mg and mix it in a babies milk bottle. I've assumed the same logic may apply in dogs. The tablet contains "enteric coated pellets" I believe.

Happened to be looking at this today (given how much cheaper the capsules are...), and the "gastro-resistant capsules" appear to just be hard gelatin capsules? I was looking to split these to 5mg and make up in cheap gelatin capsules. Didn't reach a conclusion on whether that was valid or not... anyone know for sure?

PS - I can confirm that felimazole still works crushed; the sugar coating is supposedly to protect the owner from handling the drug (the factory it was made in had capability to do sugar coating, so was convenient), but it's hardly the most hazardous drug in the world and I note a liquid formulation passed approval...

RE: What tablets can't you crush?

Julian Earl — Sun, 31 Mar 2019 16:59:30 GMT

If sugar-coated then don't crush. Nor empty out capsules. e were aught that amoxycillin has a far higher bio-availability than say, ampicillin, so I have always that he former could be used in food but not the latter. In humans, non-steroidals are advised ken after food so those may be okay in food as well for dogs? Anything in a palatable base is surely okay inood? eg. Rimadyl? Or -Pet-Tabs, on the grounds that if a palatable base does not affect absorption why should a modest volume of food do so?

One culd always ask the manufacturers tablet by tablet I suppose. But adding this crucial info. to the data sheet would be very sensible.

RE: What tablets can't you crush?

Sammy82 — Sun, 31 Mar 2019 15:23:08 GMT

Anything that has a coating I wouldn't crush as even if not gastro-resistant the coating is there to hide a horrible taste. Anything that is meant to be split can be safely crushed. I always advise to mix medicines in small amount of food and give the rest of the meal once this has been eaten, unless the animal reliably finishes their meal in 2min flat.

RE: What tablets can't you crush?

Lucy Fleming — Sun, 31 Mar 2019 10:23:26 GMT

I know that tramadol and amitryptilline are meant to be particularly bitter and unpleasant tasting, so wouldn't advise crushing them (as tablet coating should help to mitigate these). There must be more but those are the ones that spring immediately to mind.

RE: What tablets can't you crush?

Michael Woodhouse — Sat, 30 Mar 2019 23:50:27 GMT

The handy thing about a tablet is that they are easy to tell if it's gone or not. How much food will you doctor with your crushed tablet? What if it only eats half? What of the dog comes along and clears the plate?

RE: What tablets can't you crush?

Neil Wheadon — Sat, 30 Mar 2019 22:39:38 GMT

[quote user="David Mills"]Thankfully, belatedly, pharma companies have started to produce splittable tablets in a lot of cases, meaning only one size needs to be stocked for dogs and cats (metrobactin, the new doxycycline, clindamycin, pimobendan). [/quote]

The problem with splittable tablets is ease of use especially small dogs and cats. Metrobactin is a good example. Sized like dinner plates, splitting into 4 means swallowing 1/4 must be pretty uncomfortable.

I've seen tablet crushers in one practice and it does seem a very good way of getting round a compliance issue.

Neil

RE: What tablets can't you crush?

David Mills — Sat, 30 Mar 2019 20:36:01 GMT

I'm not sure there is a list, I've never seen one.

Generally, from a purely bioavailability viewpoint, if they are in dry tablet form, crushing shouldn't affect their efficacy. There are other considerations, related to the owner, such as with methimazole or carbimazole, but this isn't related to efficacy AFAIK.

Some are in gastro-resistant form so shouldn't be split - I think omeprazole is like that, there may be others. Generally the capsulated medication is only housed in gelatin, which dissolves when it hits the stomach, so the powder can be split from inside.

Thankfully, belatedly, pharma companies have started to produce splittable tablets in a lot of cases, meaning only one size needs to be stocked for dogs and cats (metrobactin, the new doxycycline, clindamycin, pimobendan).