Can lopressor be crushed. What are the risks of crushing certain medications. How to properly administer metoprolol for maximum efficacy. When is it safe to crush or split tablets. What alternatives exist for patients who have difficulty swallowing pills.

Understanding Metoprolol (Lopressor) and Its Proper Administration

Metoprolol, commonly known by its brand name Lopressor, is a beta-blocker medication used to treat various cardiovascular conditions. Proper administration of this drug is crucial for its effectiveness and patient safety. One common question that arises is whether Lopressor can be crushed.

Can Lopressor be crushed? The answer depends on the specific formulation of metoprolol being used. Some forms of metoprolol can be crushed, while others should not be. It’s essential to understand the differences and consult with a healthcare professional before altering any medication.

Types of Metoprolol Formulations

• Immediate-release tablets (Lopressor)
• Extended-release tablets (Toprol XL)
• Oral solution

Immediate-release metoprolol tablets (Lopressor) can generally be crushed if necessary. However, extended-release formulations like Toprol XL should not be crushed, as this can alter the drug’s release profile and potentially cause harmful side effects.

The Importance of Proper Medication Administration

Administering medications correctly is vital for their efficacy and patient safety. Crushing tablets or opening capsules can sometimes be necessary, but it’s not always appropriate or safe.

Why is proper administration so important? When medications are formulated, their design takes into account factors such as:

• Drug absorption rate
• Release timing
• Protection from stomach acid
• Taste masking

Altering the medication’s form by crushing or chewing can disrupt these carefully designed features, potentially leading to reduced effectiveness or increased side effects.

When Crushing Medications Is Not Recommended

Certain types of medications should never be crushed or chewed. These include:

1. Sustained-release or extended-release formulations
2. Enteric-coated tablets
3. Sublingual or buccal tablets
4. Capsules containing beads or pellets
5. Sugar-coated tablets for taste masking

How can you identify these medications? Look for specific prefixes or suffixes in the drug name, such as CR, ER, XL, XR, or SR, which often indicate extended-release formulations. Always consult the medication’s package insert or a healthcare professional if you’re unsure.

Alternatives for Patients with Swallowing Difficulties

For patients who have trouble swallowing pills, there are several potential alternatives:

• Liquid formulations
• Dissolvable tablets
• Transdermal patches
• Injectable forms (in some cases)

In the case of metoprolol, an oral solution is available for patients who cannot swallow tablets. Always consult with a healthcare provider or pharmacist to determine the most appropriate alternative for your specific situation.

Administering Medications Through Enteral Feeding Tubes

For hospitalized patients with enteral feeding tubes, medication administration requires special consideration. How should medications be given through these tubes?

1. Use liquid formulations when available
2. Consult hospital pharmacy for extemporaneous liquid preparations
3. Consider injectable formulations if appropriate and compatible
4. Crush only immediate-release tablets that are safe to crush

It’s crucial to consult with a hospital pharmacist before administering any medication through an enteral feeding tube to ensure compatibility, stability, and proper absorption.

The Role of Pharmacists in Medication Administration

Pharmacists play a critical role in ensuring safe and effective medication use. They can provide valuable information on:

• Whether a specific medication can be crushed or split
• Alternative formulations available
• Potential drug interactions
• Proper administration techniques

When in doubt about how to take a medication, always consult your pharmacist. They are an excellent resource for medication-related questions and can help prevent potential errors in administration.

New Developments in Drug Formulations

Pharmaceutical companies are continually developing new formulations to improve medication administration and patient compliance. Some recent innovations include:

• Scored extended-release tablets that can be halved (e.g., Toprol XL)
• Orally disintegrating tablets
• Long-acting injectable formulations
• Transdermal patches for various medications

These advancements aim to provide more options for patients with different needs and preferences, potentially improving medication adherence and outcomes.

Recent FDA Approvals and Their Administration Guidelines

The FDA regularly approves new drugs and formulations. Here are some recent approvals with specific administration guidelines:

Cinryze (C1 esterase inhibitor)

Approved for routine prophylaxis against angioedema in patients with hereditary angioedema (HAE). It is administered intravenously every three to four days.

Sancuso (Granisetron transdermal patch)

Used for preventing chemotherapy-induced nausea and vomiting. The patch is applied to the upper outer arm 24 to 48 hours before chemotherapy and can be worn for up to seven days. It should not be cut.

Tussicaps (Hydrocodone bitartrate/chlorpheniramine)

An antitussive/antihistamine combination approved as a Schedule III controlled substance. The adult dosage is one capsule every 12 hours.

Vimpat (Lacosamide)

Approved as add-on therapy for uncontrolled, partial-onset seizures in patients 17 years and older. It’s available in both oral tablet and IV infusion forms, which are bioequivalent.

Apriso (Mesalamine extended-release)

Approved for once-daily dosing for the maintenance of remission of ulcerative colitis. As an extended-release formulation, these capsules should not be crushed.

These new approvals highlight the importance of understanding specific administration guidelines for each medication. Always refer to the prescribing information or consult a healthcare professional for proper use.

The Impact of Medication Formulation on Patient Adherence

The formulation of a medication can significantly impact patient adherence. Factors that can affect adherence include:

• Ease of administration
• Dosing frequency
• Taste
• Side effects

How does formulation affect adherence? Extended-release formulations that allow for once-daily dosing can improve adherence by simplifying the medication regimen. Similarly, taste-masked formulations can make medications more palatable, increasing the likelihood of patients taking them as prescribed.

Conversely, medications that are difficult to swallow or have unpleasant tastes may lead to poor adherence. This underscores the importance of discussing any difficulties with medication administration with a healthcare provider to find suitable alternatives.

The Future of Drug Delivery Systems

The pharmaceutical industry is continuously innovating to improve drug delivery systems. Some emerging technologies include:

• 3D-printed medications for personalized dosing
• Smart pills with embedded sensors for monitoring adherence
• Nanotechnology-based drug delivery systems
• Gene therapy and RNA-based treatments

These advancements aim to enhance drug efficacy, reduce side effects, and improve patient outcomes. As these technologies develop, it will be crucial for healthcare providers and patients to stay informed about proper administration techniques for these novel delivery systems.

In conclusion, understanding the proper use of medications like metoprolol (Lopressor) is essential for optimal treatment outcomes. While some formulations can be crushed or split, others must be taken whole to maintain their intended effects. Always consult with a healthcare professional or pharmacist before altering any medication, and explore alternative formulations if you have difficulty swallowing pills. As drug delivery systems continue to evolve, staying informed about proper administration techniques will remain crucial for both healthcare providers and patients.

To Crush or Not to Crush

There are multiple reasons for crushing tablets or capsule contents before administering medications, but there are numerous medications that should not be crushed. These medications should not be chewed, either, usually due to their specific formulations and their pharmacokinetic properties.1 Most of the no-crush medications are sustained-release, oral-dosage formulas. The majority of extended-release products should not be crushed or chewed, although there are some newer slow-release tablet formulations available that are scored and can be divided or halved (e.g., Toprol XL).

A common reason for crushing a tablet or capsule is for use by a hospitalized patient with an enteral feeding tube. A recent review in the American Journal of Health-System Pharmacy provides more details about administering medications in patients with enteral feeding tubes.2 Oral solutions can be used when commercially available and medically appropriate. If an oral solution or suspension is not available, the hospital pharmacy should be consulted to determine if a liquid formulation of the product can be extemporaneously prepared. In some cases, after careful consideration of compatibility, stability, and drug absorption changes, an injectable formulation of a product may be used. You should always consult your hospital pharmacist for information on this modality of drug administration.

Some patients have difficulty swallowing tablets or capsules; some dislike the taste. In these cases, crushing of medication for powdered delivery (to be mixed with food or beverages) should be considered. But beware of certain caveats, as not all medications are suitable for crushing. Generally, meds that should not be crushed fall into one of these categories:

• Sustained-release tablets, which can be composed of multiple layers for different drug release times, as can beads within capsules. Some of the more common prefixes or suffixes for sustained-release, controlled-release, or controlled-delivery products include: 12-hour, 24-hour, CC, CD, CR, ER, LA, Retard, SA, Slo-, SR, XL, XR, or XT.
• Enteric-coated tablets, which are formulated because certain drugs can be irritating to the stomach or are degraded by stomach acid. By enteric-coating tablets or capsule beads, the drug’s release can be delayed until it reaches the small intestine. Prefixes include EN- and EC-.

Other medications have objectionable tastes and are sugar-coated to improve tolerability. If this type of medication is crushed, the patient would be subject to its unpleasant taste, which could significantly impair medication adherence. Additionally, both sublingual and effervescent medications should not be crushed because it will decrease the medication’s effectiveness.

Hospital Pharmacy publishes a wall chart that includes many of these types of formulations, along with their do’s and don’ts. If there is ever any doubt about the best way to administer a particular product or whether it can be halved or crushed, ask your pharmacist.3 TH

Michele B. Kaufman, PharmD, BSc, RPh, is a freelance medical writer based in New York City.

New Generics

• Stavudine capsules (generic Zerit)4

New Drugs, Indications & Dosage Forms

Cinryze, a C1 esterase inhibitor (human), is FDA-approved as a new orphan drug for routine prophylaxis against angioedema in patients with hereditary angioedema (HAE). 5 The drug is administered intravenously (IV) and can be administered every three to four days for routine HAE attack prevention, which can spontaneously occur during stress, surgery, or infection, and lead to rapid swelling of the hands, feet, limbs, face, intestinal tract, or airway.6

Granisetron 3.1mg/24-hour transdermal patch (Sancuso) is FDA-approved for preventing nausea and vomiting in adults receiving moderate or high-chemotherapy regimens for up to five consecutive days.7 To dose the patch, apply it to a clean, dry area of intact healthy skin on the upper outer arm 24 to 48 hours before chemotherapy, and remove it at least 24 hours after chemotherapy has been completed. A patch may be worn for up to seven days. They should not be cut.

Hydrocodone bitartrate 10-mg/chlorpheniramine 8-mg (Tussicaps) is FDA-approved as a Schedule III controlled substance as an antitussive/antihistamine combination.8 Adult dosage is one capsule every 12 hours.

Lacosamide (Vimpat) is FDA-approved for add-on therapy in patients ≥17 years with uncontrolled, partial-onset seizures. 11 The starting dose is 50 mg twice daily and may be increased to a daily dose of 200-400 mg as two divided doses. The most common adverse reactions in clinical trials were diplopia, headache, dizziness, and nausea. Both the oral tablets and the IV infusion are bioequivalent.

Mesalamine extended-release 0.375-gm capsules (Apriso) is FDA-approved for once-daily dosing for the maintenance of remission of ulcerative colitis.9 Mesalamine is a local-acting aminosalicylate. The recommended dose is four capsules (1.5 g/day) in the morning with or without food. Because release of the active drug is pH-dependent, it should not be administered with antacids.

Ranolazine (Ranexa) is FDA-approved as an initial treatment for chronic angina.10 It can be used as monotherapy, in combination with beta blockers, or with other drugs.

Quetiapine extended-release tablets (Seroquel XR) are FDA-approved to treat depressive episodes in bipolar disorder, manic and mixed episodes in bipolar I disorder, and the maintenance treatment of bipolar I disorder as adjunct therapy to lithium or divalproex. 11 It already is approved to treat schizophrenia. It is available in two new dosage strengths, 50- and 150-mg tablets.12 This is in addition to the previously available strengths of 200-, 300- and 400-mg tablets.

New Warnings

There have been more than 1,000 serious adverse events—including 50 deaths—associated with the use of varenicline (Chantix) since its approval in 2006.13 The FDA’s MedWatch program, which underestimates and does not determine causality, noted at least 3,325 serious injuries.14 The FDA has warned of suicidal ideation in patients taking varenicline, along with the possibility of severe mood and behavior changes, as well as worsening or recurring psychiatric illness with this agent.

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Tablet splitting: Product quality assessment of metoprolol succinate extended release tablets

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Elsevier Science

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. 2010 Nov 30;401(1-2):25-31.

doi: 10.1016/j.ijpharm.2010.09.004.

Epub 2010 Sep 19.

Na Zhao 
¹
, Ahmed Zidan, Mobin Tawakkul, Vilayat A Sayeed, Mansoor Khan

Affiliations

Affiliation

• ¹ Division of Product Quality Research, Office of Testing and Research, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), United States.

• PMID:

  20849940

• DOI:

  10.1016/j.ijpharm.2010.09.004

Na Zhao et al.

Int J Pharm.

2010.

. 2010 Nov 30;401(1-2):25-31.

doi: 10.1016/j.ijpharm.2010.09.004.

Epub 2010 Sep 19.

Authors

Na Zhao 
¹
, Ahmed Zidan, Mobin Tawakkul, Vilayat A Sayeed, Mansoor Khan

Affiliation

• ¹ Division of Product Quality Research, Office of Testing and Research, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), United States.

• PMID:

  20849940

• DOI:

  10.1016/j.ijpharm.2010.09.004

Abstract

Metoprolol succinate extended release tablets comprise a multiple unit system containing metoprolol succinate in a multitude of controlled release pellets. Each pellet acts as a separate drug delivery unit and is designed to deliver metoprolol continuously over the dosage interval. Despite the flexibility that controlled release pellets may offer, segregation is one of the challenges that commonly occur during tableting for such drug delivery system. Since all commercial metoprolol succinate extended release tablets are scored, they are deemed suitable for splitting. The present study was aimed at utilizing an innovative technology to determine the dose uniformity for split tablets. Four marketed drug products consisting of innovator and generics were evaluated for effect of splitting on weight, assay and content uniformity. Novel analytical tool such as near infrared (NIR) chemical imaging was used to visualize the distribution of metoprolol succinate and functional excipients on the surfaces of the marketed tablets. The non-homogeneous distribution of directly compressed metoprolol succinate beads on the surface of the tablets as well as the split intersection explained the large variation in the split tablets’ weight and content uniformity results. The obtained results indicated the usefulness of NIR chemical imaging to determine the need for content uniformity studies for certain split tablets.

Published by Elsevier B.V.

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