Appendix C

Appendix C: Reference Charts for Patient Counseling

Card 1 of 5Do Not Crush

Appendix Opening

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Counseling reference charts

Drugs That Should Not Be Crushed

Slow-release (controlled-release, extended-release, long-acting, timed-release) and enteric-coated (delayed-release) products should not be crushed or chewed. Crushing them destroys the release mechanism, potentially causing dose dumping, loss of the protective coating, or degradation. Sublingual and buccal tablets must also stay intact.

Trace why crushing these products is dangerous:

1A slow-release product is designed to release drug gradually over hours

2Crushing it destroys that mechanism -> the whole dose is released at once

3This 'dose dumping' can cause toxicity or overdose

4An enteric coating protects the drug from stomach acid or protects the stomach

5Crushing removes that coating -> degradation or gastric irritation

6So slow-release and enteric-coated products must be swallowed whole

The Suffix Clue

Product name suffixes that signal do-not-crush include SR, ER, XR, XL, CR, CD, LA, and EC. Examples: Adderall XR, Adalat CC, Aciphex (EC), Allegra-D 12/24 Hour, Toprol-XL. Capsules containing slow-release or enteric-coated PELLETS may often be opened onto soft food, but the patient must not chew the particles.

📖 “Slow-release (CR/ER/LA/timed) and enteric-coated (delayed-release) products: do not crush/chew. Crushing destroys release -> dose dumping/toxicity; removes enteric coating -> degradation/gastric irritation. Suffixes SR/ER/XR/XL/CR/CD/LA/EC (Adderall XR, Adalat CC, Aciphex EC, Allegra-D, Toprol-XL). Slow-release/enteric pellets in capsules may be opened onto soft food; don't chew. Sublingual/buccal tablets stay intact.”