Antidepressant Tablets Suitable for Crushing
Several selective serotonin reuptake inhibitors (SSRIs) have tablet formulations that can be crushed for administration in patients with dysphagia when no swallowable formulation is feasible. Film-coated immediate-release SSRI tablets (citalopram, escitalopram, paroxetine, and sertraline) can be crushed and/or dispersed for this purpose. [1]
Core Rule for Crushing Safety
Modified-release products and enteric- or gastric-coated medicines should not be crushed. [2]
Crushing-Compatible SSRIs (Tablet Formulations)
The following SSRIs can be crushed and/or dispersed in water or crushed and given with soft food when used off-label for adults with swallowing difficulties. [1]
- Citalopram tablets. [1]
- Escitalopram tablets. [1]
- Paroxetine tablets. [1]
- Sertraline tablets. [1]
SSRI Formulations That Should Not Be Crushed
The following antidepressant formulations should not be crushed based on available swallowing-guidance information. [1]
- Fluoxetine 20 mg dispersible tablets should not be crushed. [1]
Antidepressants Commonly Used for Dysphagia When Crushing Is Not Appropriate
When a crush-compatible tablet formulation is not available or crushing is contraindicated, alternative antidepressant formulations may be used. [2]
- Duloxetine: do not chew or crush capsules; capsule contents can be mixed with apple juice or apple sauce. [2]
- Mirtazapine: oro-dispersible tablet or solution. [2]
- Trazodone: liquid. [2]
Practical Administration Process for Crushable Tablets
Crushing should be performed only when the tablet is suitable for crushing and only immediately before administration. [3]
- Medicines should be crushed one at a time. [3]
- Crushing should be done using an appropriate tablet-crushing method (tablet crusher, crushing syringe, or pestle and mortar). [3]
- Dispersing in water should be performed immediately before administration. [3]
Common Pitfalls to Avoid
Crushing or opening without explicit prescriber direction should be avoided. [3]
- Crushing should be documented in the medicines administration record and care plan. [3]
Key Clinical Safety Constraint
Carriers such as water should not be assumed to be acceptable for all dysphagic patients. [3]
- Use of thickened fluids or soft food may be required for safe administration based on swallow assessment and local protocol. [3]
- Crushing guidance emphasizes preparation immediately before dosing to reduce administration errors. [3]
Antidepressant List Summary (Crushable vs Non-Crushable)
- Crushable tablets (SSRIs): citalopram, escitalopram, paroxetine, sertraline. [1]
- Not crushable (example formulation): fluoxetine 20 mg dispersible tablets. [1]
- Not to be crushed (example formulation): duloxetine capsules. [2]
- Prefer non-crush formulations: mirtazapine oro-dispersible tablet or solution, trazodone liquid. [2]
Sources
This list is restricted to the antidepressants and formulation instructions explicitly described in the cited dysphagia medication-preparation guidance. [1], [2]