Why are modified release dosage medication forms (XL, XR, SR, CD, etc.) inappropriate to crush for administration via enteral feeding?

• A. They are too large to pass through the tube
• B. Crushing these dosage forms destroys the modified releasing properties, risking overdose
• C. They dissolve too quickly in water
• D. They are expensive to crush

Answer: (B)

Modified-release forms are designed to release the drug gradually over time through a coating or matrix. Crushing or breaking these forms destroys that release mechanism, causing most or all of the drug to be released at once. This rapid release can lead to higher peak blood levels than intended, increasing the risk of toxicity or adverse effects, especially for drugs with narrow therapeutic windows. When administered via enteral feeding, the problem is the loss of the controlled release profile, not the size of the pill or how quickly it dissolves in water, and cost isn’t the issue. If a patient needs tube feeding, use an immediate-release formulation or an appropriate liquid form and consult a pharmacist for a safe alternative.