Crushing and Liquid ARV Formulations

ORAL ANTIRETROVIRAL ADMINISTRATION: INFORMATION ON CRUSHING AND LIQUID DRUG FORMULATIONS
Drug Oral Liquid Preparation Case Reports/Clinical Information on Crushing or

Compounding Splitting Tablets
Commercial Formulation Stability
Oral Liquid
Available?
Combination Products:
Atripla no Consider use of Atripla tablet was crushed, See information on crushing
Truvada tabs and dissolved in 5 mL of water and Atripla in the Case Reports
(efavirenz/ efavirenz caps as diluted to 20 mL with Ora-Sweet section.
emtricitabine/ alternate formulations oral vehicle. The solution was
tenofovir) (see separate entries) prepared within 24 hours of Although Truvada tablets may
administration to ensure drug be split, splitting Atripla tablets
stability in solution. has not been studied. There are
no studies evaluating the
Bioequivalence of Atripla tablet pharmacokinetics of a split
and compounded oral liquid tablet vs. a whole tablet.
formulation (above) in HIV- Efavirenz is not water soluble.
negative volunteers was not
demonstrated. The 90% CI for
FTC Cmax and AUC fell within
the range of 0.8-1.25 thus,
bioequivalence was met, but the
90% CI for efavirenz Cmax fell
below the range of
bioequivalence while efavirenz
AUC fell slightly above the
range and tenofovir Cmax and
AUC fell above the range.
Tenofovir Cmax and AUC
were approximately 40% and
20% higher, respectively with
the liquid formulation. The
clinical implications of these
data are unknown, however the
authors state that crushed
Atripla may be a viable option
in certain patients and risks vs.
benefits should be carefully
considered. [King et al. JAIDS
M. Foisy, Pharm.D., AAHIVP, Northern Alberta Program, Royal Alexandra Hospital Site, Edmonton, C. Hughes, Pharm.D., AAHIVP, Northern Alberta Program,
KEC Site, Edmonton, Alberta, and A. Tseng, Pharm.D, AAHIVP, Toronto General Hospital. www.hivclinic.ca December 2014
Page 1 of 18
Oral Liquid
Available?
2011;56(5):e131-2].
Combivir yes Use lamivudine & No data, but likely OK to crush

(lamivudine/ (individual zidovudine liquid tablets (film-coated); crush
zidovudine) components) products immediately before ingestion.
May have bitter taste.
Complera no Splitting or crushing Complera
(emtricitabine/ tablets into a liquid medium has
tenofovir/ not been studied and is not
rilpivirine) recommended. Rilpivirine
hydrochloride is insoluble in
water over a wide pH range.
(Email communication, Gilead
July 2012).
Kivexa yes Use abacavir & Film-coated immediate release
(abacavir/ (individual lamivudine liquid tablet; however no studies
lamivudine) components) products regarding stability of split or
crushed tablets. (Email
communication,
GlaxoSmithKline, May 2008)
Tablet may be split or crushed
and added to a small amount of
food or water. (European
Medicines Agency, EPAR
summary for the public, Ziagen
updated 05-2010)
Prezcobix no See darunavir and
(darunavir/ Splitting Prezcobix film-coated
ritonavir for potential tablets has not been studied.
cobicistat) liquid formulations Tablets should be swallowed
(substitution of whole without breaking or
cobicistat with crushing to ensure
ritonavir may be administration of the entire
required) dose. (Prezcobix Product
Monograph, 2014)
Page 2 of 18
Oral Liquid
Available?
Case report describing Crushing Stribild tablets into a

Stribild no successful virological liquid medium has not been
(elvitegravir/ suppression with crushed studied and is not
cobicistat/ Stribild in juice (Fulco et al. recommended. While
emtricitabine/ AJHP 2014;71(10);784-6). emtricitabine and tenofovir are
tenofovir) soluble in water, cobicistat and
elvitegravir are practically
insoluble in water. Currently,
there are no studies evaluating
the pharmacokinetics (e.g., oral
bioavailability) of a crushed
Stribild tablet dispersed into a
liquid medium (e.g., milk, water,
juice) compared to a whole
tablet.
Splitting Stribild tablets has not

been studied and it is not
recommended. (Communication
from Gilead Canada, April 2013)
Triumeq no Use abacavir & Triumeq is film-coated, non-

(abacavir/ lamivudine liquid scored, and non-sustained
lamivudine/ products. Dolutegravir released formulation. Although
dolutegravir) tablets may be not studied, splitting or crushing
crushed (see tablets is not expected to affect
dolutegravir). See the dissolution or absoprtion.
Crushing &Splitting Tablets may be crushed and
section also. added to a small amount of
semi-solid food or liquid, and
consumed immediately. (Data
on File, ViiV Healthcare, Oct
2014)
Trizivir yes
Page 3 of 18
Oral Liquid
Available?
(abacavir/ (individual Use abacavir, Film coated immediate release
lamivudine/ components) lamivudine & tablet however no studies
zidovudine) zidovudine liquid regarding stability of split or
products. crushed tablets.
Truvada yes See tenofovir & The absorption of raltegravir, May split tablets. May crush
(tenofovir/ (individual emtricitabine. etravirine, emtricitabine, and and stir into water, grape juice
emtricitabine) components- tenofovir was not compromised or orange juice. The stability of
US only) when the drugs were crushed, the mixture is unknown. (Email
dissolved in 60 mL warm water, communication, Gilead, July
and administered by 2012).
gastrostomy tube to a 52 year
old HIV-positive male with
ulcerative esophagitis.
(Sandkovsky et al.
Pharmacother 2012;32(2):142-
7).
INDIVIDUAL ANTIRETROVIRAL AGENTS:
abacavir yes 20 mg/mL oral Store oral Tablet is film-coated; no data on
solution; 240 mL solution at room whether can be crushed.
bottle. Yellow, temperature.
strawberry-banana
flavoured liquid.
amprenavir no-product See fosamprenavir for
discontinued liquid formulation.
atazanavir yes (US 50 mg/1.5 g Powder: mix Capsules: In an open label, Capsules: May be opened and
only) dispersible oral with food such multicentre study of atazanavir the contents mixed with
powder packet as applesauce and atazanavir/ritonavir in applesauce for immediate
or yogurt (1 children 91 days-21 years, the ingestion with a light meal. In-
TBSP pharmacokinetics of atazanavir house study showed that the
Page 4 of 18
Oral Liquid
Available?
minimum). capsules and atazanavir bioavailability of the contents of
Mixing with a orange-vanilla flavoured powder two 200-mg atazanavir capsules
beverage (milk, were studied. Day 7 atazanavir mixed with applesauce was
formula, water- kinetics were compared in 91.7% relative to atazanavir
30 mL + children of similar age receiving capsules taken intact. In
additional 15 mL powder vs. capsules; the addition, administration of the
after to consume powder was found to be 40% contents of two 200-mg
residual drug) less bioavailable at the same capsules was well tolerated
can be used if BSA-based dose. Therefore, (Bristol Myers Squibb, Personal
infant is able to suggest converting from powder Communication, October 22,
drink from a cup. to capsule by multiplying the 2008).
For younger powder dose by 0.6 and
infants who rounding up to the nearest 50
cannot eat solid mg. (Kiser J et al. AIDS
food, mix with 2011;25:1489-96.)
infant formula
(10 mL +
additional 10 mL
after to consume
residual drug)
and administer
via oral syringe.
Stable for 1 hour
at room
temperature
once mixed in
food or
beverage. (Refer
to Reyataz US
Product
Monograph for
additional
information on
mixing/administr
ation).
Page 5 of 18
Oral Liquid
Available?
darunavir yes (US 100 mg/mL oral Store oral In two patients, one with No pharmacokinetic data are
only) suspension suspension at dysphagia and Candida available on chewing or
room esophagitis and one with a crushing of PREZISTA film-
temperature. stomach tube, who received coated tablets. However, since
Shake well darunavir tablets crushed and the tablets are not formulated as
before use. dissolved and administered with an extended release
ritonavir oral solution, adequate formulation, no potential
plasma darunavir levels were problem is anticipated if the
achieved along with good tablets are chewed or crushed
virologic response.(Scholten et for administration through a
al. J Int AIDS Soc nasogastric (NG) tube. It is
2010;13(Suppl 4):P114). unlikely that chewing or
crushing PREZISTA tablets
A case report describes an would have a significant impact
intubated 44 year old man on on pharmacokinetics (Data on
tenofovir/emtricitabine, File, Tibotec, November 2006).
darunavir, and ritonavir in ICU
who was given darunavir tablets
via orogastric tube crushed and
dissolved in 15-20mls of water.
Viral load did not change
significantly and adequate
darunavir trough levels were
achieved. (Kim et al. CJHP
2014;67(1):39-42).
delavirdine no Can dissolve 100 mg tablets in

water to make slurry (20%
bioavailability). Disperse tablets
in at least 90 mL of water, allow
to stand for a few minutes, stir
and consume.
didanosine yes (SAP) 4 g oral powder 30 days Reconstitute with commercially
(ddI) (pediatric solution); 10 available antacid that contains
mg/mL final as active ingredients aluminum
concentration. Take hydroxide (400 mg per 5 mL),
Page 6 of 18
Oral Liquid
Available?
on an empty stomach. magnesium hydroxide (400 mg
Do not give with fruit per 5 mL), and simethicone (40
juices or acidic drinks, mg per 5 mL))
feeds or milk. If above strength not available,
reconstitute with similar antacid
of strength using these
alternative instructions: Add
400 mL of antacid in two, 200
mL portions, shaking the
contents after each addition of
200 mL. The admixture may be
dispensed in flint-glass or
plastic bottles. Shake well
before using. Stable for 30 days
in fridge. Available via SAP (call
Maggie Jackson from BMS at
514-333-2287).
dolutegravir no 50 mg/10g pediatric In comparison to the Tablets may be crushed and

oral granule commercially available tablet, added to a small amount of
formulation in dolutegravir exposures following semi-solid food or liquid, all of
development administration of the granule which should be consumed
formulation alone, with different immediately. (ViiV data on file,
types of water and with formula November 18, 2013).
exceeded that of the tablet,
demonstrating the dolutegravir
oral granule can be given
without restriction on the type of
liquid, or can be administered
directly to mouth (e.g., when
potable water is not available).
(Patel et al. Antivir Ther
2014;19(3):229-33.)
efavirenz no 30 mg/mL; 180 mL Tablets: A pediatric Splitting efavirenz tablets has
bottle- not available pharmacokinetic intensive study not been well studied. With the
Note:
Page 7 of 18
Oral Liquid
Available?
pediatric Consider use of that utilized weight band dosing exception of the study by
suspension capsule formulation and a combination of capsules Fillekes et al (JAIDS
is no longer as described in or half of a 600 mg tablet 2011;58(4):392-298), there are
available Clinical Compounding reported low overall plasma no well controlled
internationall efavirenz concentrations in both pharmacokinetic studies
y (2014) groups (higher doses need to evaluating a split tablet vs. a
be investigated). They found no whole tablet. Efavirenz is not
significant differences across water soluble. The use of the
weight bands, suggesting no capsule formulation is preferred
discernible effect of using half when possible. (see Case
tablets. (Fillekes et al. JAIDS Reports/Clinical Compounding)
2011;58(4):392-298).
Capsules: Can open capsules
and mix powder with two
teaspoons of one of four
possible food vehicles:
applesauce, grape jelly, yogurt,
or infant formula (but may result
in hot jalapeno sensation).
Specific instructions [Kaul et al.
AJHP 2010;67(3):217-22].
1. Hold the capsule vertically
with the cap facing up.
2. Pull the cap away from the

body of the capsule carefully,
sprinkle and mix the contents
with the food in a 100-mL
container.
3. Administer the mixture with a

spoon as soon as possible but
no more than 30 minutes after
mixing.
Page 8 of 18
Oral Liquid
Available?
4. After administration of the

efavirenzfood mixture, rinse
the container three times with
50 mL of water, patient should
swallow each rinse.
5. After the three rinses, patient

should consume an additional
90 mL of water.
For nasogastric administration,
may open capsules and mix
with either 5 mL MCT oil or 15
mL Ora-Sweet/any aqueous
vehicle (grind powder first to
enhance dissolution). Do NOT
mix with polyethylene glycol (will
bioavailability). Splitting
tablets is not recommended
(Email communication, Bristol-
Myers Squibb, June 1, 2011).
elvitegravir no Case report describing No information on crushing in
successful virological product monograph. See
suppression with crushed Stribild for more information.
Stribild in juice (Fulco et al.
AJHP 2014 71(10);784-6).
emtricitabine no (US only) 10 mg/mL oral Store oral 200 mg capsules may be
(FTC) solution solution opened and mixed with water.
refrigerated;
stable for 3 mos
at room
temperature.
etravirine no See Crushing and Consume The absorption of raltegravir, Patients who are unable to
Splitting section for immediately. etravirine, emtricitabine, and swallow etravirine tablets whole
Page 9 of 18
Oral Liquid
Available?
dispersion tenofovir was not compromised may disperse the tablets in a
information. when the drugs were crushed, glass of water. A bioavailability
dissolved in 60 mL warm water, study has shown that the PK of
and administered by etravirine tablets when
gastrostomy tube to a 52 year swallowed whole and when
old HIV-positive male with taken after dispersion in a glass
ulcerative esophagitis. of water are comparable. Both
(Sandkovsky et al. the 100 mg and 200 mg tablet
Pharmacother 2012;32(2):142- formulations of etravirine may
7). be dispersed in water (Kakuda
et al. Int J Clin Pharmacol Ther
2013;51(9):725-37).
Place the tablet in 5 mL of cold

water or at least enough liquid
to cover the medication. Stir
until a homogenous, white,
cloudy, suspension is obtained.
If desired, add more water or
alternatively orange juice or
milk. Once dispersed, patients
should stir the dispersion well
and drink it immediately. The
glass should be rinsed with
water, orange juice or milk
several times and each rinse
completely swallowed to ensure
the entire dose is consumed.
Avoid the use of grapefruit juice,
o
warm liquids ( 40 C) or
carbonated beverages.
(Intelence Product
Monograph, 2014).
fosamprenavir yes 50 mg/mL oral Store oral No information on crushing or

suspension, 225 mL suspension dissolution of 700 mg tablets.
Page 10 of 18
Oral Liquid
Available?
o
bottle. 0.6% propylene between 2-30 C. Fosamprenavir calcium tablets
glycol Grape Do not freeze. and suspension are equivalent
bubblegum and Discard the on a mg per mg basis.
peppermint flavour. suspension 28
days after first
In adults, oral
opening.
suspension should be
taken on an empty
stomach (1 hr before
or 2 hours after food).
In pediatric patients,
oral suspension
should be given with
food.
indinavir no 10 mg/mL indinavir syrup Do NOT open capsules (bitter
complex compounding taste; stability uncertain).
formulation. Stable for 14 days
in refrigerator, store in glass
bottle. (Hugen et al. AJHP 2000;
57(14):1332-9).
lamivudine yes 10 mg/mL oral Store at room Can also crush or split tablets.
(3TC) solution; 240 mL temperature.
bottle. Pale yellow,
strawberry-banana
flavoured solution);
(NB: contains 6% v/v
ETOH & 3g sugar).
lopinavir/ yes 80 mg/20 mg per mL; Stable in Administration of crushed NB: Adult and pediatric
ritonavir 160 mL bottle. refrigerator until 200/50 mg lopinavir/ritonavir Kaletra tablets should be
Cotton-candy expiry date; tablets to children significantly swallowed whole and not
flavoured yellow- stable at room reduced lopinavir and ritonavir chewed, broken, or crushed.
orange oral solution. temperature for exposure with a decrease in Risk of tablets shattering if
Oral solution contains 42 days. AUC by 45% and 47%, broken/crushed.
the excipients alcohol respectively. Therefore, the use
(42.4% v/v) and of crushed lopinavir/ritonavir
Page 11 of 18
Oral Liquid
Available?
propylene glycol tablets should be avoided, if
(15.3% w/v). possible. (Best et al. JAIDS
Increased risk of 2011;58:385-91).
toxicity in preterm
infants.
maraviroc no Film coated immediate release
tablet. No pharmacokinetic data
available for crushing/chewing
tablet. (Data on File, Pfizer).
While the company does not
have any specific kinetic
information, crushing or cutting
the tablets is not expected to
negatively affect bioavailability.
nelfinavir yes (US 50 mg/g oral powder; Oral Powder: For infants, can also dissolve
only); 144 g bottle. (1g = 1 mix with small tablets (i.e. 250 mg tablet) in 5
discontinued level scoop). Take amount of water, mL sterile water to yield a 50
in Canada with food or close to milk, formula, or mg/mL liquid. Use syringe with
time of feeds. dietary 1 mL increments to measure.
supplements Round dose to nearest 50 mg
(acidic food or and consume immediately.
juice such as Tablets also readily dissolve in
apple juice, water and produce a dispersion
orange juice, that can be mixed with
apple sauce not milk/chocolate milk. Tablets
recommended- can be crushed and given with
bitter taste); pudding. Tablet may be mixed
consume with food or liquid and taken
immediately; immediately. Do not mix with
may be stored in acidic food/juice (orange or
fridge for up to 6 apple juice) due to bitter taste.
hours.
Page 12 of 18
Oral Liquid
Available?
nevirapine yes-SAP 10 mg/mL;240 mL Stable at room Can crush immediate-release
bottle sweet-flavoured temperature. (200 mg) tablets in water. NB:
syrup Extended-release (400 mg XR)
tablets must be swallowed
whole; they must not be
chewed, crushed or divided.
raltegravir Yes (US 20 mg/mL oral The oral NB: Because the formulations Crushing film coated tablets not
only) banana flavoured suspension are not bioequivalent, do not recommended. Granules (sub-
granular powder should be substitute raltegravir chewable units of the tablet) dissolve
(single-use packet of administered tablets or oral suspension for faster than intact tablets and
100 mg raltegravir) orally within 30 the 400 mg film-coated tablet. may result in faster release of
minutes of The maximum dose of drug which could affect in-vivo
mixing chewable tablets is 300 mg performance. (Data on file,
25 mg & 100 mg twice daily. The maximum dose Merck Frosst, May 2008)
pediatric chewable of oral suspension is 100 mg
tablets (Canada & twice daily. Drug has a bitter taste which is
US) masked by the film coating.
The pharmacokinetics of Chewable tablet may be
raltegravir were compared in 67 chewed or swallowed whole.
patients who swallowed the Oral suspension, chewable
intact tablet with 13 HIV-infected tablets and film-coated tablets
patients who chewed the are NOT interchangeable. The
raltegravir tablet due to maximum dose of the chewable
swallowing difficulties. HIV- tablets is 300 mg BID and the
infected patients receiving maximum dose of the oral
raltegravir by chewing the tablet suspension is 100 mg BID.
showed higher drug absorption
and reduced pharmacokinetic
variability compared with
patients swallowing the intact
tablet. Crushed tablets tested in
water or in a pH 6.8 buffer
exhibited prompt and complete
dissolution of RAL.(Cattaneo et
al. AAC 2012;56(12):6132-6.)
In healthy volunteers, RAL 800
Page 13 of 18
Oral Liquid
Available?
mg daily (chewed) vs. 400 mg
BID (swallowed intact) resulted
in a 2-fold increase AUC, 4-fold
increase in Cmax, similar Cmin
concentrations, and less
pharmacokinetic variability in
the 800 mg daily group.
(Cattaneo et al. Ther Drug Monit
2014 Jul1. (Epub ahead of
print).
The absorption of raltegravir,
etravirine, emtricitabine, and
tenofovir was not compromised
when the drugs were crushed,
dissolved in 60 mL warm water,
and administered by
gastrostomy tube to a 52 year
old HIV-positive male with
ulcerative esophagitis.
(Sandkovsky et al.
Pharmacotherapy 2012; 32:
142-7).
rilpivirine no Film coated tablet. No data
available on stability of splitting
or crushing rilpivirine tablets.
Rilpivirine is insoluble in water
over wide pH range. (Email
communication, Janssen, July
2012).
ritonavir yes 80 mg/mL oral liquid; Stable at room Tablets may not be split or
240 mL bottle. temperature; do crushed (Norvir Product
Orange-coloured oral not refrigerate. Monograph).
solution, peppermint Liquid is unpalatable, bad
See tips for
& caramel-flavoured. aftertaste. Tips:
taking liquid in
43% v/v alcohol. - Mix oral solution with
Page 14 of 18
Oral Liquid
Available?
Shake well before Crushing & milk/chocolate milk or pudding
each use Splitting section. - Give after popsicle/frozen juice
to dull taste buds
- Give after grape jelly, maple
syrup, or peanut butter which
coats mouth
-Give strong flavour after dose:
syrup, cheese, chewing gum
In an open-label, randomized, 4
period study in adults, the Hard gel caps (Invirase) may
saquinavir no Liquid not being
bioavailability of 1000 mg be opened and powder
formulated due
opened saquinavir capsules sprinkled on food, simple syrup
to unpalatability
suspended in simple syrup, or water (unpleasant taste).
baby formula and jelly jam (plus Take with food.
ritonavir 100 mg oral solution)
was approximately 10%, 60%
and 40% higher, respectively, 6 x 200 mg Fortovase (soft-gel
than 1000 mg unopened caps) whole caps mixed with 50
saquinavir capsules plus mL of whole milk or Advera
ritonavir. In terms of palatability, nutritional supplement took 5-15
saquinavir suspended in simple minutes to dissolve when
o
syrup or jelly jam ranked higher heated to 40, 60 or 80 C. The
than saquinavir suspended in mixture remained in solution for
th
baby food.(McKay et al. 8 Int up to 1 hour at room
Workshop Clin Pharm HIV Ther temperature. If refrigerated for
2007, abstract 6). 24 hours, it turned into a gel, but
reliquified after reheating to 30
degrees C. The drug was still
stable at 24 hours. (data on file,
Hoffmann-LaRoche)
stavudine yes- SAP 1 mg/mL oral Stable 30 days Can also open up capsules give
(d4T) suspension; 200 ml in fridge. in small portion of food or 5-10
bottle. Fruit- mL cool tap water.
flavoured. Shake well.
Page 15 of 18
Oral Liquid
Available?
tenofovir yes (US 40 mg per 1 gram of Administer Crushed tablet dissolves in 100
only) oral powder immediately to mL water in 20 minutes; grape
formulation. Oral avoid a bitter juice may also be used.
powder should be taste. Consume immediately. NB:
mixed in a container crushed tablets have very
with 2 to 4 ounces (60 disagreeable taste. May also try
to 120 mL) of soft splitting tablets and inserting
food not requiring into empty gelatin capsules to
chewing (e.g., mask taste.
applesauce, baby
food, yogurt). Do not
attempt to mix in a
liquid as the powder
may float on top even
after stirring.
tipranavir yes (US 100 mg/mL oral Store oral 250 mg capsule. Avoid splitting
only) solution; contains 116 solution and or crushing capsule.
IU/mL vitamin E. room
temperature
(25C). Use
solution within
60 days of
opening the
bottle.
zalcitabine no Investigational oral
(ddC) solution is no longer
available.
zidovudine yes 10 mg/mL oral syrup; Store at room May open capsules & give in
(AZT) 240 mL bottle. temperature. small portion of food or 5-10 mL
Strawberry-flavoured. cool tap water.
OTHER:
Page 16 of 18
Oral Liquid
Available?
acyclovir yes 200 mg/5 mL;125 mL Store between
bottle. Banana- 15-25 C
flavoured suspension.
azithromycin yes pediatric oral Store May also open capsules and
powder/suspension reconstituted mix with water (ingest
100 mg/5 mL (300 mg suspension immediately on empty stomach,
bottle) OR 200 mg/5 between 5-30C. follow with full glass of water).
mL (600 & 900 mg Dispose unused
bottles). Cherry- suspension after
flavoured suspension. 10 days.
clarithromycin yes 125 mg/5 mL & 250 Store
mg/5mL; 55, 105 and reconstituted
150 mL bottles. Fruit- liquid at room
flavoured suspension. temperature.
Shake well before
use.
daclatasvir no Manufacturer recommends not
chewing or crushing the tablet
as it has a very unpleasant
taste.(Daklinza Summary of
Product Characteristics, EU,
September 2014).
hydroxyurea no Can open up capsules and mix
with water; take immediately.
Some inert material (used as a
vehicle in capsule) may not
dissolve, and may float on top.
Do not allow powder to come in
contact with skin and mucous
membranes. Avoid inhalation of
powder when opening capsules.
rifabutin no Can open capsules (experience
in pediatrics: OK to mix with
Page 17 of 18
Oral Liquid
Available?
applesauce, syrup, cherry
syrup); drug not soluble in water
sofosbuvir no Sofosbuvir tablets can be
disintegrated in water, juice, or
milk with minor stirring and
pressure with a spoon.
However, the stability of
sofosbuvir in these liquids is
unknown at this time.
Furthermore, there are no
studies evaluating the
pharmacokinetic parameters of
the disintegrated or crushed
sofosbuvir tablet versus the
whole tablet. In addition, a
disintegrated or crushed
sofosbuvir tablet may have an
unpleasant taste.(Personal
communication, Gilead
Sciences Canada, December
2013).
telaprevir no Manufacturer recommends not
breaking, chewing or crushing
the tablet as it has a bitter
taste.(Incivek Product
Monograph, Canada, December
2013).
TMP/SMX yes pediatric suspension Store at room
40 mg/200 mg per 5 temperature
mL (= SS tablet);
400 & 800 mL bottles
Key: SAP= Special Access Program, Health Protection Branch, Ottawa (ph: 613-941-2108; fax: 613-941-3194; http://www.hc-sc.gc.ca/hpfb-
dgpsa/tpd-dpt/sap_requestform_e.html )
Page 18 of 18

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ORAL ANTIRETROVIRAL ADMINISTRATION: INFORMATION ON CRUSHING AND LIQUID DRUG FORMULATIONS

Drug Oral Liquid Preparation Case Reports/Clinical Information on Crushing or

Combivir yes Use lamivudine & No data, but likely OK to crush

Case report describing Crushing Stribild tablets into a

Splitting Stribild tablets has not

Triumeq no Use abacavir & Triumeq is film-coated, non-

delavirdine no Can dissolve 100 mg tablets in

dolutegravir no 50 mg/10g pediatric In comparison to the Tablets may be crushed and

2. Pull the cap away from the

3. Administer the mixture with a

4. After administration of the

5. After the three rinses, patient

Place the tablet in 5 mL of cold

fosamprenavir yes 50 mg/mL oral Store oral No information on crushing or

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