Can you crush Lagevrio (molnupiravir) capsules?

Molnupiravir (Lagevrio) Capsules Should Not Be Crushed

Molnupiravir (Lagevrio) capsules should not be crushed due to safety concerns related to its mutagenic mechanism of action and potential exposure risks.

Administration Guidelines for Molnupiravir

• Molnupiravir is an orally administered antiviral prodrug that works by inhibiting SARS-CoV-2 replication through inducing viral RNA errors 1
• The standard dosing is 800 mg (four 200 mg capsules) taken orally every 12 hours for 5 days, with administration recommended within 5 days of symptom onset 2, 3
• Crushing tablets or opening capsules can alter drug absorption, potentially resulting in overdose or underdosing, which may render treatment ineffective or dangerous 4

Safety Concerns with Crushing Molnupiravir

• Molnupiravir has a mutagenic mechanism of action that poses potential risks if the medication is crushed 5
• Crushing would expose the person handling the medication to drug particles that may be carcinogenic, teratogenic, or fetotoxic 4
• Due to its mechanism of action causing viral mutations, direct exposure to the active ingredient through crushing could pose theoretical risks to handlers 1, 5

Special Populations and Precautions

• Molnupiravir should not be used in children due to evidence of impact on growth plate thickness and decreased bone formation in animal studies 2
• The medication is contraindicated in pregnant or breastfeeding individuals due to embryo-fetal lethality and teratogenicity observed in animal studies 2
• Men who might father a child should use reliable contraception during treatment and for at least three months after the last dose of molnupiravir 2
• The unknown long-term risk of genotoxicity is likely to be higher in younger patients compared with older patients 2

Alternative Approaches

• For patients with difficulty swallowing, it is better to consider and research the impact crushing will have on the drug's effects 4
• Before crushing any tablet or opening any capsule, healthcare providers should consider using a different dosage form or a different active ingredient 4
• For COVID-19 treatment in patients who cannot swallow capsules, alternative medications like nirmatrelvir/ritonavir (Paxlovid) or remdesivir may be considered if appropriate for the patient's clinical situation 2

Clinical Efficacy Context

• In clinical trials, molnupiravir reduced the risk of hospitalization or death in high-risk patients with mild to moderate COVID-19 3, 6
• The WHO conditionally recommends molnupiravir only for patients with non-severe COVID-19 at high risk of hospitalization 2
• For patients at moderate or low risk of hospitalization, the WHO recommends against using molnupiravir due to concerns about toxicity outweighing benefits 2

Key Takeaway

• Molnupiravir capsules should remain intact and be swallowed whole to maintain proper dosing and prevent exposure to the active ingredient 4, 1
• If a patient cannot swallow capsules, consultation with a pharmacist or physician about alternative COVID-19 treatments is recommended rather than crushing or opening the capsules 2, 5