From the Guidelines
Medroxyprogesterone (Provera) tablets should not be crushed unless absolutely necessary, due to potential risks of exposure to the drug and inaccuracies of drug dosing, as emphasized in the espen guideline on home enteral nutrition 1. When considering the administration of medroxyprogesterone through an enteral feeding tube, it's crucial to consult the relevant Summary of Product Characteristics to understand the legal position regarding individual prescriptions and dosage forms. The choice of dosage form for administration through an enteral feeding tube presents practical considerations, such as the potential for tube occlusions with solid dosage forms and the risk of gut disturbances with liquid medicines. However, if crushing is necessary, it is essential to mix the crushed tablet with a small amount of soft food, like applesauce or yogurt, and consume the entire mixture immediately to ensure the full dose of medication is received. It's also important to note that extended-release or enteric-coated formulations of medroxyprogesterone should not be crushed, as this would alter the intended release mechanism of the drug. In cases where patients regularly have trouble swallowing pills, discussing alternative administration methods with a healthcare provider is recommended, as they might be able to prescribe a liquid formulation or suggest other options. Ultimately, the decision to crush medroxyprogesterone tablets should be made with caution and under the guidance of a healthcare professional, taking into account the potential risks and benefits, as well as the patient's individual needs and circumstances, as highlighted in the espen guideline on home enteral nutrition 1.
From the Research
Medroxyprogesterone (Provera) Tablets
- Medroxyprogesterone (Provera) tablets are not explicitly mentioned in the provided studies as being safe or unsafe to crush.
- However, the studies suggest that crushing tablets can have serious consequences, including alteration of the drug's absorption, overdose, or underdosing 2, 3, 4, 5.
- The Institute for Safe Medication Practices (ISMP) Do Not Crush List is a resource for healthcare providers to determine whether an oral solid drug product can be manipulated, but the list may have weaknesses or missing evidence for some products 6.
- In general, it is recommended to consider and research the impact of crushing a tablet on the drug's effects before doing so, and to use a different dosage form or active ingredient if necessary 2, 5.
- Healthcare providers should discuss medication administration with patients, clarify the dosing schedule, and clearly indicate the route of administration to avoid potential hazards 3, 5.