Can you crush Zofloza (generic name)?

Crushing Zofloza (Bictegravir/Tenofovir Alafenamide/Emtricitabine)

Crushing bictegravir/tenofovir alafenamide/emtricitabine (Zofloza) is not recommended. 1

Rationale for Not Crushing

• Crushing bictegravir/tenofovir alafenamide/emtricitabine is specifically contraindicated according to antiretroviral treatment guidelines from the International Antiviral Society-USA panel 1
• Altering the tablet formulation by crushing may affect the drug's:
  • Bioavailability and absorption rate 2
  • Pharmacokinetic properties 2
  • Overall efficacy in treating HIV infection 1

Risks of Crushing Tablets

• Crushing tablets can lead to several potential problems:
  • Alteration of drug absorption resulting in overdose or underdosing 2
  • Disruption of sustained-release properties (if present) 2
  • Degradation of active ingredients when exposed to light, moisture, or food 2
  • Exposure of healthcare workers to drug particles that may be harmful 2

Alternative Approaches

For patients who have difficulty swallowing:

• Consider alternative antiretroviral medications that are available in liquid formulation 1
• Consult with an HIV specialist to determine an appropriate alternative regimen 1
• For patients with temporary swallowing difficulties (such as those undergoing chemotherapy with mucositis), switching to a regimen that can be crushed or delivered in liquid formulation is recommended 1

Special Considerations

• In cancer patients experiencing severe mucositis where swallowing is difficult, the guidelines specifically recommend switching to antiretroviral regimens that can be crushed or delivered in liquid formulation rather than crushing bictegravir/tenofovir alafenamide/emtricitabine 1
• The practice of crushing tablets should only be done as a last resort and after consulting with a pharmacist or physician 3
• Inappropriate crushing of medications can compromise treatment efficacy and patient safety 4

Best Practice Recommendations

• Before considering crushing any medication, consult with a pharmacist to determine if it's appropriate 5
• For patients with HIV who cannot swallow tablets, work with an HIV specialist to select an alternative regimen with appropriate formulations 1
• Document any decision regarding medication administration in the patient's medical record 6
• Consider the legal and clinical implications of altering medication formulations 3, 6