Can you crush dexamethasone (corticosteroid) tablets?

Can Dexamethasone Tablets Be Crushed?

Yes, dexamethasone tablets can generally be crushed for patients with swallowing difficulties, but this practice requires careful consideration of the specific formulation, proper crushing technique, and appropriate administration methods to ensure patient safety and drug efficacy.

Key Considerations Before Crushing

Formulation-Specific Guidance

• Standard immediate-release dexamethasone tablets are typically safe to crush when necessary for patients with dysphagia or those unable to swallow 1, 2.
• The guidelines consistently reference dexamethasone administration as "oral or IV" without specifying restrictions on tablet manipulation, suggesting standard formulations are amenable to modification 3.
• Never crush extended-release, enteric-coated, or sustained-release formulations, as this destroys the drug delivery mechanism and can cause overdose or underdosing 1.

Clinical Context for Crushing

Crushing may be appropriate when:

• Patients have documented dysphagia or swallowing difficulties 2, 4
• Enteral feeding tubes are in use 2
• No alternative liquid formulation is available 2
• The clinical benefit outweighs the risks of improper administration 4, 5

Proper Crushing Technique

Safety Precautions

• Use appropriate protective equipment when crushing to avoid exposure to drug particles, which can be allergenic or cause other adverse effects in healthcare workers 1, 6.
• Use dedicated crushing equipment for each patient to prevent cross-contamination 6.
• Minimize drug loss during the crushing process, as spillage can result in underdosing 6.

Administration Method

• Mix crushed tablets with water or jellified water as the preferred vehicle 6.
• Avoid mixing with acidic juices, hot liquids, or foods that may interact with or degrade the medication 6.
• Administer immediately after crushing to prevent degradation from light, moisture, or air exposure 1.

Alternative Approaches to Consider First

Before crushing dexamethasone tablets:

• Switch to intravenous dexamethasone if the patient has IV access, as guidelines consistently present oral and IV routes as equivalent alternatives 3.
• Consider that dexamethasone 6-8 mg IV provides adequate coverage for 24 hours in perioperative settings, eliminating the need for multiple oral doses 3.
• Consult with pharmacy about liquid formulation availability 2.

Important Caveats

• Document the clinical rationale for crushing tablets, as this practice must be legally defensible 4, 5.
• Crushing should be a last resort after exploring all other options 4.
• In studies of geriatric units, crushing was inappropriate or potentially harmful in 12.7% of cases, highlighting the need for careful evaluation 6.
• The person crushing tablets assumes legal and professional responsibility for ensuring the practice is appropriate 5.

Clinical Bottom Line

While standard dexamethasone tablets can be crushed when medically necessary, switching to IV administration is often preferable given the drug's excellent bioavailability and the equivalent dosing between routes 3. If crushing is required, use proper technique with appropriate protective equipment, administer in water immediately after crushing, and document the medical necessity 1, 2, 6.