Can Zyvox (Linezolid) Tablets Be Crushed?
Yes, Zyvox (linezolid) tablets can be crushed for administration in patients who cannot swallow whole tablets, though this should be done with appropriate precautions and only when necessary.
Evidence Supporting Crushing
The practice of crushing linezolid tablets is supported by clinical guidelines for specific patient populations:
Unconscious or critically ill patients: Taiwan guidelines for MRSA infections explicitly recommend linezolid at 10 mg/kg/dose PO/IV every 8 hours (not to exceed 600 mg/dose) for pediatric patients, with oral administration options available for those unable to swallow 1.
Pediatric and tuberculosis patients: Guidelines for drug-resistant tuberculosis note that most oral TB drugs used in children "often have to be crushed or put into suspension" when child-friendly formulations are unavailable, and this practice is accepted when necessary 1.
Pharmacokinetic Considerations
Linezolid's pharmacokinetic profile supports the feasibility of crushing:
Complete oral bioavailability: Linezolid is fully bioavailable (100%) following oral administration compared to IV, meaning crushing should not significantly alter absorption 2.
Food effects are minimal: Food slightly decreases the rate but not the extent of absorption, suggesting that mixing crushed tablets with soft foods or liquids should not compromise efficacy 2.
No special coating: Linezolid tablets are immediate-release formulations without enteric coating or sustained-release properties that would be compromised by crushing 2.
Administration Guidelines When Crushing
If crushing is necessary, follow these specific steps:
Crush immediately before administration: Use a mortar and pestle to crush the tablet into a fine powder 3.
Mix with appropriate vehicle: Suspend the crushed powder in plain water or mix with soft food at room temperature 3, 4.
Administer within 2 hours: Give the dose promptly after preparation to minimize degradation risk 3.
For feeding tubes: Flush the tube with at least 30 mL of water before and after administration to prevent obstruction 5.
Important Caveats
Occupational exposure risk: Healthcare workers crushing tablets are exposed to drug particles, which may cause allergic reactions or other adverse effects 6.
Last resort only: Crushing should only be done when alternative formulations are unavailable, as it carries inherent risks 6, 7.
Alternative formulations: Linezolid is available as an oral suspension (100 mg/5 mL) and IV formulation, which should be considered first for patients with swallowing difficulties 1.
Legal and professional considerations: Crushing tablets may contravene manufacturer recommendations and should be documented appropriately 7.
Clinical Decision Algorithm
- First: Consider IV linezolid (600 mg every 12 hours for adults) if patient has IV access 1.
- Second: Request oral suspension formulation if available from pharmacy 1.
- Third: Only if above options unavailable, crush tablets using proper technique with immediate administration 3, 4.
- Always: Document the rationale for crushing and method used 7.