Can chlorthalidone be crushed?

Can Chlorthalidone Be Crushed?

Chlorthalidone tablets can be crushed for patients with dysphagia or swallowing difficulties, as it is an immediate-release formulation without special coating or sustained-release properties that would be compromised by crushing.

Rationale for Crushability

Chlorthalidone is a standard immediate-release thiazide-like diuretic that does not appear on specialized "Do Not Crush" lists for formulation-specific reasons. The medication lacks:

• No sustained-release mechanism that would cause dangerous dose dumping if disrupted 1, 2
• No enteric coating requiring gastric protection that crushing would destroy 1
• No special nanocrystal or amorphous solid dispersion technology that altering would compromise bioavailability 2

The drug is dosed once daily due to its inherently long half-life (24-72 hours), not because of extended-release formulation design 3.

Practical Administration Guidelines

When crushing chlorthalidone tablets:

• Mix the crushed tablet immediately with a small amount of soft food (applesauce, pudding) or liquid vehicle to ensure complete dose administration 4
• Administer promptly after crushing to prevent degradation from light or moisture exposure 1
• Ensure the patient consumes the entire mixture to receive the full therapeutic dose 4

Critical Safety Precautions

For healthcare workers handling crushed tablets:

• Use appropriate technique to minimize exposure to drug particles, though chlorthalidone is not classified as a hazardous drug requiring special precautions 1

For patients receiving crushed medication:

• Monitor electrolytes within 4 weeks of any dose change, as crushing does not alter the risk of hypokalemia or hyponatremia that chlorthalidone inherently carries 5, 3
• Maintain the same dosing schedule (once daily) as the intact tablet 3
• Watch for therapeutic efficacy with blood pressure monitoring, as absorption should remain unchanged 3

Alternative Considerations

If crushing becomes problematic or adherence is difficult:

• Liquid formulations may be available through compounding pharmacies, though this requires verification with your pharmacist 4
• Consider switching to a different antihypertensive class if swallowing difficulties persist and crushing is not feasible long-term 4

The decision to crush should involve coordination between the physician, pharmacist, and nursing staff to ensure proper technique and monitoring 4.