Can Augmentin (amoxicillin and clavulanic acid) be crushed for patients with swallowing difficulties, such as the elderly or young children?

Can Augmentin Be Crushed?

Yes, Augmentin tablets can be crushed for patients with swallowing difficulties, but the oral suspension formulation is strongly preferred for children and patients who cannot swallow tablets whole. 1, 2

Preferred Administration Methods

For Pediatric Patients

• Oral suspension is the standard formulation for children and should be used instead of crushing tablets whenever possible 1, 2
• Age-based suspension dosing is well-established: children 1-12 months receive 2.5 ml of 125/31 suspension three times daily, children 1-6 years receive 5 ml of 125/31 suspension three times daily, and children 7-12 years receive 5 ml of 250/62 suspension three times daily 1
• The suspension formulations maintain the proper ratio of amoxicillin to clavulanate (14:1 for high-dose preparations) which is critical for efficacy and minimizing gastrointestinal side effects 3

When Tablets Must Be Crushed

• If tablets must be crushed for adults or older children who cannot swallow whole tablets, they should be crushed immediately before administration and mixed with a small amount of water or soft food 4, 5
• The crushed medication should be consumed immediately and completely to ensure the full dose is received 4
• Do not crush extended-release formulations (such as Augmentin XR 2000/125 mg), as this destroys the pharmacokinetically enhanced delivery system designed to maintain therapeutic drug levels 5

Critical Considerations

Formulation-Specific Guidance

• Standard immediate-release Augmentin tablets (250/125 mg, 500/125 mg, 875/125 mg) can be crushed if necessary 4, 5
• The high-dose adult formulation (2000/125 mg twice daily) is an extended-release tablet that must NOT be crushed, as crushing eliminates the enhanced pharmacokinetic profile 5
• For patients requiring high-dose therapy who cannot swallow tablets, use the oral suspension at 90 mg/kg/day of amoxicillin component in two divided doses instead 1, 2

Practical Pitfalls to Avoid

• Verify the suspension concentration before dispensing (125/31 vs 250/62) to avoid dosing errors when switching from tablets to suspension 1
• The 14:1 ratio formulation in high-dose suspension causes significantly less diarrhea than crushing tablets with higher clavulanate ratios 3
• Crushing tablets may result in bitter taste, which can lead to incomplete dosing in children—another reason suspension is strongly preferred 4

Alternative Strategies

• For severe infections requiring IV therapy when oral administration is impossible, use 30 mg/kg three times daily IV for pediatric patients or 1.2 g three times daily IV for adults 2, 6
• Switch to oral formulation (preferably suspension for children) as soon as clinically appropriate 2