Can Fexofenadine Be Crushed?
There is no established evidence supporting the crushing of fexofenadine tablets, and this practice should be avoided in routine clinical use. The available formulations—tablets, capsules, and oral suspension—are bioequivalent and designed for intact administration 1, 2.
Available Formulations and Administration
Fexofenadine is available in multiple formulations including tablets, capsules, and an FDA-approved oral suspension specifically developed for pediatric use 1, 2.
The oral suspension formulation is bioequivalent to the 30 mg tablet and is indicated for children aged 2-11 years for seasonal allergic rhinitis and children aged 6 months-11 years for chronic idiopathic urticaria 2.
All three formulations (tablet, capsule, and oral suspension) are bioequivalent, meaning the suspension provides an appropriate alternative when tablet swallowing is difficult 1.
Evidence Regarding Crushing
No clinical data exist on the safety, efficacy, or bioavailability of crushed fexofenadine tablets 1, 2, 3, 4, 5.
The only reference to crushing tablets in the provided evidence relates to fexinidazole (a different medication for African trypanosomiasis), not fexofenadine, where crushing feasibility is "currently under investigation" but not yet established 6.
Practical Recommendations for Vulnerable Populations
For Young Children (Ages 2-11 Years)
- Use the FDA-approved oral suspension formulation rather than attempting to crush tablets 2.
- The suspension was specifically developed to facilitate administration in young children who cannot swallow tablets 2.
For Children Under 2 Years
- Fexofenadine safety has been established down to 6 months of age for chronic idiopathic urticaria using the oral suspension 2.
- For seasonal allergic rhinitis, the approved age is 2 years and older 2.
For Elderly Patients
- Fexofenadine is well tolerated in elderly patients without dose adjustment 3.
- If swallowing difficulty exists, the oral suspension formulation should be considered rather than crushing tablets 2.
Critical Considerations
Crushing tablets may alter bioavailability since the formulations are designed for intact administration, though this has not been formally studied for fexofenadine 1.
Fexofenadine bioavailability is already reduced by orange and grapefruit juices, suggesting that mixing crushed tablets with certain vehicles could further compromise absorption 1.
The drug does not require food for absorption (unlike fexinidazole), but crushing and mixing with food or liquids of unknown compatibility could theoretically affect pharmacokinetics 6, 1.
Common Pitfalls to Avoid
Do not assume tablet crushing is acceptable simply because an oral suspension exists—use the suspension formulation instead 2.
Do not mix fexofenadine with citrus juices (orange or grapefruit), as these significantly reduce bioavailability 1.
Do not combine with other antihistamine-containing products to prevent overdosage 7.