Can Cephalexin Be Crushed?
Yes, cephalexin tablets can be crushed for administration in patients who cannot swallow whole tablets, as standard cephalexin formulations do not have properties that would be compromised by crushing.
Administration Guidelines
Standard Crushing Protocol
- Cephalexin is completely absorbed in the upper intestine (not the stomach), making it suitable for crushing without compromising bioavailability 1
- The drug should be crushed immediately before administration and mixed with a small amount of soft food or liquid 2
- For enteral tube administration, crushed tablets should be suspended in water and given through gastric tubes (not jejunal tubes) to ensure proper absorption 3
Tube Feeding Considerations
- Flush the feeding tube with at least 30 mL of water before and after administration to prevent tube obstruction 3
- Administer the crushed medication immediately after preparation 3
- Pharmacist consultation is recommended to ensure appropriate administration technique, particularly in complex medication regimens 3
Special Population Considerations
Patients with Renal Impairment
- Cephalexin dosing must be adjusted in patients with creatinine clearance less than 30 mL/min, as 70-100% of the drug is renally excreted unchanged 1
- Dose reduction should be proportional to reduced renal function 1
- The drug can accumulate and cause nephrotoxicity in patients with impaired renal function, though this is rare 4
Patients with Gastrointestinal Issues
- Cephalexin is well-tolerated and can be administered in relatively high oral doses without significant gastrointestinal irritation 1
- Because it is absorbed high in the intestinal tract, it does not disturb lower bowel flora 1
- Gastrointestinal side effects (nausea, vomiting, diarrhea) are relatively infrequent and rarely require drug discontinuation 5
Pediatric Patients
- Children may require higher doses per kilogram than adults due to greater body water turnover 1
- Typical pediatric dosing ranges from 20-100 mg/kg/day depending on infection severity 5
Important Caveats
Drug Interactions and Timing
- Do not administer cephalexin within 2 hours of antacids or medications containing divalent cations, as these can interfere with absorption (though this applies more to fluoroquinolones, similar precautions are prudent) 6
- When administering multiple crushed medications, coordinate timing to avoid interactions 2
Allergy Considerations
- Cephalexin has a low incidence of allergic reactions due to its chemical stability and configuration 1
- However, use caution in patients with documented penicillin allergy, as cross-reactivity can occur 4
Clinical Effectiveness
- First-generation cephalosporins like cephalexin are inactive against certain pathogens including Haemophilus influenzae (50% failure rate in H. influenzae otitis media) and Borrelia burgdorferi (Lyme disease) 6, 5
- Ensure the infection is caused by susceptible organisms before crushing and administering cephalexin 6