My son was cannot swallow his 18mg Concerta medication. The doctor said to crush it up and put it in Sprite. I want to know if this is safe. It specifically says on the bottle not to chew or crush.
At a glance
- Concerta should be swallowed whole.
- It should not be crushed, cut or split. Doing so will destroy the extended-release mechanism of the drug.
Concerta (methylphenidate extended-release) should not be crushed, cut or split.
Doing so will destroy the extended-release properties of drug, resulting in the entire dose being delivered at once. This is known as "dose dumping" and can increase the risk of side effects as well as shorten the duration of action of the drug.
Per the prescribing information for Concerta:
"Do not chew, crush, or divide the tablets. Swallow CONCERTA tablets whole with water or other liquids. Tell your doctor if you or your child cannot swallow CONCERT whole. A different medicine may need to be prescribed."
Concerta Release Mechanism
Concerta (methylphenidate extended-release) tablets utilize what is known as an osmotic 'biphasic' release mechanism.
After taking a dose by mouth, there is an initial release of methylphenidate, with maximum concentrations occurring after one hour. After this initial release of the drug, there is a gradual release of more drug, increasing concentrations over the next 5 to 9 hours.
The prescribing information details exactly how the drug is delivered by the specially designed tablet:
"In an aqueous environment, such as the gastrointestinal tract, the drug overcoat dissolves within one hour, providing an initial dose of methylphenidate. Water permeates through the membrane into the tablet core. As the osmotically active polymer excipients expand, methylphenidate is released through the orifice [drilled in the tablet]. The membrane controls the rate at which water enters the tablet core, which in turn controls drug delivery."
This biphasic release allows the drug to take effect quickly and lengthens the duration of action while avoiding the significant fluctuations in drug concentration that can happen with immediate release products.
Below is a chart illustrating the 'biphasic' release of Concerta (taken once daily) compared to immediate-release methylphenidate (taken three times daily):
Source: Concerta Prescribing Information
Why You Shouldn't Crush Concerta
As mentioned above, crushing Concerta will destroy the release mechanism.
Not only will the entire dose be released at once, increasing the risk of side effects, but it will also have a significantly shortened duration of action (around 3 to 6 hours versus 10-12 for intact Concerta).
Possible side effects from Concerta include:
- Increased blood pressure
- Increased heart rate
- GI upset
- Decrease in appetite
Be sure to clarify with the doctor how they want your son to take his medication. If Concerta cannot be swallowed, it may make sense to switch to a different product.
There are extended-release methylphenidate suspensions and chew-tabs available (Quillivant XR) which may be viable alternatives.