Can You Crush Kalydeco Tablets?

lookapancake asked

Can Kalydeco tablets been crushed, dissolved, and put into a feeding tube safely?

Answer

Kalydeco (ivacaftor) is available in two dosage forms:

• Tablets
• Granules

Kalydeco tablets are not intended to be cut, split or crushed. In fact, they are 'film-coated' and modifying them will destroy this coating.

There are a number of reasons why a manufacturer may choose to 'film-coat' a tablet or pill. These reasons include:

• Helps to mask a bitter taste
• Makes them easier to swallow (they go down the throat more easily)
• Reduces nausea due to a delay in dissolution (they dissolve in the small intestine versus the stomach)

If you are crushing a tablet for the purpose of administering via a feeding tube, many of the attributes of film-coated tablets are of no consequence (e.g. there is no need to mask the taste of a tablet if you aren't swallowing it).

Nevertheless, there are still some concerns with crushing the film-coated Kalydeco since again, they aren't intended to be crushed.

I couldn't find any data on how difficult they are to crush but based on the inactive ingredients the drug contains (which are listed in the prescribing information), it doesn't appear that the tablets will easily dissolve/disperse in a liquid, which will certainly increase the chances that a feeding tube could get blocked with drug sediment when administered (even if crushed finely).

Most guidelines that discuss administering drugs via a feeding tube recommend that your first-line option should be a drug that is either a commercially available liquid/suspension or a drug that is completely dispersible in a liquid. Kalydeco tablets don't meet these suggestions.

Therefore, if you need to administer Kalydeco via a feeding tube, you likely should use the granules, which are dispersible in liquid.

Using the granules will save you from having to crush film-coated tablets and will likely lessen the chance of a feeding tube being blocked.

Kalydeco granules can be mixed in a variety of liquids, including:

• Water
• Breast milk
• Infant formula
• Milk
• Juice

You don't need much liquid, only 5 mL (~ one teaspoon) according to the prescribing information for the drug. If you want to lessen the viscosity (i.e. thickness) of the resulting suspension, you could certainly use a little more liquid (this will also decrease the risk of feeding tube blockage).

In the vast majority of situations, your insurance company should cover Kalydeco tablets and granules for the same price. If for some reason there is a coverage issue, your provider should be able to appeal to the insurance company on the grounds that the granules are more suitable and safer for feeding tube administration.

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