Can Metformin be crushed

[fluenz]

Hi guys,

I have a question. Can Metformin be crused?
I have come across with a real case where the patient found Metformin 1000mg XR in the stools with out getting dissolved completely. Is it possible?

[sonuritu]

Hmm..this is interesting!
XR/ER/CR formulations CANNOT be crushed .... period . The whole point of the release technology is lost ,except in special cases like metoprolol succinate where it can be broken along the split line to take half the dose .In the case above, we need to find out how he is administering his medication and what is his other disease states..He should be advised to drink water with the med , to aid in dissolution.Also find out if he suffering from any GI disease, cos the tablet needs gastric secretions for the initial phase of dissolution and normal GI peristalsis for the tablet to be broken down later and excreted in feces as a soft mass.
my 2 cents.

[ginas202]

If drug brand names have XR, CR, SR, DR like suffix (special ends with "R"), then that drug cannot be crushed...

ODT = Orally Disintegrating Tablets/waffers... This universal rule does not apply for these categories of drug (buccal drugs).

There are few exceptions... metoprolol succinate... Toprol XL... I don't remember one other drug but on naplex digest they have asked one question on that drug.

[odunik]

I believe that extended release formulations can't be crushed, unless manufacturer specifies it.
About undissolved pieces of tablets in the stool: since it is extended release tabs, they made a polymer matrix with the drug incorporated into it. GI fluids get into matrix, hydrate and swell it. Then drug will slowly released from the matrix (based on pH dif). Even though the matrix is not rigit, it may occasionaly remains intact and excreted in the feces.(Similar to carbamazepin, nifedipine ext rel and others, actually, we need to consult patients about seeing empty matrix in the stool - don't worry if you see ... etc.)

[wenep]

If it is dissolution; usually related with moisture not pH. Extended release have to have different release phase (e.g. loading and maintaining Css). Metformin have immediate release component and then matrix based extended release component. Matrix based component can be seen in stool but it does not mean that drug has not been released. Yes Matrix based component is supposed to swell and crushed along with peristalsis, if not, most important factor is emptying time.

[fluenz]

Hi Sonuritu,

Thank you for your inputs.

[fluenz]

Hi,

Thank you for your inputs.

[MorphineRx]

Hi guys,

I have a question. Can Metformin be crused?
I have come across with a real case where the patient found Metformin 1000mg XR in the stools with out getting dissolved completely. Is it possible?

I would say that there are a few issues here:
1)Is the metformin controlling the Diabetes alone or in combination therapy? How long has the patient been diagnosed and been on metformin? Has teh patient had any GIT surgery (chrones, gastric bypass, etc.)

1a)If it is controlled, then the metformin tablet not being dissolved completely is not a problem.

2)Metformin can cause severe GIT Upset with higher doses. This is limited by giving an extended release preparation, and as most have said before, it CANNOT be Crushed. Beyond that, maybe his dose is too high and is causing increased diarrhea. The Diarrhea would cause the metformin to pass through the GIT much faster than might be released from the tablet. If Having Diarrhea and Abdominal Cramps is not a problem for the patient, which I highly doubt (haha), then you could switch to Immediate Release Metformin.

3)Is the patient taking anything other than the Metformin? The drug has relatively Slow Absorption--- meaning that it needs to be present in the GIT longer to have it be absorbed, and other medications might limit this if taken together, or may cause increased adverse effects (GIT).

In General, I would never Crush any Metformin (XR or IM). It may cause increased adverse effects and, although rare for Metformin, Biguanides have been known to cause lactic acidosis, let alone, I can't imagine that it would taste good on anything. Applesauce can't cut that smell LOL! hahah I hope this helps you out. I would agree with sonuritu also.