Don't Rush to Crush

Included in the Pharmacy Board of Australia’s list of essential references for pharmacy practice, Advanced Pharmacy Australia’s Don't Rush to Crush+ is Australia’s essential guide to safely administering oral medicines to people with enteral feeding tubes or swallowing difficulties. When giving tablets, capsules or oral liquids to these patients, healthcare professionals need answers to these questions: 

  • Can I crush it?
  • Can I disperse it? 
  • Can I open the capsule? 
  • Is this liquid medicine safe and appropriate for my patient? 
  • Can I give the injection orally? 
  • How do I give a dose that is less than a whole tablet or capsule? 

The answers to these questions and more are available in Don’t Rush to Crush+.
 

Don’t Rush to Crush is now fully digital

This latest edition, Don’t Rush to Crush+ has a new look and is wholly online, with the environmentally sustainable format enabling a more flexible and targeted presentation of monographs and an agile response to changes and new information.

The shift respects that health professionals and trainees – including pharmacists and pharmacy students, nurses and nursing students, health professionals in aged care, speech pathologists and dietitians – prefer the accessibility and convenience of online information.

Access Don’t Rush to Crush+:

MIMS AusDI
 

Informed by Australia-first research 

The recommendations in Don’t Rush to Crush+ are informed by our most comprehensive dispersion testing of tablets and capsules to date which includes the physical suitability of dispersed tablets and capsules for administration into enteral feeding tubes. In partnership with the Department of Pharmacy and Pharmacology at University of Tasmania, the testing so far encompasses over 160 medicines with testing of another 150 + medicines currently underway.
 

A focus on patient safety 

Informed by evidence that suggests large tablets and capsules may increase the risk of choking, even for people without recognised swallowing difficulties, Don’t Rush to Crush+ now highlights tablets or capsules that are considered to be large within the medicine monographs. 

This builds on recent safety additions including internationally-recognised classification (IDDSI) of the thickness of oral liquid medicines and whether they are suitable for people with swallowing difficulties, as well as factors to consider when giving medicines to people who have undergone gastrointestinal surgery, or who have altered gastrointestinal function. 
 

Current advice via continuous updates  

Don’t Rush to Crush+ is a comprehensive reference of over 600 oral medicines available in Australia.  Updates to monographs are released four times a year, with focus on a different therapeutic class each quarter. 
 

February 2025 release

The General information section has been completely reviewed and updated, and includes new information about tablet technologies that are not suitable for crushing, and the size of tablets and capsules as a potential choking risk.

Extensive dispersion testing of more than 60 gastrointestinal medicines, including testing for suitability of administration into size 8 French enteral feeding tubes.

Monograph review and updates (141):

  • gastrointestinal medicines, including new dispersion data and updated Comparative information for proton pump inhibitors
  • cancer therapies
  • electrolytes
  • chelators and binders
  • enzyme replacement therapies
  • ivacaftor (and combinations)

New monographs (7):

  • aluminium hydroxide
  • Orkambi
  • ritlecitinib
  • selumetinib
  • Symdeko
  • tepotinib
  • Trikafta

Monographs with significant changes (24):

  • Balsalazide (dispersion data)
  • Dabrafenib (formulation, administration)
  • Entrectinib (administration)
  • Esomeprazole (dispersion data)
  • Gilteritinib (administration)
  • Lansoprazole (dispersion data)
  • Lenvatinib (administration)
  • Mebeverine (dispersion data)
  • Mesalazine (dispersion data)
  • Metoclopramide (dispersion data)
  • Midostaurin (compounded suspension)
  • Nintedanib (administration)
  • Nizatidine (dispersion data)
  • Obeticholic acid (dispersion data)
  • Omeprazole (formulation)
  • Pantoprazole (dispersion data)
  • Patiromer sobitex calcium (administration)
  • Pomalidomide (administration)
  • Ruxolitinib (compounded suspension)
  • Sotorasib (administration)
  • Trametinib (formulation)
  • Ursodeoxycholic acid (dispersion data)
  • Vemurafenib (administration)
  • Vorinostat (hazard classification)