ORAL ANTIRETROVIRALS: INFORMATION ON CRUSHING AND LIQUID FORMULATIONS

Combination Medications

DRUG COMMERCIALLY AVAILABLE FORMULATION INFORMATION ON CRUSHING AND SPLITTING TABLETS
Atripla® (efavirenz/ emtricitabine/ tenofovir DF) No Consider use of Truvada® tabs and efavirenz caps as alternate formulations Although Truvada® tablets may be split, splitting Atripla® tablets has not been studied. There are no studies evaluating the pharmacokinetics of a split tablet vs. a whole tablet. Efavirenz is not water soluble.
Biktarvy® (bictegravir/ emtricitabine/ tenofovir alafenamide) No N/A Note that Biktarvy tablets should be administered whole. Crushing BIC/FTC/TAF tablets into a liquid medium has not been studied and is not recommended. While TAF is soluble in water, it has a bitter and burnt aromatic taste flavor profile. While FTC is soluble in water, BIC is practically insoluble (solubility of 0.1 mg/mL in water at 20°C). Currently, there are no studies evaluating the pharmacokinetics (e.g., oral bioavailability) of a crushed BIC/FTC/TAF tablet dispersed into a liquid medium (e.g., milk, water, juice) compared to a whole tablet. (Data on File, Gilead US, May 2018) Similarly, splitting BIC/FTC/TAF tablets has not been studied and it is not recommended. Currently, there is no study evaluating the pharmacokinetics of a split tablet versus a whole tablet. (Data on File, Gilead US, May 2018).
Combivir® (lamivudine/ zidovudine) Yes (individual components). Use lamivudine & zidovudine liquid products No data, but likely OK to crush tablets (film-coated); crush immediately before ingestion. May have bitter taste. Tablets can be crushed and added to small amount of liquid or semi-solid food; consume immediately.
Complera® (tenofovir DF/emtricitabine/rilpivirine) No N/A Splitting or crushing Complera® tablets into a liquid medium has not been studied and is not recommended. Rilpivirine hydrochloride is insoluble in water over a wide pH range.
Descovy® (tenofovir AF emtricitabine) No N/A Crushing or splitting Descovy® tabletshas not been studied and is not recommended. TAF is soluble in water. However, it has a bitter and burnt aromatic flavor profile. Emtricitabine is soluble in water.
Delstrigo® (doravirine/ lamivudine/ tenofovir DF) Yes Only lamivudine liquid available Crushing or splitting Delstrigo® has not been studied and is not recommended. The product should be swallowed whole. The tablets are film-coated.
Dovato® (dolutegravir/ lamivudine) Yes Only lamivudine liquid available The manufacturer recommends swallowing the tablet whole. The tablets are film-coated. For patients who cannot swallow the tablet who, in theory, the tablet may be split in halves or crushed and added to a small amount of semi-solid food or liquid and the full contents consumed immediately.
Evotaz® (atazanavir/ cobicistat) No N/A The manufacturer recommends swallowing the tablet whole; do not crush or chew tablets.
Genvoya® (elvitegravir/ cobicistat/ tenofovir AF/ emtricitabine) No N/A Splitting or crushing Genvoya® tablets into a liquid medium has not been studied and is not recommended. TAF is soluble in water but has a bitter and burnt aromatic taste. Emtricitabine is soluble in water, but cobicistat and elvitegravir are practically insoluble.
Juluca® (dolutegravir/ rilpivirine) No N/A The efficacy, safety and pharmacokinetics of crushing dolutegravir/rilpivirine have not been evaluated. The tablet should be swallowed whole and taken with a meal to ensure administration of the entire dose. The tablets are film-coated. Based on clinical judgment if the Juluca® tablet requires splitting, it should be split in half and both halves ingested immediately with a meal. If the Juluca® tablet requires crushing, it should be crushed and added to a small amount of liquid or semi-solid food and the full tablet content consumed immediately with a meal.
Odefsey® (tenofovir AF/ emtricitabine/ rilpivirine) No N/A Crushing or splitting Odefsey® tabletshas not been studied and is not recommended. TAF is soluble in water. However, it has a bitter and burnt aromatic flavour profile. Rilpivirine hydrochloride is insoluble in water over a wide pH range.
Prezcobix® (darunavir/ cobicistat) No See darunavir and ritonavir for other liquid options (substitution of cobicistat with ritonavir may be required) Splitting Prezcobix® film-coated tablets has not been studied. Tablets should be swallowed whole without breaking or crushing to ensure administration of the entire dose. Tablets are immediate-release formulation; no anticipated absorption issues if the tablets are chewed, split or crushed.
Stribild® (elvitegravir/ cobicistat/ emtricitabine/ tenofovir) No N/A Pharmacokinetics of crushed Stribild® tablets were studied in healthy volunteers. Whole tablets with breakfast were compared to: I. Crushed and suspended with breakfast; II. Crushed and suspended with enteral nutrition (Nutrison®). The groups were shown to be bioequivalent for elvitegravir, tenofovir and emtricitabine. Elvitegravir Cmax failed to fall within bioequivalence range (100-120%), but this difference is unlikely to be clinically significant. Cobicistat AUC was reduced by 10% for intervention I only.
Symtuza® (darunavir/ cobicistat/ emtricitabine/ tenofovir alafenamide) No N/A Symtuza® should be swallowed whole. The manufacturer does not recommend breaking or crushing Symtuza® to ensure administration of the entire dose. Film-coated tablets.
Triumeq® (abacavir/ lamivudine/ dolutegravir (DTG)) No Use abacavir & lamivudine liquid products. Dolutegravir tablets may be crushed (see dolutegravir). Triumeq® is film-coated, non-scored, and non-sustained released formulation. Although not studied, splitting or crushing tablets is not expected to affect the dissolution or absorption. Tablets may be crushed and added to a small amount of semi-solid food or liquid, and consumed immediately.
Trizivir® (abacavir/ lamivudine/ zidovudine) Yes (individual components) Use abacavir, lamivudine & zidovudine liquid products. Film coated immediate release tablet however no studies regarding stability of split or crushed tablets.
Truvada® (tenofovir/ emtricitabine) Yes (individual components) Tenofovir & Emtricitabine May split tablets. May crush and stir into water, grape juice or orange juice. The stability of the mixture is unknown.

Individual Medications

DRUG COMMERCIALLY AVAILABLE FORMULATION INFORMATION ON CRUSHING AND SPLITTING TABLETS
Abacavir (Ziagen) No Consider use of Truvada® tabs and efavirenz caps as alternate formulations Although Truvada® tablets may be split, splitting Atripla® tablets has not been studied. There are no studies evaluating the pharmacokinetics of a split tablet vs. a whole tablet. Efavirenz is not water soluble.
Atazanavir (Reyataz) Yes 50 mg/1.5 g dispersible oral powder packet Capsules: May be opened and the contents mixed with applesauce for immediate ingestion with a light meal.
Darunavir (Prezista) Yes 100 mg/mL oral suspension No data is available on chewing or crushing of Prezista® film-coated tablets. However, since the tablets are not formulated as an extended release formulation, no potential problem is anticipated if the tablets are chewed or crushed for administration through a nasogastric (NG) tube. It is unlikely that chewing or crushing Prezista® tablets would have a significant impact on pharmacokinetics.
Dolutegravir (Tivicay) No N/A 10, 25 and 50 mg tablets should ideally be swallowed whole. All tablet strengths may also be split into halves followed by immediate ingestion of both halves or crushed and added to a small amount of semi-solid food or liquid, all of which should be consumed immediately.
Doravirine (Pifeltro) No N/A Crushing or splitting Pifeltro® has not been studied and is not recommended. The product should be swallowed whole. The tablets are film coated.
Efavirenz (Sustiva) No Consider use of capsule formulation Splitting efavirenz tablets has not been well studied. There are no well controlled studies evaluating a split tablet vs. a whole tablet. Efavirenz is not water soluble. The use of the capsule formulation is preferred when possible.
Elvitegravir No N/A Crushing or splitting Genvoya® tablets has not been studied and is not recommended. While emtricitabine and TAF are soluble in water, cobicistat and elvitegravir are practically insoluble in water.
Emtricitabine (Emtriva) No 10 mg/mL oral solution 200 mg capsules may be opened and mixed with water.
Etravirine (Intelence) No N/A Patients who are unable to swallow etravirine tablets whole may disperse the tablets in a glass of water. Both the 100 mg and 200 mg tablet formulations of etravirine may be dispersed in water.

Place the tablet in 5 mL of cold water or at least enough liquid to cover the medication. Stir until a homogenous, white, cloudy, suspension is obtained. If desired, add more water or alternatively orange juice or milk. Once dispersed, patients should stir the dispersion well and drink it immediately. The glass should be rinsed with water, orange juice or milk several times and each rinse completely swallowed to ensure the entire dose is consumed. Avoid the use of grapefruit juice, warm liquids (>40°C) or carbonated beverages.
Fosamprenavir (Lexiva) Yes 50 mg/mL oral suspension, 225 mL bottle. 0.6% propylene glycol Grape bubblegum and peppermint flavor. No information on crushing or dissolution of 700 mg tablets. Fosamprenavir calcium tablets and suspension are equivalent on a mg per mg basis.

In adults, oral suspension should be taken on an empty stomach (1 hr before or 2 hours after food). In pediatric patients, oral suspension should be given with food.

Store oral suspension between 2-30°C. Do not freeze. Discard the suspension 28 days after first opening.
Indinavir (Crixivan) No N/A Do NOT open capsules (bitter taste; stability uncertain).
Lamivudine (3TC) (Epivir/Epivir HBV) Yes 10 mg/mL oral solution; 240 mL bottle. Pale yellow, strawberry-banana flavored solution) Can also crush or split tablets.
Lopinavir/Ritonavir (Kaletra) Yes 80 mg/20 mg per mL; 160 mL bottle. Cotton-candy flavored yellow-orange oral solution. Oral solution contains the excipients alcohol (42.4% v/v) and propylene glycol (15.3% w/v). Increased risk of toxicity in preterm infants. Adult and pediatric Kaletra® tablets should be swallowed whole and not chewed, broken, or crushed. Risk of tablets shattering if broken/crushed. Tablets are film-coated and formulated using Meltrex (Melt Extrusion Technology) which improves the poor solubility of lopinavir/ritonavir by dissolving drug in a polymer and allowing drug to remain in dispersion as the polymer hardens. The extruded material can then be processed into tablets.
Maraviroc (Selzentry) Yes 20 mg/ml clear, colorless, strawberry flavored oral solution Film coated immediate release tablet. No pharmacokinetic data available for crushing/chewing tablet. While the company does not have any specific kinetic information, crushing or cutting the tablets is not expected to negatively affect bioavailability.
Nevirapine (Viramune/Viramune XR) Yes 10mg/mL;240 mL bottle suspension Contains sorbitol 162 mg/mL Can crush immediate release (200 mg) nevirapine tablets in water. Extended-release (400 mg XR) tablets must be swallowed whole; they must not be chewed, crushed or divided.
Raltegravir (Isentress/Isentress HD) Yes 20 mg/mL oral banana flavored granular powder (single-use packet of 100 mg raltegravir)

25 mg & 100 mg pediatric chewable tablets
Crushing 400 mg and 600 mg HD film coated tablets is not recommended. Drug has a bitter taste which is masked by the film coating.

Chewable tablets may be chewed or swallowed whole.

Oral suspension, chewable tablets and film-coated tablets are NOT interchangeable. The maximum dose of the chewable tablets is 300 mg BID and the maximum dose of the oral suspension is 100 mg BID.
Rilpivirine (Edurant) No N/A Film coated tablet. No data available on stability of splitting or crushing rilpivirine tablets. Rilpivirine is insoluble in water over wide pH range.

Crushed tablets added to a small amount of semisolid food or liquid is not expected to have an adverse effect if consumed immediately. Since tablets are small, ensure the whole dose is consumed.
Ritonavir (Norvir) Yes 80 mg/mL oral liquid; 240 mL bottle. Orange-colored oral solution, peppermint & caramel-flavored. 43.2% v/v alcohol, propylene glycol 26.57% w/v. Shake well before each use.

100 mg Oral Powder (100 mg/packet)
Tablets should be swallowed whole and not chewed, broken or crushed. Tablets are film-coated. Norvir® tablets are formulated using Meltrex (Melt Extrusion Technology) which improves the stability in heat and poor solubility of ritonavir by dissolving drug in a polymer and allowing drug to remain in dispersion as the polymer hardens. The extruded material can then be processed into tablets.

Liquid is unpalatable, bad aftertaste. Tips: Mix oral solution with milk/chocolate milk or pudding; Give after popsicle/frozen juice to dull taste buds; Give after grape jelly, maple syrup, or peanut butter which coats mouth; Give strong flavor after dose (syrup, cheese, chewing gum).

Oral powder (100 mg/packet): The entire packet should be mixed with soft food such as apple sauce or vanilla pudding, or mixed with liquid such as water, chocolate milk, or infant formula. All soft food or liquid should be consumed within 2 hours of preparation. The bitter taste may be decreased if taken with food. The powder should be used in 100 mg increments only. The oral powder can also be administered via feeding tube after being mixed with water.
Tenofovir DF (Vemlidy/Viread) Yes 40 mg per 1 gram of oral powder formulation. Oral powder should be mixed in a container with 2 to 4 ounces (60 to 120 mL) of soft food not requiring chewing (e.g., applesauce, baby food, yogurt). Do not attempt to mix in a liquid as the powder may float on top even after stirring. Crushed tablet dissolves in 100 mL water in 20 minutes; grape juice may also be used. Consume immediately. Crushed tablets have very disagreeable taste. May also try splitting tablets and inserting into empty gelatin capsules to mask taste.
Zidovudine (Retrovir) Yes 10 mg/mL oral syrup; 240 mL bottle. Strawberry-flavored. May open capsules & give in small portion of food or 5-10 mL cool tap water.
Karen T.
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Yolanda P.
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"Always helpful to save money on medication and very kind."
Michael A.
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"Helpful and knowledgeable. Can't ask for better service, thank you!"
Patti E.
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"The staff at Drug Mart are exceptionally helpful. The quality of their products are top notch. I recommend Drug Mart to everyone. Am with them for life!!"
Darryl F.
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"This is the best pharmacy I have ever been to. They are caring, helpful and treat you with respect."
Anita H.
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"My daughter was able to get emergency medication after hours within half hour of making the phone call to the 800#. I can't recommend Drug Mart more highly."
Robert T.
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"I've been going here for years since my doctor recommended this pharmacy. They're busier now then when I first started but their service is still top notch. Thanks again for all your help!"
David D.
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"They are most accommodating, courteous, friendly and professional pharmacist I've ever dealt with. I'm so grateful to call this pharmacy my own."
Tonia B.
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"Always very caring when asking a question about your medication they know what they're talking about and they are very knowledgeable I've been going to them for oh my goodness since they opened up wow where did time go anyway my drug store for life thank you!"
Josh P.
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"This pharmacy is one of the best. Pharmacist has lots of knowledge and staff takes time to explain in detail. They do other half of what doctors should do. Also, no waiting like big name pharmacy. I highly recommend this pharmacy. They also deliver and ship to anywhere in USA."
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Drug Mart Pharmacy
5.0
Based on 163 reviews
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Chanice Dorsey
Chanice Dorsey
02:45 12 Mar 20
The staff at Drug Mart are truly an extension of my family. Vik offered me one of the greatest opportunities while in... nursing school, as a graduate, and as a working professional. He continues to encourage young adults to pursue their dreams and provides them with opportunities to be impactful within the community. You can’t get any better than this.read more
langston hannah
langston hannah
12:02 07 Mar 20
I am very pleased with the service that I receive from the pharmacy. The people who serve you are very helpful and... friendly and assist you in any way that they can. The pharmacist are well informed with your prescription needs, if there's a problem with anything you need they will do their best to resolve any issue you have. I recommend everyone to check them out and get their prescriptions filled at Drug Mart. I will always be a customer of Drug Mart because they are so good at what they do.read more
tracey evans
tracey evans
16:32 03 Mar 20
Drug Mart is my family, I’ve been with them since day 1. I moved away for a few years to another state, I’ve been... back i NJ. a little over 5 years and I’m still a happy customer. They’re very friendly, knowledgeable and very helpful and understanding, prices are better then most..read more
Cassandra Hemby
Cassandra Hemby
21:33 28 Feb 20
I so appreciate the dear people @Drug Mart! I am recovering from cancer and one day while in Chemotherapy I was told I... would need a certain cream right away, but I wouldn't be able to pick it up that day.however there is this very courteous and sweet young lady named Michele that assured me it would be delivered to me in at my daughter's home in Woodbridge, NJ, because that is where I go after having treatment.The kind of caring and compassion received there have made the staff endearing to me and has restored my faith in customer service again.read more
Denise Eady
Denise Eady
20:38 24 Feb 20
I love this place. Best pharmacy around!!!. I have been using this pharmacy since it opened. Whenever I walk in,... everyone is very cordial and always pleasant and with a smile, and they always greet me by nmy name. Vic and the other Pharmacists are very knowledgeable, and the staff takes the time to explain any new medications in detail. If you are not able to pick up your prescriptions, they do HOME delivery which is great. I transferred from Walgreens pharmacy and I am so glad I did!!!read more
Jay Bhatt
Jay Bhatt
21:05 22 Feb 20
The quality of service provided by the pharmacist and the staff is excellent! I wouldn't go to any other pharmacy. They... truly care.read more
Cindy Hall
Cindy Hall
15:21 20 Feb 20
I never have to wait. This is the best pharmacy I ever went to. I highly recommend them to everyone!
Maisha Bryant
Maisha Bryant
00:32 20 Feb 20
I have known Vik and his family since they opened. They have bright back what it means to have a home town family... operated pharmacy. He remembers you, that you have had a baby etc. He is compassionate and always goes above and beyond. He trains his staff to pursue their own dreams. Some have gone on to school. My prayer is that God gives him a long healthy life and that his business continues to prosper. Oh and BTW if you move he does mail order so he can continue to be your pharmacist no need to switch!read more
Sharel E. Gordon-Love
Sharel E. Gordon-Love
19:46 19 Feb 20
My family has been with Drug Mart since they first open and we’ve received top notch service every single time. Vic... and the staff are very friendly, and we are greeted with a smileread more
Tammy Nichols
Tammy Nichols
23:23 18 Feb 20
I used to get my prescriptions at Cvs. But when Drug Mart open close to my house i figured I give then a try and have... not looked back. The staff is always kind, helpful, and considerate. LOVE THIS PLACE.❤read more
Yolanda Parker
Yolanda Parker
20:50 17 Feb 20
I enjoyed the customer service I experience when I go into this store the friendly atmosphere the warm welcome you get... upon entering and exitingread more
Mike Webb
Mike Webb
16:48 06 Feb 20
Great being able to pick up my meds at this pharmacy. They are the best!
Janet Bynum
Janet Bynum
18:21 28 Jan 20
Leaving his experience I had with Drug Mart it's coming there getting my medication and then delivering it to me very... happy who had Drug Mart in my life far as my medications is concerned I don't have to call for refills they deliver them to me I've been the drug mart play my medications concern about 7 years or more appreciate the people they appreciate me I'm happy with Drug Mart this is my the best pharmacist that I know thank youread more
james hunter
james hunter
21:25 24 Jan 20
Always ready to help! Any way possible thank you for all your years of service!
Michelle Reyes
Michelle Reyes
21:03 24 Jan 20
Awesome staff always willing to help out 🙂
cindy ortega
cindy ortega
20:41 24 Jan 20
I love this pharmacy. Everyone makes you feel like your family. Any issues with prescription they try to resolve it... asap. I recommend this pharmacy to everyone.read more
jacqueline wells
jacqueline wells
19:33 31 Dec 19
Drug mart has the most pleasant employees and the service is swift I can't say enough good things about this pharmacy... Thanks for your years of dedication and service in our communityread more
Chris Hanington
Chris Hanington
13:47 18 Jul 19
These people take great care of THEIR people. Impressive!
R Turner
R Turner
21:57 01 Jun 19
I've been going here for years since my doctor recommended this pharmacy. They're busier now then when I first started... but their service is still top notch. Thanks again for all your help!read more
John Aleksandrowicz
John Aleksandrowicz
22:21 14 Apr 19
Great pharmacy with great customer service. Vik is great. He obviously cares about people and understands the needs of... each. Thank you!read more
Karen T
Karen T
18:54 06 Jan 19
This pharmacy is the best! I left Walgreens and very glad I did. They take the time to explain my medicines and know me... by name. I recommended them to all my family and friends.read more
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