PTCB Certified Pharmacy Technician (PTCE)MedicationsHard
A patient is prescribed 'Diltiazem CD 180 mg, take 1 capsule daily.' The patient asks if they can cut the capsule in half because it is difficult to swallow. How should the pharmacy technician advise the patient?
- AYes, it is safe to cut the capsule in half.
- BNo, the capsule should be swallowed whole due to its extended-release formulation.
- CNo, but they can chew the capsule if swallowing is difficult.
- DYes, the contents can be sprinkled on applesauce if swallowing is difficult.
Show answer & explanationAnswer & explanation
Correct answer: B. No, the capsule should be swallowed whole due to its extended-release formulation.
Diltiazem CD is an extended-release (CD stands for 'Controlled Delivery') formulation. Cutting, crushing, or chewing such capsules would destroy the controlled-release mechanism, leading to rapid drug release (dose dumping) and potentially serious adverse effects, including toxicity or loss of therapeutic effect.
Why the other options are wrong
- A. Cutting an extended-release capsule is dangerous and can lead to dose dumping.
- C. Chewing an extended-release capsule would also destroy the controlled-release mechanism.
- D. While some extended-release capsules can be opened and contents sprinkled, 'CD' formulations often have specific release mechanisms that make this unsafe unless explicitly stated by the manufacturer.
Extended-Release Dosage Forms
Extended-release (ER, XR, CD, SR, LA, etc.) dosage forms are designed to release medication slowly over an extended period, and should generally not be cut, crushed, or chewed.
- Maintain consistent drug levels
- Prevent frequent dosing
- Disrupting them causes 'dose dumping'
- Dose dumping can lead to toxicity or subtherapeutic levels
Memory trick: ER = Extended Release, Requires Respect.