Can You Crush Stalevo?
In our latest question and answer, the pharmacist discusses why it is not recommended to crush Stalevo.
Can I pulverize/crush Stalevo 200mg so it will work faster?
Stalevo is a medication used for the treatment of Parkinson's Disease, and consists of three active ingredients:
Stalevo should not be crushed, chewed or split. Only intact tablets should be taken.
The prescribing information for Stalevo states the following:
Important Administration Instructions
Do not split, crush or chew Stalevo tablets. Administer only one tablet at each dosing interval.
Why You Can't Crush Stalevo
There are a variety of reasons why some medications should be left intact, and not crushed or split. These reasons include:
- Destroying an extended or modified-release mechanism could cause an entire dose to be released at once (i.e. dose-dumping).
- Some medications can have an undesirable bitter or metallic taste. In some cases, certain medications can cause severe irritation to the esophagus and stomach.
- Some medications are cytotoxic and can be harmful if they come in contact with the skin. Some medications are even absorbed through the skin, and could potentially cause birth defects if handled by pregnant women (e.g. Avodart).
When it comes to Stalevo, there are a few reasons it should not be crushed, and I discuss this in the next sections.
The Tablets Are Film-Coated
Stalevo tablets are 'film-coated'. This makes them easier to swallow, which can often be difficult for those dealing with the effects of Parkinson's Disease. Crushing the tablets will destroy the film-coating, making them more difficult to swallow and increase the risk of esophageal irritation.
Additionally, Stalevo is reported to be extremely bitter and unpalatable. The film-coating on Stalevo tablets prevents you from experiencing unpleasant tastes.
Film-coated tablets also protect the tablet from premature breakdown, as it guards against moisture and light.
'Film-coated' tablets are generally not considered an extended-release mechanism and therefore, removing the coating (e.g. by crushing) won't affect the medications rate or extent of absorption in the body. However, they generally aren't recommended being modified for the reasons stated above.
The Medication Has A Bitter Taste
This was already mentioned in the 'film-coated' section, but it is worth pointing out again that it has been reported that Stalevo has a bitter taste, which may be irritating and could make them more difficult to swallow.
All Strengths Of Stalevo Contain The Same Amount Of Entacapone
There are six different strengths of Stalevo available, but all contain the same amount of one ingredient, entacapone.
Since every Stalevo tablet contains 200 mg of entacapone, splitting is discouraged as to avoid confusion with regard to dosing. This is the main reason cited by the manufacturer as to why Stalevo should not be crushed or split.
The amount of levodopa (one of the active ingredients in Stalevo) needed for therapeutic effectiveness can vary significantly, even in one individual over the course of a day. The manufacturer of Stalevo wants to discourage splitting tablets (which may be done to achieve a certain amount of levodopa) to avoid accidentally underdosing or overdosing the entacapone component.
Therefore, the manufacturer recommended dosing instructions are to only take one tablet per dosing interval. From the prescribing information:
Administer only one tablet at each dosing interval. All strengths of Stalevo contain 200 mg of entacapone. Combining multiple tablets or portions of tablets to achieve a higher levodopa dose may lead to an overdose of entacapone.
Additional Information On Crushing
Although the manufacturer recommends against crushing Stalevo, and there are many reasons not to, there could certainly be a situation where your doctor recommends it. Some prescribers or organization do recommend crushing if no other options or alternatives are available.
Again, Stalevo is not an extended release product so crushing will not significantly alter the absorption properties of the drug. Be sure to follow your doctor's advice on how to take the medication.
If you are not experiencing any benefit from taking Stalevo, your doctor can help you evaluate your therapy and make any adjustments necessary (for example adding on additional levodopa).