Can you crush Paxlovid?
By
Dr Natalia Marceli Stephanes (PhD)
Author bio
Dr Natália Marcéli Stephanes PhD is a Pharmacist with expertise in Drugs Administration and Toxicity; Discovery of New Drugs; Cancer Treatment; Biochemical Analyzes and Hematological Analyzes. She writes and reviews content on these topics.
Dr Natália Marcéli Stephanes’ Highlights:
- Pharmacist at the Department of Health of Santa Catarina State, Brazil
- PhD with a focus on oncology treatment
- Years of experience in commercial pharmacy
- Bachelor, Master and PhD degrees in Pharmacy at the Federal University of Santa Catarina
Professional Experience:
From her undergraduate studies to her Master’s and Doctorate degrees in Pharmacy, Dr Natália Marcéli Stephanes has participated in numerous scientific studies in the field of oncology and onco-hematology at the University Hospital of the Federal University of Santa Catarina, Brazil. Her research has focused on understanding the molecular and biochemical bases of malignant neoplasms and investigating safer and more effective therapeutic alternatives.
Dr Natália Marcéli Stephanes has also served as an assistant professor of haematology for undergraduate students at the Federal University of Santa Catarina. Additionally, she held the position of professor of Hospital Pharmacy at the Qualificar Technical School in Brazil, where she developed instructional materials for use in the Pharmacy Postgraduate Program at the Leonardo Da Vinci University Center.
In addition to her academic experiences, Dr Natália Marcéli Stephanes possesses a strong expertise in commercial pharmacy, with in-depth knowledge of medications, their routes of administration, desired effects, adverse effects, and toxicity.
Currently, Dr Natália Marcéli Stephanes works as a Pharmacist at the Health Department of Santa Catarina State, where her role entails providing pharmaceutical scientific consulting services to judges.
Education:
- 2016 Bachelor in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2018 Master in Pharmacy at the Federal University of Santa Catarina, Brazil
- 2023 PhD in Pharmacy at the Federal University of Santa Catarina, Brazil
The main publications of Dr Natália Marcéli Stephanes are:
Falchetti M ; Delgobo M, Zancanaro H, Almeida K, Das Neves RN, Dos Santos B, Stefanes NM, et al. Bishop Omics-based identification of an NRF2-related auranofin resistance signature in cancer: Insights into drug repurposing. Comput. Biol. Med [Internet]. 2023; 152:106347.
Feuser PM, Matos dos Santos PC, Cordeiro AP, Stefanes NM, Walter LO, Maioral MF, Santos-Silva MC, et al. Antineoplastic activity of free 4-nitrochalcone and encapsulated in poly(thioether-ester) nanoparticles obtained by thiol-ene polymerization in two human leukemia cell lines (Jurkat and K562). J Drug Deliv Sci Technol [Internet]. 2022; 67:102924.
Jacques AV, Stefanes NM, Walter LO, Perondi DM, Efe FL, Souza LFS, Sens L, et al. Synthesis of chalcones derived from 1-naphthylacetophenone and evaluation of their cytotoxic and apoptotic effects in acute leukemia cell lines. Bioorg. Chem [Internet]. 2021; 116:105315.
Duarte BF, Vieira DSC, Lisboa ML, Stefanes NM, Grando LJ, Santos-Silva MC. Características clínico-epidemiológicas de pacientes portadores de carcinoma de células escamosas de boca. Arquivos Catarinenses de Medicina. 2021; 50(2): 232–245.
Machado V, Jacques AV, Stefanes NM, Santos-Silva MC, Biavatti MW. Anti-leukemic activity of semisynthetic derivatives of Lupeol. Nat. Prod. Res. 2021; 35(22):4494-4501.
Bigolin A, Maioral MF, Stefanes NM, Mascarello A, Chiaradia-Delatorre LD, Nunes RJ, Yunes RA, et al. A novel sulfonamide derivative as a strong and selective apoptotic agent against hematological malignancies. Chem. Pap. 2020; 74:2965–2976.
Bigolin A, Maioral MF, Stefanes NM, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Cytotoxic mechanisms of primin, a natural quinone isolated from Eugenia hiemalis, on hematological cancer cell lines. Anticancer Drugs. 2020; 31(7):709-717.
Maioral MF, Stefanes NM, Neufeldt PD, Chiaradia-Delatorre LD, Nunes RJ, Santos-Silva MC. Aldehyde biphenyl chalcones induce immunogenic apoptotic-like cell death and are promising new safe compounds against a wide range of hematologic cancers. Future Med. Chem. 2020; 12(8):673–688.
Perondi DM, Jacques AV, Stefanes NM, Maioral MF, Sens L, Pacheco LA, Cury NM, et al. A novel thiosemicarbazone as a promising effective and selective compound for acute leukemia. Anticancer Drugs. 2019; 30(8):p 828-837.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Argenta DF, Dotto MER, Santos-Silva MC, et al. PEO-chitosan nanofibers containing carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanoparticles loaded with pyrazoline for skin cancer treatment. Eur. Polym. J. 2019; 119:335-343.
Rengifo AFC, Stefanes NM, Toigo J, Mendes C, Santos-Silva MC, Nunes RJ, Parize AL, et al. A new and efficient carboxymethyl-hexanoyl chitosan/dodecyl sulfate nanocarrier for a pyrazoline with antileukemic activity. Mater. Sci. Eng. C [Internet]. 2019; 105:110051.
Maioral MF, Stefanes NM, Bigolin A, Zatelli GA, Philippus AC, Falkenberg MB, Santos-Silva MC. Miconidine acetate, a new selective and cytotoxic compound with synergic potential, induces cell cycle arrest and apoptosis in leukemia cells. Invest. New Drugs. 2019; 37:912–922.
Srefanes NM, Toigo J, Maioral MF, Jacques AV, Chiaradia-Delatorre LD, Perondi DM, Ribeiro AAB, et al. Synthesis of novel pyrazoline derivatives and the evaluation of death mechanisms involved in their antileukemic activity. Bioorg. Med. Chem. 2019; 27(2):375-382.
Maioral MF, Bodack CN, Stefanes NM, Bigolin A, Mascarello A, Chiaradia-Delatorre LD, Yunes RA, et al. Cytotoxic effect of a novel naphthylchalcone against multiple cancer cells focusing on hematologic malignancies. Biochim. 2017; 140:48-57.
You can view some of Dr Natália’s work below and links to her professional profile below.
Research Gate: https://www.researchgate.net/profile/Natalia-Stephanes
Linkedin: https://www.linkedin.com/in/nataliamarceli/
Can you crush Paxlovid?
No, it is not recommended to crush or split Paxlovid tablets and they should be swallowed whole. Paxlovid is a combination of two antiviral medications – Nirmatrelvir and Ritonavir (1).
Paxlovid tablets are immediate-release tablets and such dosage forms are generally considered safe to crush or cut to make them easy to swallow, but Paxlovid is an exception here.
The drug comes with a clear warning from the manufacturer to not crush, split, cut, or chew the tablets (2,3).
The Food and Drug Administration (FDA) has also recommended swallowing the tablets whole, without giving a proper reason as to why the tablets can’t be crushed despite their immediate-release properties (1,3).
So it’s best to follow the given recommendations and not crush Paxlovid tablets. If you can’t swallow them whole, ask your local pharmacist if the liquid formulations of these meds are available to be used as an alternative to Paxlovid tablets.
Potential risks of crushing Paxlovid
Crushing Paxlovid can be risky because it can change how the medication works in your body. Paxlovid is designed to be taken as a whole tablet, and crushing it can affect the way the medication is absorbed and released in your system.
This could lead to potential issues like receiving too much or too little of the medication, which may reduce its effectiveness or cause unexpected side effects (1,3).
It’s crucial to take Paxlovid exactly as prescribed by your healthcare provider. If you have difficulty swallowing tablets, talk to your doctor about alternative options or methods of administration that are safe and suitable for your condition.
Never crush, break, or alter the medication without your doctor’s approval, as it can have serious consequences for your health and the effectiveness of the treatment. Always follow your doctor’s instructions to ensure the safe and successful use of Paxlovid.
Alternatives to crushing Paxlovid
If you have difficulty swallowing Paxlovid tablets, there are alternatives to crushing the medication. Firstly, discuss your concerns with your healthcare provider.
They may be able to provide you with alternative forms of the medication, such as a different strength or a different formulation, if available.
If none of the alternative options is available for you, your healthcare provider may consider prescribing a different antiviral medication that comes in a form more manageable for you to take.
The key is to communicate openly with your healthcare provider about any challenges you face with medication administration. Your doctor can work with you to find a solution that ensures you receive the appropriate treatment while minimizing risks and discomfort.
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References
1.-
Pfizer. Manufacturing Fact Sheet – PAXLOVID [Internet]. Available from: https://cdn.pfizer.com/pfizercom/Pfizer_PGS_PAXLOVID_FactSheet_061322.pdf
2.-
National Health Service. How and when to take Paxlovid. [Internet]. London: National Health Service (NHS). Available from: https://www.nhs.uk/medicines/paxlovid/how-and-when-to-take-paxlovid/
3.-
The Food and Drug Administration (FDA). Fact sheet for healthcare providers: emergency use authorization for – FDA [Internet]. Available from: https://www.fda.gov/media/155050/download
