In this episode, I’ll discuss what happened to the “ISMP’s Do Not Crush List.”
If you navigate to the page on the website for the Institute for Safe Medication Practices that once hosted the document titled “Oral Dosage Forms That Should Not Be Crushed” you will instead find a notice that the list has been removed from the ISMP website. Furthermore, the ISMP says that they do not “…own, update, or review content on the List of Oral Dosage Forms That Should Not Be Crushed.”
How is this possible when we all have referred to this list as the “ISMP’s Do Not Crush List” for over a decade? The removal appears to be in response to the publication of a 2021 article in the International Journal of Pharmaceutical Compounding.
The ISMP gives a history of the list in a newsletter published shortly after it was removed from their website:
The List of Oral Dosage Forms That Should Not Be Crushed (commonly referred to as the Do Not Crush List) was first posted on ISMP’s website in 2006 (www.ismp.org/node/140). The list was originally compiled and updated by John Mitchell, PharmD, who passed away on June 10, 2014. The list has since been maintained and updated by Thomas Land Publishers and is available for purchase as a wall chart on ISMP’s website. In 2021, a journal article was published describing an in-depth analysis of products on the ISMP Do Not Crush List, with the goal of removing unnecessary restrictions and providing conditional recommendations when needed (Uttaro E, Zhao F, Schweighardt A. Filling the gaps on the Institute for Safe Medication Practices [ISMP] Do Not Crush List for immediate-release products. Int J Pharm Compd. 2021;25[5]:364-71). ISMP would like to take this opportunity to clarify that we do not own, update, or review content on this list. ISMP recognizes the Do Not Crush List as a clinically important resource and appreciates Uttaro and colleagues for their efforts to reconcile discrepancies. ISMP encourages organizations to maintain, update, and periodically review a list of oral dosage forms that may require alteration through evaluation of package inserts, drug manufacturer inquiries, tertiary drug information resources, and primary literature. Any inquiries regarding the Oral Dosage Forms That Should Not Be Crushed should be directed to: mary@thomasland.com.
So it turns out the list we always thought was the ISMP’s Do Not Crush List, was never the ISMP’s list. Unfortunately, The website and phone number for Thomas Land Publishers are not in service, suggesting the company may be defunct. This could explain why the list was slow to update with information on new dosage forms as discussed back in episode 575.
It appears that Pharmacist’s Letter has stepped in to fill the need for this list as in February 2023 they published and updated a list of Meds That Should Not Be Crushed. This list includes the more recent amorphous solid dispersion formulations that never made it to the previous list.
Many organizations have listed the previous list from the ISMP website in their internal policies and procedures and they now should consider whether the list published by Pharmacist’s Letter should be used instead.
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