Dysphagia can include difficulty starting a swallow (oropharyngeal dysphagia), issues in the throat (pharyngeal dysphagia), and the sensation of food being stuck (esophageal dysphagia).

Unfortunately, liquids derived from crushed/compounded tablets raise concerns about patient safety and efficacy, and they have come under increasing scrutiny from the FDA.

It’s important to optimize treatment plans for patients with dysphagia given these complications. Dysphagic patients who suffer from chronic heart failure, edema caused by heart or liver failure, and/or hypertension are often prescribed medications that are crushed/compounded from tablets into a liquid form.

Dysphagic Patients:

2x

more likely to die while in the hospital²
33%

more likely to need nursing home care
3.8

days longer in the hospital on average
$6243

higher hospital bills on average
69%

of older patients report missing doses of a tablet or capsule due to difficulties swallowing

Patients Who Have
Difficulty Swallowing

Patients who need a liquid formulation may
also have a comorbid condition that
creates difficulty swallowing.

“Compounded drugs should only be distributed to meet the needs of patients whose medical needs cannot be met by an FDA-approved drug”

Scott Gottlieb, MD: Former FDA Commissioner

READ THIS BEFORE YOU CRUSH/COMPOUND ANOTHER TABLET

Range of Potency: 68% to 268%²

The range of potency compounded products exhibited in a 2006 FDA survey was 68% to 268%.² Patients who have difficulty swallowing are often given crushed/compounded formulations of the prescriptions. However, crushed/compounded formulations can exhibit a wide variation in potency due to non-uniformity of compounded materials. These dosing inconsistencies of compounded suspensions have long been a persistent challenge for pharmacists and patients.³
Higher Risk of Contamination²

In 2007, the CDC found compounded drugs have a higher risk of contamination.² Due to fatalities related to contamination, the FDA recently released stricter guidance regarding crushing/compounding and recommended against using crushed/compounded products considered “essentially copies of a commercially available drug product” without permission, especially if an FDA-approved alternative exists.⁴
Costly Protocols

Crushing medications can require expensive safety protocols that take up valuable staff time and can trigger additional requirements and guidelines:

• Not following CMS guidelines for crushing medications can result in F-tag violations.¹
• Ensuring crushed medications are NOT combined and given all at once either orally or via feeding tube.¹
Short Shelf Life

Crushed and compounded products can have variable and very costly, short shelf lives.

1 Milligan, Lynn. “F-Tag 760: Avoiding a Citation When Crushing Medication.” American Association of Post-Acute Care Nursing. Accessed March 2, 2023. https://www.aapacn.org/dns/f-tag-760-avoiding-a-citation-when-crushing-medication/
2 Gudeman, Jennifer, Michael Jozwiakowski, John Chollet, and Michael Randell. “Potential Risks of Pharmacy Compounding.” Drugs in R&D 13, no. 1 (2013): 1-8. doi:10.1007/s40268-013-0005-9.
3 Kindy K, Sun L, Crites A. Compounding pharmacies have been linked to deaths, illnesses for years. Washington Post. February 7, 2013. http://www.washingtonpost.com. Accessed October 2, 2017.
4 Food Drug Administration Center for Drug Evaluation & Research (2016). Guidance for Industry: Compounded Drug Products That Are Essentially Copies of a Commercially Available Drug Product Under Section 503A of the Federal Food, Drug, and Cosmetic Act (FDA, Maryland) 1-8. doi:10.1007/s40268-013-0005-9.

Patients pay as
little as $0^*

on each prescription
using the EasyPay Card

Terms and Conditions
* Void where prohibited by law. CMP Pharma reserves the right to rescind, revoke or amend this program without notice. Offer not valid for patients eligible for benefits under Medicaid (including Medicaid managed care), Medicare, TRICARE, Veterans Affairs, FEHBP, or similar state or federal programs. Offer void where prohibited, taxed, or otherwise restricted. Offer good only in the U.S.A. No generic substitution with this offer.

Important Safety Information

Indications and Usage

ATORVALIQ is indicated:

To reduce the risk of:
- Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD.
- MI and stroke in adults with type 2 diabetes mellitus with multiple risk factors for CHD but without clinically evident CHD.
As an adjunct to diet to reduce low-density lipoprotein cholesterol (LDL-C) in adults with primary hyperlipidemia and adults and pediatric patients aged 10 years and older with heterozygous familial hypercholesterolemia (HeFH).
As an adjunct to other LDL-C lowering therapies, or alone if such treatments are unavailable, to reduce LDL-C in adults and pediatric patients aged 10 years and older with homozygous familial hypercholesterolemia (HoFH).
As an adjunct to diet for the treatment of adults with primary dysbetalipoproteinemia or hypertriglyceridemia.

Contraindications

Acute liver failure or decompensated cirrhosis.
Hypersensitivity to atorvastatin or any excipients in ATORVALIQ.

Warnings and Precautions

Myopathy and Rhabdomyolysis: Risk factors include age 65 years or greater, uncontrolled hypothyroidism, renal impairment, concomitant use with certain other drugs, and higher ATORVALIQ dosage. Discontinue ATORVALIQ if markedly elevated CK levels occur or myopathy is diagnosed or suspected. Temporarily discontinue ATORVALIQ in patients experiencing an acute or serious condition at high risk of developing renal failure secondary to rhabdomyolysis. Inform patients of the risk of myopathy and rhabdomyolysis when starting or increasing ATORVALIQ dosage. Instruct patients to promptly report unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever.
Immune-Mediated Necrotizing Myopathy (IMNM): Rare reports of IMNM, an autoimmune myopathy, have been reported with statin use. Discontinue ATORVALIQ if IMNM is suspected.
Hepatic Dysfunction: Increases in serum transaminases have occurred, some persistent. Rare reports of fatal and non-fatal hepatic failure have occurred. Consider testing liver enzymes before initiating therapy and as clinically indicated thereafter. If serious hepatic injury with clinical symptoms and/or hyperbilirubinemia or jaundice occurs, promptly discontinue ATORVALIQ.

Adverse Reactions

Most common adverse reactions (incidence ≥ 5%) are nasopharyngitis, arthralgia, diarrhea, pain in the extremity, and urinary tract infection.

To report SUSPECTED ADVERSE REACTIONS, contact CMP Pharma, Inc. at 1-844-321-1443 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Drug Interactions

See full prescribing information for details regarding concomitant use of ATORVALIQ with other drugs or grapefruit juice that increase the risk of myopathy and rhabdomyolysis.
Rifampin: May reduce atorvastatin plasma concentrations. Administer simultaneously with ATORVALIQ.
Oral Contraceptives: May increase plasma levels of norethindrone and ethinyl estradiol; consider this effect when selecting an oral contraceptive.
Digoxin: May increase digoxin plasma levels; monitor patients appropriately.

See full prescribing information for ATORVALIQ dosage modifications due to drug interactions.

Please see full prescribing information for additional safety information.

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To report SUSPECTED ADVERSE REACTIONS, contact CMP Pharma, INC. at 1-844-321-1443 , or FDA at 1-800-FDA-1088 or www.fda.gov/MedWatch

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Indication

Atorvaliq^® is indicated to reduce the risk of myocardial infarction, stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with coronary heart disease (CHD), multiple risk factors for CHD, or type 2 diabetes. Atorvaliq reduces LDL-C in adults with primary hyperlipidemia. Atorvaliq is indicated to reduce LDL-C in adults and pediatric patients 10 years of age and older with heterozygous familial hypercholesterolemia (HeFH) or homozygous familial hypercholesterolemia (HoFH). Atorvaliq is also indicated for the treatment of adults with primary dysbetalipoproteinemia and hypertriglyceridemia.

Contraindications

Atorvaliq is contraindicated for patients with acute liver failure or decompensated cirrhosis.

This website is for healthcare providers

The First and Only FDA-approved Oral Suspension of Atorvastatin

COMPLIANT & SAFE

CONSISTENT

QUICK & EASY

Atorvaliq Educational Resources

Dysphagia & The Need For Liquid Alternatives

more likely to die while in the hospital²

more likely to need nursing home care

days longer in the hospital on average

higher hospital bills on average

of older patients report missing doses of a tablet or capsule due to difficulties swallowing

Patients Who Have
Difficulty Swallowing

READ THIS BEFORE YOU CRUSH/COMPOUND ANOTHER TABLET

Patients pay as
little as $0^*

on each prescription
using the EasyPay Card

Important Safety Information

Indications and Usage

Contraindications

Warnings and Precautions

Adverse Reactions

Drug Interactions

Request a Representative

Indication

Contraindications

This website is for healthcare providers

The First and Only FDA-approved Oral Suspension of Atorvastatin

COMPLIANT & SAFE

CONSISTENT

QUICK & EASY

Atorvaliq Educational Resources

Dysphagia & The Need For Liquid Alternatives

more likely to die while in the hospital2

more likely to need nursing home care

days longer in the hospital on average

higher hospital bills on average

of older patients report missing doses of a tablet or capsule due to difficulties swallowing

Patients Who Have Difficulty Swallowing

READ THIS BEFORE YOU CRUSH/COMPOUND ANOTHER TABLET

Patients pay as little as $0*

on each prescription using the EasyPay Card

Important Safety Information

Indications and Usage

Contraindications

Warnings and Precautions

Adverse Reactions

Drug Interactions

Request a Representative

Indication

Contraindications

more likely to die while in the hospital²

Patients Who Have
Difficulty Swallowing

Patients pay as
little as $0^*

on each prescription
using the EasyPay Card