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Published: March, 2011; Vol 7, Num 10

 

When Splitting Pills, Beware of Risks

If you have ever taken a pill, chances are you have encountered at least one of these situations:

  1. Your medication is a tablet size that you find difficult to swallow. To avoid choking, you break it in half.
  2. You have symptoms that are best addressed with a dosage that is not standard. Your health care provider directs you to take one tablet plus half of another.
  3. You are in need of a medication that is not available in a cost-saving generic equivalent. Your health care provider prescribes a higher strength tablet with instructions that it be split. As most pharmaceutical manufacturers follow flat pricing policies – maintaining a drug’s cost regardless of dosage – splitting the higher strength tablet provides two doses for the price of one.

These are all legitimate reasons for pill splitting, but the practice has risks. Common means of splitting – kitchen knives, scissors or using an actual pill splitter, the only recommended method – can lead to two pieces of medication of unequal dosage and with a substantial amount of the tablet lost from the splitting. Serious health consequences can arise when splitting is not accurate. The difference between a therapeutic dose and one that is toxic or ineffective is sometimes a very narrow margin.

A recent study published in the Journal of Advanced Nursing (JAN) found that when pills were split, nearly a third deviated from recommended dosages by as much as 15 percent. The study calls on drug manufacturers to produce a wider range of tablet doses or liquid formulations, which would make the practice of pill splitting unnecessary.

The Food and Drug Administration (FDA), the American Medical Association (AMA) and the American Pharmacists Association (APhA) advise against pill splitting, unless a manufacturer specifically lists it as a prescribing option. They also recommend that patients consult with their doctors and pharmacists to determine if pill splitting is appropriate for them. Some patients, for example, the elderly, may not have the dexterity to split a tablet properly. Furthermore, some pills like capsules and time-release drugs should never be split.

Tablets that can be split are usually scored (see graphic) with a mark indicating the appropriate place. Statins like Crestor and Lipitor, antidepressants like Paxil and Zoloft, ace-inhibitors like Monopril and Prinvil and angiotensin receptor blocks like Avapro and Cozaar are among medications that can be split.

 DOs and DON’Ts of PILL SPLITTING

  • Use the right equipment. Use a pill splitter, available at pharmacies and through online retailers. Never cut pills with knives, scissors or break them in half with your fingers.
  • Never split an entire supply of pills at once without first checking with your doctor or pharmacist. Splitting exposes ingredients to air and moisture, which may reduce their effectiveness. Split pills only as needed.
  • Only split pills that are scored. Capsules and timed-release pills cannot be split and have ingredients remain in equal proportion.
  • A scored tablet indicates it can be split, but it does not mean it should be split. Discuss your medications with your health care provider and your pharmacist before splitting any tablets.
  • Pills that can be split are made that way to assure you receive appropriate dosing. Never split your pills to stretch a prescription. Taking less than the prescribed amount may make a medication ineffective. Always take your medication as directed.

Under appropriate circumstances, pill splitting can be a convenience and a means to save money. Talk with your health care provider and your pharmacist to find out if you are someone who could benefit.

[Janet Lubman Rathner]