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Splitting Pills May Have Risks

Study Shows Patients Who Split Pills May End Up With Doses That Are Too High or Too Low

To Split or Not to Split? continued...

A half or a quarter of a pill may be better than nothing, but this varies based on the type of medication and its dosing formulation.

“Different tablets split differently,” he says. “Some crumble, others are hard and cut very clean. Some tablets are coated, others are long acting or short acting, and some are capsules or extended release,” he says. “Others are scored down the middle and can be broken with your thumbs, and a lot don't have any scores at all.”

There is no clear-cut consensus on which pills you can, or can’t, split, he says.

“It would be unsafe to say ‘yes you could do this with three out of five of your pills or all of your medications,’” he says. “You need to evaluate how well your disease is controlled, why you are splitting, and what tablets you want to split.”

Pills are split all the time, and some insurers even offer incentives to get their members to cut their pills, says Alan M. Weiss, MD, an internal medicine doctor at the Cleveland Clinic in Ohio. “It can be a great cost-saving mechanism for patients who can do it and do it on the right pills.”

"There are some pills where you can break the seal if you cut them, and this can cause the medication to degrade,” he says.

Extended Release, Coated Pills Can’t Be Split

“If want to split a pill, there are a lot that are already scored and are designed to be cut,” he says.

“Extended-release tablets and capsules can’t be cut.”

Yuly Belchikov, PharmD, an assistant director for clinical pharmacy services and education at Long Island Jewish Medical Center, New Hyde Park, N.Y., says that pill splitting can be a problem for pills with a small therapeutic window. This refers to a pill that needs to be taken in very controlled, precise doses.

“Pill-splitting a medication with a small therapeutic window is concerning because any deviation from the recommended dose, even a small percentage, can have serious consequences,” he says.

Papatya Tankut, PharmD, vice president of pharmacy professional services at CVS Caremark in Woonstocket, R.I., sums it up this way: “Ask a pharmacist or a physician before you split any pill. Don’t decide to do it on your own because there are some toxic effects of splitting pills that weren’t designed to be split.”

“Use a pill-splitting device so you are accurately splitting the dose,” she says, and split pills only on an as-needed basis. “Air or moisture can change the formulation and deem it less effective when you do it in advance.”


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