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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?

Jeffrey Brewer, PharmD, an associate professor at Albany College of Pharmacy and Health Sciences in New York, says that pill splitting is a widespread practice in the U.S. among people who are trying to get an intermediate dose or to keep their health care costs down.

“The new study puts the downsides of pill splitting into a very specific light,” he says.

In some cases, pill splitting may be a person’s only option due to financial constraints. For example, a 90-day supply could last for six months if the pills are split.

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.

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