Pill Splitting: When Is It Safe? When Is It Unsafe?

Pill splitting can help save almost 50% of the cost of some prescription drugs.

Medically Reviewed by Brunilda Nazario, MD on October 04, 2010

Want to save almost 50% on some of your prescription drugs? Buy a $5 pill splitter.

Well, it's not quite that simple. But because of a quirk of how some drugs are priced, a tablet that's twice as strong as another may not be twice the price. In fact, it might be about the same price. So, sometimes, cutting a higher strength pill in half can get you two doses for about the price of one. With a little manual labor -- just snapping down the lid of a pill cutter with your finger -- pill splitting can save quite a lot of money.

Pill splitting is a cost-saving solution so effective and so simple that many people -- not to mention health care systems and HMOs -- have embraced it.

But pill splitting is not right for every person, or every pill. "Sometimes, it makes a lot of financial sense to split pills," says Kevin Schulman, MD, Professor of Medicine and business administration at the Duke University Medical Center in Durham, N.C. "But if you try to split the wrong sort of medications, that could be potentially dangerous."

So here's the lowdown: when pill splitting makes sense and when it doesn't.

First, you might want an answer to the obvious question: how could this be? Why would a drug that's twice as powerful as another cost the same? It's a marketing strategy sometimes used by pharmaceutical companies called "flat pricing." Regardless of potency, the price of a specific pill is more or less equal.

Part of the reasoning is that it protects patients from price jumps if they start to need a higher dose of a medicine. Suddenly doubling the price of a drug they've been using for years might cause them to stop taking it. It also might be seen as financially punishing a person for getting sicker, says Schulman.

It also has to do with production expenses. The cost difference in manufacturing a 10-milligram pill and a 20-milligram pill is less than you might think.

"With some drugs, the biggest cost is not the active ingredient, but making the pill itself," says Rich Sagall, president and co-founder of NeedyMeds, a Philadelphia nonprofit that provides information about financial assistance for drugs. "And that cost is pretty much the same no matter how much of the active ingredient is used."

While it was probably not the intention of pharmaceutical companies when they devised this pricing system, it's ideal for the practice of pill splitting.

If you're interested in pill splitting, the first step is to talk to your doctor or pharmacist. Find out if any of the medicines you use can be safely split. Equally important, find out whether splitting them will save you enough money to justify the slight inconvenience.

The pills best suited to splitting -- and according to some, the only pills -- are those scored down the middle, making them easier to divide.

Some pills that are commonly split include:

Having the right equipment helps. Don't try splitting a pill by pushing it against the edge of the counter, or hacking at it with a kitchen knife. Shell out for a proper pill cutter. You might not want to get the absolute cheapest one, either. Researchers found that people tended to do best with pill cutters that have a rubber insert, which holds the pill in place while you cut it. Price: about $5.

For convenience, you might be tempted to split the whole bottle of pills at once. But check with your doctor first. It's possible that exposing the interior of the pills to the air could reduce their effectiveness.

There are limits to the wonders that you and your pill splitter can achieve. Many medicines, because of their ingredients or design, cannot be split safely.

So what drugs shouldn't be split?

  • Drugs with an enteric coating, designed to protect the stomach. Once split, the interior of the pill could irritate the stomach, leading to potentially serious problems.
  • Drugs that are time-release or long-acting. Cutting the pill destroys the time-release effect, which means you could get too much of the medicine too quickly. "If you split a pill that has a long-acting release, you could conceivably get an overdose," says Sagall.
  • Drugs taken more often than once a day. Drugs that work best with pill splitting are usually taken once a day. They last a while in the body. Why is this important? Even if you're careful when splitting pills, you won't always get it quite right. Sometimes one half will be a bit bigger than the other. But if the drug lasts a long time in the body, these variations won't matter. The amount of medicine in your body at any given time stays pretty level. That's not true with drugs that are taken several times a day, since the body processes them quickly. The amount of the medication in your system will fluctuate more dramatically: too little one day and too much the next.
  • Drugs in capsules.
  • Prepackaged drugs in specific doses, like birth control pills.

Splitting the wrong sort of pills isn't the only risk. Another danger lies with the person who's splitting them: what if he or she isn't doing it correctly?

For instance, a person might not split the pill evenly, resulting in two pieces with very different dosages. Or he or she might use a dull blade which crushes the pill as it splits it, leaving too much of the medicine as powder on the bathroom counter, and too little for the body. Or, what if a person taking multiple medications gets confused and starts splitting the wrong pills?

Because of the potential problems, some experts recommend that patients should not split pills themselves. Instead, they say, the pill splitting should be done by a pharmacist.

However, some proponents of pill splitting find these precautions excessive. And they point out that studies of patient pill splitting have not shown any of these potential problems to be issues. For instance, a 2007 study looked at 200 people using statins to control cholesterol. The researchers found that, after six months of splitting pills, the group:

  • Was just as likely to take their medicine as they were before.
  • Had equally successful control of their cholesterol levels as they did before.

That said, some people have physical or cognitive problems that could interfere with their ability to split pills. Experts say that you shouldn't split pills on your own if you have:

  • Poor eyesight
  • Lost a limb
  • Tremors
  • Severe arthritis
  • Other medical conditions that could make accurate pill splitting difficult

It might not surprise you that some of the most enthusiastic supporters of pill splitting have been HMOs anxious to cut costs. One insurer allegedly made pill cutting mandatory for patients taking certain drugs, a practice condemned by the American Medical Association and other organizations. After a class action lawsuit, health plans now stress that pill-splitting programs are optional.

Nonetheless, institutional pill splitting is becoming more common. In 2006, the University of Michigan started a pill-splitting program. In the first year, the university saved $195,000, and members saved over $25,000 in the costs of their drugs. One insurer, UnitedHealth Group, says that members can save up to $300 per year using its pill-splitting program.

While there's no doubt pill splitting can save money on prescription drugs, you need to consider whether it's worth it for you. As always, the key is to talk to your doctor and go over the pros and cons. Some people might be uncomfortable with the idea, or it might seem like too much of a hassle. If that's the case, don't let yourself get pushed into it. But for many people, pill splitting offers a two-for-one bargain that's far too good to pass up.

Show Sources

SOURCES: Berkowitz, S.A. The Journal of the American Medical Association, Feb. 28, 2007; vol 297: pp 868-870. Choe, H.M. American Journal of Managed Care, June 2007; vol 13: pp 298-304. Cross, M. Managed Care, February 2003; vol 12: pp 37-38. FDA web site: "Preventing Errors with Tablet Splitting." Gee, M. Journal of Managed Care Pharmacy, November/December 2002; vol 8: pp 453-458. Miller D.P. American Journal of Managed Care, June 2007; vol 13: pp 473-480. NeedyMeds web site: "Splitting Pills to Save Money." Noviasky, J. Journal of Family Practice, August 2006; vol 55: pp 707-08. Richard Sagall, MD, president and co-founder, NeedyMeds, Philadelphia. Kevin Schulman, MD, professor of medicine and business administration, Duke University Medical Center, Durham, N.C. Stafford R.S and Radley D.C. American Journal of Managed Care, August 2002; vol 8: pp 706-712. UnitedHealth Group web site: "UnitedHealth Pharmaceutical Solutions Expands Innovative Pill-Splitting Program."University of Michigan Human Resources and Affirmative Action Benefits Office web site: "Pill Splitting Instructions." WebMD Medical News: "Splitting Pills Can Save Money."

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