You spend $100 monthly on medication to manage your chronic condition. Is it possible to buy medication which is double the strength at perhaps $75 and split each pill in half? Shyamala Narayanaswamy, Senior Principal Clinical Pharmacist, Department of Pharmacy, Singapore General Hospital, answers this question and tells us how to do so safely.
Is it safe to split tablets of higher strength to save money?
Higher strength tablets may generally be split when there is a score line on the tablet to guide the split, and where there are no specific dangers (see below). The score line helps to keep the split even, and the chance of crumbling is reduced; both halves of the tablet should then contain equal amounts of the active drug.
DANGERS
The drug may not be stable when the cut surface is exposed to light, moisture or oxygen.
The remaining half tablet may not be clearly identifiable, and a medication error may occur.
Poor cutting techniques can result in uneven pieces that contain varying amounts of medication.
DO NOT SPLIT
Controlled-release tablets. Splitting these may contradict the slow-release characteristic and result in a “rush” of medicine being released from the tablet.
Medicines that are very bitter (these have a special coating to mask the taste). Medicines that are destroyed by stom ach acid. These are normally coated with a special layer to protect the drug until it reaches the more alkaline environment of the small intestine.
Tablets without a score line as they are difficult to halve reliably.
Triangular or other odd-shaped tablets that may not be easy to split evenly since commercial tablet splitters are for use on round tablets.
Split decisions
Can cutting a tablet in half save you money?
Tablets that have a coating may not “sit still” under the tablet splitter blade, resulting in an uneven split.
SAFE SPLITTING
If a tablet is deemed safe for splitting, follow these steps and precautions:
Use a proper pill splitter, available at pharmacies and medical stores.
Do not use scissors or razor blades to cut tablets.
Wipe off any remaining particles on the tablet splitter after each use to remove fragments of medication.
What about capsules? If they can be split, what is the proper way?
Capsules usually have a powder or liquid inside a hard or soft gelatin shell. These are therefore difficult to be reliably split and should be guided by consideration of several specific pharmacologic factors.
If a patient or caregiver needs to split a capsule, they should ask their pharmacist or nurse for the safest method to do so.
In extreme cases in a hospital setting, for example, a caregiver may open a capsule to remove as much of the contents as possible for the drug to be given through a nasogastric tube to a patient who cannot be fed by any other means.
What are some generic medications (used in the treatment of chronic diseases) that may be split?
Atenolol 50mg tablets and prazosin 1mg tablets (both used to treat hypertension) may be split. However, some highstrength tablets should not be split as they may have carcinogenic potential and should not be handled with bare hands, or an exact dose must be given and splitting may compromise the amount.
Click here for jpeg format