Pill Splitting

What is pill splitting ?

• It is not uncommon for a 30 mg tablet to have the same copay as the 15 mg version. To save money, people buy the 30 mg tablets and split them in half. Essentially you are buying two doses of the prescription for the price of one.

When the economy is down, people tend to change the way they take their medications. This includes skipping doses and splitting tablets in an effort to save money.

Depending on the medication, this might be a smart money-saving strategy. But it can be risky if the wrong medication is split.

• Pharmaceutical companies are against this practice. They say splitting is dangerous. It's true the two halves aren't always exactly equal. But for many common drugs, like statins and blood pressure pills, studies haven't shown it hurts people's health.

The Food and Drug Administration (FDA), the American Medical Association and other medical groups advise against splitting pills unless the drug's label actually says the tablet can be split. The FDA's Tablet Splitting page still gives the same advice today.

♦ It is important to understand not all pills can be split safely.

Because prescription prices keep rising (especially for brand-name drugs) many doctors and even health insurance plans suggest pill splitting to help keep patients from stopping or skipping their medication.

Most notably, the cholesterol-lowering drugs known as statins can be split, as can many of the drugs used to treat high blood pressure and depression.

♦ The easiest pills to split are fairly flat, round ones with a scored center. That's a slightly indented line that runs across the middle of the pill. However, many pills are too small to split easily and evenly. And not every pill with a scored center is meant to be split. Check with your doctor or pharmacist first.

♦ Doctors have long suggested pill splitting, but in the beginning it wasn't really about cost. Doctors asked patients to split pills so they could take a lower dose and lower their risk of side effects. If you are thinking about splitting your medication, talk to your doctor first.

♦ Many insurance companies like pill splitting because it saves them money. Some now provide a list of approved drugs to split.

By lowering the cost of prescriptions, pill splitting could actually improve people's health. It helps them afford the drugs they need so they can stick with the treatment their doctor recommends.

Best practices for pill splitting

The FDA has put out a list of best practices for tablet splitting. It doesn't fit every situation, but here are the main points:

• If a tablet is FDA-approved to be split, it will say so in the "How Supplied" section of the drug's label insert.

Most people never see the full insert. Pharmacies usually just hand you a bottle and a short printout that rarely mentions splitting. But you can ask your pharmacist, or look up your drug for free on DailyMed (dailymed.nlm.nih.gov). Check the "How Supplied" section.

• The tablet will be scored with a mark showing where to split it.

This can be confusing, because some tablets are scored but splitting isn't recommended. And some tablets aren't scored but can be split.

• The FDA suggests patients talk to their health care provider. This point cannot be overemphasized.

• Only split pills as you need them, and take both halves before splitting another tablet.

The reason is that heat, humidity and moisture can affect a pill more once it's split.

The catch: you might forget to split the next pill and accidentally take the whole thing, giving yourself double the dose your doctor intended.

• Consider using a tablet splitter to cut your pills in half. They're cheap and sold at most pharmacies.

• Splitters may not work well for oddly shaped tablets.

• Don't use a knife or razor to cut tablets. The pill may splinter, and you could cut yourself.

• When you switch to a new medication, or even a new generic version, ask your doctor or pharmacist whether the new tablet can be split.

Why splitting pills can be risky

You might get confused about the correct dose

There have been cases where people bought higher-strength tablets to split, then forgot to split them and took the whole tablet. That means they accidentally took too much medicine.

The medicine may not be split evenly

Studies have shown that the two halves of a split tablet often contain different amounts of medicine. They may look the same, but they don't necessarily have the same dose.

Even when a tablet has a score line down the middle, one half may have more medicine than the other.

Some tablets are hard to split

Some tablets are too small to split, have an odd shape, or crumble easily. And some people just have a hard time splitting tablets accurately, because of arthritis or poor eyesight, for example.

Not all pills are safe to split

People may assume any pill can be split. But some, such as capsules and time-release drugs, should always be taken whole.

♦ Some tablets have a coating that releases the medicine slowly. Splitting them destroys the coating, which means you might absorb the medicine too fast, or not at all.

• The dose you take of most medicines matters. If you don't get the right dose, the drug may not work nearly as well.

Your doctor should know which drugs can be split and which can't. A pharmacist may also be willing to show you how to split your pills.

Pills should only be split in half, never into smaller pieces such as thirds or quarters

There is no official, complete list of medicines that can be split, and some drugs are dangerous to split. That makes it doubly important to check with a doctor or pharmacist.

Generally, these kinds of pills should not be split:

• Chemotherapy drugs

• Birth control pills

• Blood thinners such as warfarin (Coumadin) and anti-seizure medicines. Even a small dose difference can matter a lot with these. Some are made to be split, but only split them if your doctor specifically tells you to.

• Capsules of any kind, including those that contain powders or gels

• Pills with a hard outside coating. Many of these are designed to:

– Release medication over time

– Protect your stomach

– Keep the pill from falling apart

• Time-release tablets. These go by several names. The most common are extended-release (ER, XR, XL), sustained-release (SR) and controlled-release (CR).

♦ Time-release medications are designed to release the drug slowly and steadily into your bloodstream. They should not be split.

Not every slow-release pill has ER, XR or SR in its name. If you're not sure, ask your pharmacist before you split.

Why do it if it is risky ?

Cost. Rising prescription prices are pushing patients toward this option. Many medications for chronic illnesses like high blood pressure, diabetes and high cholesterol cost hundreds of dollars a month.

Insurance companies keep shifting more of those costs to patients in the form of higher copays and deductibles.

Restrictive insurance plans refuse to cover some drugs altogether, leaving patients with no other options.

♦ Done correctly, pill splitting can be a very effective way to keep prescription costs from getting out of control. Typically, your doctor writes a prescription for double the strength and you take half a pill. Some insurance plans will cut the pill count in half to match, so check how your plan handles it.

Prescription prices are a bit odd.

• A 20 mg tablet often costs the same as a 10 mg tablet. If you need 10 mg, you can effectively save 50% by buying the 20 mg tablet and splitting it.

That's why a lot of people split pills.

♦ It is very important that you talk to your health care provider first.