DURING these tough times in our economy, many might consider pill-splitting as a way to get the most out of their medication dollar but, unless pill-splitting is done properly and safely, it can pose a health risk for individuals concerned, says the June 2011 issue of the Cleveland Clinic’s Men’s Health Advisor.

In fact, the U.S. Food and Drug Administration (FDA) does not encourage tablet splitting unless it’s specified in the drug’s professional prescribing information, adds the health letter.

Nevertheless, pill-splitting can be done safely provided you know which pills can be halved and how to split them properly, and to seek help if you’re unsure.

Mandy Leonard, R.Ph., Pharm.D., BCPS, system director of Drug Use Policy and Formulary Management with Cleveland Clinic’s Department of Pharmacy, says, “Just talk with your pharmacist about whether the pill can be split in the first place. It’s very drug specific. That’s why a lot of pill-splitting programs are looked at drug by drug.”

The health letter points out instances when pill-splitting may pose a health risk:

• Some individuals have purchased higher-strength tablets intending to split them, but then forgot to split them and accidentally took too much of a drug.

• Certain pills are too small, while others, like hydrochlorthiazide, crumble too easily when split.

• Others, even though scored with a line running down the middle, break unevenly.

• When knives or scissors were used, pill-splitting produced fragments that were 15-25 percent off the recommended doses in 17 and 22 percent of cases, respectively.

• In 13 percent of cases, even using cutters specifically designed for pill-splitting, the same margin of error occurred.
With some medications...such as statin drugs, which lower cholesterol in a cumulative or aggregate manner...such deviations from the recommended dose have no immediate effect on the body and aren’t damaging, explains Dr. Leonard.

However, the doctor offers a list of some drugs that you should avoid splitting:

• Blood pressure medication — Getting the wrong dose may cause fluctuations in blood pressure that produce immediate symptoms, such as lightheadedness.

• Drugs taken multiple times a day — “In the aggregate, the dosage probably doesn’t make a difference but if you’re looking at something that you dose more frequently, then you start to worry that larger fluctuations in blood levels of these drugs may produce unwanted consequences,” she adds. “It depends on the patient’s sensitivity, as well.”

• Drugs with narrow therapeutic index, such as digoxin (Lanoxin) or warfarin (Coumadin) — These drugs which require very precise dosing and may be dangerous if you take too much or too little, should not be split, Dr. Leonard cautions.

• Capsules — These should never be opened.

• Drugs that are prepackaged in specific doses — Splitting these drugs and extended-release tablets will break the integrity of that formulation and risk an overdose.

• Pills with enteric coatings — They should not be split since they are designed to protect the stomach.

The health letter offers these tips to help make pill-splitting safe:

1. First, talk to your pharmacist to find out if your pills can be split.

2. Use only a specially designed pill cutter (not knives or scissors), preferably a splitter with rubber inserts or other parts that hold the pill in place and recommended by your pharmacist.

3. Never share a pill-splitter...residue from someone else’s prescription drug may linger on the cutter and cause undesired side effects on you.

4. Make sure you split the pill as evenly as possible and cut along any lines scored into the tablet. Follow the drug’s professional prescribing information.

5. Throw away any pills that crumble.

6. Split only one or two pills at a time. Do not split a whole bottle at once.

7. “If you can’t split them, see if your pharmacist or a caregiver is willing to do it,” Dr. Leonard says.

Self-help measures to cut medication costs other than by pill-splitting include:

• Ask your doctor or pharmacist if a less expensive generic version of your medication is available.

• Inquire if a less expensive medicine in the same class is suitable for you.

• Periodically review your medications with your doctor to make sure which ones you still need.

• See if you qualify for an assistance program through a drug company. Call the Partnership for Prescription Assistance at 1-888-477-2669 or visit their website at, concludes the health letter.

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