Tablet Splitting - Scored Lines (Don't Do It)

Why Split?

Costs -

One of the main reasons tablets are split is to cut costs. Breaking pills in half or even quarters can save the patient, the healthcare system and insurance companies a significant amount of money. For those with financial strains, splitting tablets of higher dose brands to get a smaller dose of the medication could still be beneficial to maintain their therapy.

Easier to swallow -

Split tablets are also easier to swallow for those who have difficulty and offer dose flexibility for children and elderly patients.

How to split?

Tablets that are made to be split have a groove or a scoring line in the center or form a cross, dividing the pill into equal parts. But it is tough to cut the tablets precisely along the scoring, especially with a knife, scissors or your hands. A pill splitter is supposed to be the most accurate but even then, there is still a margin of error in the weight on the medication.

Why you Shouldn’t Split

Dose variation -

Many tablets available on the market can be split and break neatly with no problems, but some can’t. It is impossible to cut tablets precisely and make sure you are getting the correct dosage each time. The split pieces generally vary wildly in strength and in turn, efficacy. It also alters the absorption of the active ingredient, causing fluctuation in its normal functionality.

Therapeutic range -

Pills such as the anticoagulant warfarin need to be taken in very controlled and precise doses as they have a small therapeutic index. For these treatments, even small changes in doses can make a big difference in the effect. Levothyroxine, taken for a deficiency of the hormone thyroxine, and digoxin used to treat heart problems (misjudging the dose can cause cardiac arrhythmias), also have narrow therapeutic windows and a small deviation from the prescribed amount can have serious consequences to the health of the patient. To paraphrase Paracelsus, the dose makes the poison. A right amount can be medicine, too much can be bad for you. If the pill was not designed to be split, there could be some toxic effects.

However, when it comes to treatments for chronic illnesses including high blood pressure, splitting the tablets will not make that much of a difference as the therapeutic index is wide.

Not made to split -

Certain tablets are film-coated, such as the TEVA brand of Generic Sildenafil. Others are long-acting or short-acting tablets, capsules, or are made to release the active ingredient over an extended period of time. Manufacturers sometimes seal or coat their tablets and if the enteric coating is broken during the split, the tablet will begin to degrade. This means that the medicine will no longer be as effective.

Before splitting, the individual medications and the patient in question have to be assessed to prevent the patient accidently getting a higher dose than recommended. Patient understanding as well as their physical ability to split the tablets are vital - elderly patients may be unable to split them and they can crumble with too much force.

There are no clear rules on which tablets can be split but there are some general points to consider -

• If they are scored, it should be fine to split the tablet
• Capsules and extended release tablets are among those that cannot be split at all as this can cause an overdose by the release of an uncontrolled amount of the active component. In fact, capsules should not be opened or broken at all.
• Take into account the size, shape, type and hardness of the tablet

Ask your pharmacist before splitting your pills. Also, split them only when you need them as exposing the pill to air and moisture will reduce the effectiveness of the medication.

If you must, use the most accurate method - the pill splitter.