splitting pills

How important is the dose your doctor prescribes? If it matters, patients should be encouraged to take exactly the prescribed dose. The perverse incentives of the pharmacy business sometimes lead doctors to encourage patients to break pills in half. The result is that they pay half as much for the medication. Alternatively, they pay the same amount but the prescription lasts twice as long. But does splitting pills result in people taking the wrong dose?

The Problems with Splitting Pills:

Q. I am a retired ER physician. I have fought a battle for 20 years to stop pill splitting. This is often what managed care organizations like Kaiser and the VA use as a cost-containing strategy.

If dose means anything, this practice should be abandoned: the pieces are not even close to exact halves. This variation in dose can harm patients.

Why People Split Pills:

A. Splitting pills¬†has often been recommended as a way to save money. That’s because the higher dose is frequently priced about the same as the lower dose. For example, the cholesterol-lowering drug pitavastatin (Livalo) costs about $300 a month whether you get it as a 2 mg tablet or a 4 mg tablet.

Are the Two Pieces Halves?

One study of pill-splitting found that volunteers who cut hydrochlorothiazide tablets in two pieces ended up with almost half of the pieces of this diuretic the wrong size (Pharmacotherapy, Jan-Feb. 1998). Researchers in Switzerland concluded that scored tablets are not always designed to be split (Swiss Medical Weekly, Feb. 27, 2010). In some cases, the scoring appears to be decorative rather than functional.

An FDA study found that the thyroid drug levothyroxine should not be cut even when tablets are scored (AAPS PharmSciTech, Sept., 2010).  Tablets of the brand-name drug Synthroid are scored, but this is considered a dose-critical drug. So variation in dose caused by uneven pill breakage could pose problems for patients.

Surprisingly, a Dutch study found that hand breaking tablets was more accurate than using a pill splitter (International Journal of Pharmaceutics, May 15, 2014). So it seems that pharmacists and physicians may need to re-think their advice on splitting pills. There may be safer ways for patients to save money on their medicines.

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  1. Kathleen
    Reply

    It should depend on the medication, the person’s ability and understanding, even the reason for dividing a pill in half. My own case, we are seeing if half a dose of a blood pressure pill is sufficient. The use of a pill splitting device is necessary for most people to get an accurate dosage. I am a retired nurse.

  2. Marilynn
    Suburban Chicago
    Reply

    Doctors are not taking our systems into consideration when they prescribe. They go by what’s ‘popular’ or average. My daughter and I are polar opposites. The standard dose for her is not enough, and the standard for me is too much. For instance, we both used to use the suppository cafergot for migraines. She had to take a second one for her headaches, while I got sick as a dog from one. So I used to use a razor blade to cut mine in half. Half worked just fine. But my doctor didn’t change.

  3. Michael
    Northern Washington
    Reply

    I split pills because they don’t come in a small-enough dose for me. Dose accuracy is not all that important.

  4. Kirstin
    Southern California, USA
    Reply

    I take levothyroxine. My endocrinologist has told me to take a whole pill Monday through Saturday and a split (half) pill on Sunday. Or, I could take whole pills every day one week and skip taking a pill on Sunday on alternate weeks. This was prescribed as a way of reducing the amount of medication that I’m taking without reducing it too much.

  5. Tony
    Reply

    the Canadian online pharmacies charge ridiculously high prices. Metformin 500 mg tablets for example can be brought here for about two US cents each. they are charging more than 50 times that price. The same applies to a lot of other medicine.. They are offering generic medicine at absolutely ridiculous prices compared with what they really cost

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