Splitting Pills? CAUTION

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Splitting Pills May Have Risks

Study Shows Patients Who Split Pills May End Up With Doses That Are Too High or

Too Low

To Split or Not to Split? continued...

A half or a quarter of a pill may be better than nothing, but this varies based

on the type of medication and its dosing formulation.

" Different tablets split differently, " he says. " Some crumble, others are hard

and cut very clean. Some tablets are coated, others are long acting or short

acting, and some are capsules or extended release, " he says. " Others are scored

down the middle and can be broken with your thumbs, and a lot don't have any

scores at all. "

There is no clear-cut consensus on which pills you can, or can't, split, he

says.

" It would be unsafe to say `yes you could do this with three out of five of your

pills or all of your medications,' " he says. " You need to evaluate how well your

disease is controlled, why you are splitting, and what tablets you want to

split. "

Pills are split all the time, and some insurers even offer incentives to get

their members to cut their pills, says Alan M. Weiss, MD, an internal medicine

doctor at the Cleveland Clinic in Ohio. " It can be a great cost-saving mechanism

for patients who can do it and do it on the right pills. "

" There are some pills where you can break the seal if you cut them, and this can

cause the medication to degrade, " he says.

Extended Release, Coated Pills Can't Be Split

" If want to split a pill, there are a lot that are already scored and are

designed to be cut, " he says.

" Extended-release tablets and capsules can't be cut. "

Yuly Belchikov, PharmD, an assistant director for clinical pharmacy services and

education at Long Island Jewish Medical Center, New Hyde Park, N.Y., says that

pill splitting can be a problem for pills with a small therapeutic window. This

refers to a pill that needs to be taken in very controlled, precise doses.

" Pill-splitting a medication with a small therapeutic window is concerning

because any deviation from the recommended dose, even a small percentage, can

have serious consequences, " he says.

Papatya Tankut, PharmD, vice president of pharmacy professional services at CVS

Caremark in Woonstocket, R.I., sums it up this way: " Ask a pharmacist or a

physician before you split any pill. Don't decide to do it on your own because

there are some toxic effects of splitting pills that weren't designed to be

split. "

" Use a pill-splitting device so you are accurately splitting the dose, " she

says, and split pills only on an as-needed basis. " Air or moisture can change

the formulation and deem it less effective when you do it in advance. "