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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.
Michael
Just read another comment about using the pill splitter instead of your finger nails, there is always residue (which side of the dose do you add this to?) in the pill splitter from the blade, but I have never seen anything in my hands when doing it manually!
Michael
Syracuse, NY
I am taking three medications now for my heart and splitting them. I can clearly see after I split them that are not equal. In fact my wife has a very expensive scale used in making hair products and cosmetics and I have found that the splitting of these pills can exceed 10% difference in weight.
Also, what about pills that are time-release, are these no longer time-released because you have exposed a significant portion the pill to no longer having any of the coating normally used for time-release fomulas.
Terry Graedon
In general, timed-release pills should NOT be split. Check with the pharmacist before you do so.
Also, tell the prescriber about your experience and ask if that 10% differential is important. If so, you may need to buy the dose you need instead of using the splitter.
Shirley Mae
Adding another thought: I was told Generic drugs only need to have 80% of the drug, while Brand names have the full 100% strength. I have to take the drug Lasix brand name only as the Generic is like taking popcorn – it does no good. Think about asking for Brand Name IF you are not getting results from the Generic drug because you might need the full does of the drug rather than 80%. Something to think about.
Shirley Mae
Corvallis, OR
I was told years ago that only pills with a scored line can be split because the mfg. makes sure there is the same amount of the drug on each side. Those pills without a scored line do not have the same amount of med on each side and you cannot be sure where the actual medication is in the split pill. I also am a retired Registered Nurse.
Carol
Florida
I have been splitting Valsartan for a long time from 80mg to 40mg. Haven’t had any reaction. Is this one that you feel is dangerous also?
Elouise M
Hampton, Va.
I have taken glipizide for several years (2.5 mg) with success. The company stopped making this dosage and I was precribed 5mg with orders to split the tablets. I have had problems with my gloucouse reading for the last 2 – 3 months. I stopped the dosage and has had better success. I have wondered if the splitting had changed the dosage.
Bob
South Carolina
I would find it hard to believe that the difference in pill size once split would make a difference in its effect. Yes, there most likely will be some difference but will it really make a difference in doing what it is supposed to do? One may ask what is the accuracy in forming a pill in the first place.
This is not an exact manufacturing processes so there will be some differences not only in size but mixture of the various components. Maybe small but there will be a difference.
DS
Texas
I split Synthroid using a device designed to split pills. I split one pill at a time and take the pieces on consecutive days. I have had no trouble at all.
Jim
New Jersey
Having worked in the pharmaceutical industry, I know when the product is made it goes through a process known as “blending”. The ingredients are throughly mixed in a tumbling tub vat and then put through the compressing machine and compressed into the tablets. The ingredients are well blended and sporadic tests are made of the tablets in the Quality Control Lab to verify this prior to shipment.
Kathleen
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.
Marilynn
Suburban Chicago
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.
Michael
Northern Washington
I split pills because they don’t come in a small-enough dose for me. Dose accuracy is not all that important.
Kirstin
Southern California, USA
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.
Katherine
Mississippi
I’d been on 0.75 mcg levothyroxine about 8 months. Blood tests showed my levels were low; my cardiologist upped it to 100. Very bad reaction w/painful itching, sensitivity to sun/heat, heart pounding/pain. My GP lowered it to 88. After taking nothing for 3 days, took an 88. Symptoms flared up. I’m wondering about cutting it in half and starting over AFTER all symptoms are GONE. Any thoughts? BTW, I’m going to find an endocrinologist – if possible. Location, location, location………..
Tony
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