Many of us do it, we take those pills that cost a fortune and we split them in half and then figure insurance will cover two month’s worth instead of one. The insurance company will save money, we have a lower co pay and fewer trips to the pharmacy, so why not? The editors at JAMA considered this “why not” and published an article about it in their Medical Letter on Drugs and Therapeutics.
A number of medications were tested and the amount of their active ingredient subsequent to cutting or breaking the tablet in half was measured. The studied medications included warfarin (an anticoagulant) and medications for hypertension, heart disease and depression (simvastin, metoprolol, lisinopril and citalopram). The good news was that the split pills were pretty much within the half dose range. The results with scored tablets were better than those with unscored tablets. The editors also cited a recent review that found that the use of split tablets did not seem to affect the clinical outcomes of patients with hypertension, hyperlipidemia (high cholesterol) or psychiatric disorders.
The article went on to state the obvious; that breaking the tablet in half is somewhat dependent on a patient’s visual acuity, strength, dexterity and cognitive ability. Clearly large, elongated tablets with deep score marks on both sides will be the easiest to split. (And just so you know…there is a tablet splitting device which you can buy at the pharmacy. I’ve actually used it, the only problem is taking a very small tablet and making sure it is cut exactly through the middle.) The article suggests that if patients want to split the tablets they do so one at a time so if one half is too small and under dosed, the next day the larger half will be taken and will compensate for the previous lower dose.
Obviously capsules should not be split, nor should tablets that are enteric-coated or extended- release. Also combination tablets in which the amount of one active ingredient changes from one size to the next, but the amount of the second does not, should not be split because that will impact the dosing. These include combination drugs that lower blood pressure and also control blood sugar (sitagliptin/simvastin also called Juvisync, linagliptin/metformin, codeine/acetaminophen, azilsartan/clorthalidone and amoxicillin/clavulanic acid) among others. (I sense that most of you reading this have looked away from this generic drug list…but I felt that in deference to the article and medical completeness I should include them.)
Bottom line: Tablet splitting probably does not have adverse clinical consequences and can reduce the cost to you and your insurance. (The pharmacy may not like this…but oh well.) This pill division is not appropriate for all drugs, nor for that matter all patients. If you do split the tablets, try to make sure that the halves are equal. And if the tablet is coated or comes with instructions not to chew or crush or if it contains a combination of medications, then take the whole tablet as prescribed.