Understanding the Risks and Benefits of Pill Splitting

Understanding Splitting Pills  

Pill-splitting or tablet splitting refers to the practice of splitting or cutting a pill or tablet in half. It essentially divides a higher-dose pill into two equal lower-dose pills, and in some cases, it’s even possible to split pills into four equal parts. 

Importance of Safe Practices

Not all pills can be safely split. The U.S. Food and Drug Administration (FDA) approves certain medications to be split, and this information is provided in the patient package insert. Without the FDA approval, the agency has not evaluated the safety and efficacy of splitting such medications. Most commonly, this is because splitting certain types of pills can cause unwanted side effects or even serious health problems. 

Limitations and Risks of Tablet Splitting

Unfortunately, not all pills are designed for splitting. For instance, some tablets come with an enteric coating to protect the medicine from stomach acid. Splitting these pills can destroy this protective barrier and cause the medicine to be more quickly degraded in the stomach, making it less effective because you receive a lower dose of the active ingredient. It can also lead to more adverse effects.

Splitting a tablet that does not have a score line down the middle can result in two unequal halves. This can cause fluctuations in dosing and lead to worsening symptoms and disease control. This is particularly concerning for medications with a small therapeutic window (the difference between a safe dose and a harmful dose of a medication is very small).

Extended-release tablets are designed to release a small amount of medicine gradually over time. Splitting these types of pills can lead to the release of a large amount of the drug at once, putting you at risk of serious adverse effects.

To find out if you can safely split a pill in half, check the “How Supplied” or “Patient Information” section of the patient information leaflet or ask your pharmacist. If it does not explicitly state that splitting the pill is safe, it may mean that tablet splitting for that particular medication is not FDA-approved. 

Common Reasons for Splitting Pills  

• Cost savings: To save money on prescription costs by cutting a double-strength pill into two. 

• Smaller doses: To take a smaller dose than commercially available dosage strengths.

• Dosage adjustment: To adjust the dose of your medication as directed by your healthcare provider.

• Easier swallowing: To make larger pills easier to swallow.

Regardless of the reason, be sure to check with your doctor or pharmacist before splitting one of your medications.

Advantages of Pill Splitting  

Cost Savings

You can potentially save a ton of money if you split tablets. In many cases you can save up to 50% on your medications, because pills with twice the strength are not twice the price! 

In order to help patients obtain the treatment they need at an affordable cost, many doctors are more than willing to write prescriptions for double strength. 

Because pharmaceutical companies often use flat pricing regardless of potency (strength), this is the perfect solution for pricey meds and ongoing treatments. But if you are considering tablet splitting, you should do so only after checking with your doctor or pharmacist to ensure it is safe. Unfortunately, this is only the case if you are paying cash (not through insurance) for your medications. Insurance companies limit dispensing to a certain day supply depending on how the medication is prescribed. 

Dose Adjustment 

Some medications are only available on the market in a higher dosage strength. If your healthcare provider wants to prescribe a lower dose to you, they may recommend a tablet-splitting program. 

In addition, your healthcare provider may recommend pill splitting after they adjust your dose. For example, if you just purchased a three-month supply of 100 mg tablets and your provider wants you to take 50 mg of the medicine from now on, they may permit pill splitting if it is safe to do so for that particular pill. This will allow you to take the pills you already have instead of purchasing an entire supply of 50-mg pills.

Easier Swallowing

Many people have trouble swallowing pills, especially pills that are large in size. Pill splitting can make these tablets easier to swallow by making them smaller in size. Your doctor or pharmacist may recommend that you cut one pill in two and swallow the two halves separately for ease.

Risks and Challenges of Splitting Pills  

What Medications Should Not Be Split?

The following medications should not be split unless advised to do so by a healthcare professional:

• Tablets that don’t have a score mark (line or indentation) down the middle.

• Film-coated or enteric-coated tablets with a hard outer coating.

• Orally disintegrating tablets (ODT) that dissolve in your mouth.

• Capsules.

• Controlled-release (CR), sustained-release (SR), extended-release (ER), and long-acting (LA) forms of medicines.

• Pills that are too small to split.

• Pills that have an odd or uneven shape.

Types of medications that should not be split include:

• Narrow therapeutic index drugs, such as:

  • Anticoagulants (blood thinners).

  • Antiseizure drugs.

  • Thyroid medications.

  • Anti-rejection drugs for after organ transplants

• Oral contraceptives (birth control pills).

• Chemotherapy drugs.

• Certain combination pills containing more than one medicine.

Impact on Medication Efficacy and Safety  

Splitting pills can impact the efficacy and safety of the medicine. For instance, cutting a pill in half may result in some of the medicine getting pulverized (turned to powder). As a result, you won’t get the correct dose of the medicine as prescribed by your doctor, making it less effective in treating your condition. Failure to split a pill evenly can result in fluctuating doses. 

How to Split Pills Safely  

How To Tell If a Pill is Safe to Split?

As insurance companies and doctors continue to recommend pill splitting as a way for patients to obtain expensive meds, the FDA has taken measures to maintain a standard by which to name, label, and evaluate scored medications.

Usually, a scored pill (tablet) is safe to cut in half. The score is an indented line across the pill. It indicates that the potency in both halves of the pill is equal. It’s the manufacturer’s guarantee that the medication can be split evenly into two halves, and sometimes into four parts. 

If a pill is not scored, it can be more difficult to split. As mentioned, some drugs are not appropriate for splitting the whole tablet into smaller parts due to modified drug release, coating, pre-packaged doses, or pills prescribed more than once per day. To be sure your pills are safe to split, confirm with the pharmacist before attempting to split pills.

Use of Pill Splitters vs. Other Methods  

If you’re saving money by splitting pills, you may consider investing about $5 to $10 in a pill splitter or pill cutter. A pill splitter can be purchased at most pharmacies and drug stores. 

This device is designed to split an appropriate pill in a controlled way, making the halves precisely equal, and keeping any dust or molecules contained and out of reach of others. Using a knife to split pills can lead to a loss in drug potency, unequal halves, and a mess!

Tablet Splitting for People with Disabilities

Some pill cutters come with a V-shaped pill holder that makes them easy to use. However, in some cases, patients are not able to split their own pills because of poor eyesight, grip problems, or other physical disabilities. Some pharmacists will split scored tablets, and they can do so more precisely than you, especially if you are not comfortable splitting your own. 

Step-by-Step Guide to Splitting Tablets

1. Place the scored tablet in the pill-splitter. 

2. Make sure the blade lines up with the score line. 

3. Take care not to touch the sharp blade. Some pill cutters have a retractable blade to prevent injuries.

4. Press firmly to close the pill-splitter.

5. Open the pill-splitter and retrieve the two halves of the tablet carefully.

To ensure equal dosage when splitting pills, cut along the score line (indented mark) on the tablet. Use a pill splitter for more precise results.

FAQs About Pill Splitting  

Is It Okay To Split Pills?

It is okay to split some pills, but not all. Only scored pills (that have a score mark or indented line down the middle) should be split. Always check with your doctor or pharmacist before splitting pills to ensure this practice is safe for that particular pill. 

What Does A Pill Splitter Do?

A pill splitter makes a precise cut on appropriately scored pills. This ensures you get two exactly equal halves. It also prevents others from being exposed to the molecules or dust from the pills. And it prevents a mess.

How Do You Split A Pill Perfectly?

You can use a pill splitter to split a pill perfectly. This commonly available device costs $5 to $10 and makes precise cuts in pills. It is a better option than using a knife which can result in unequal parts and potential loss of strength.