Cutting Pills to Cut Costs?

Things to Consider Before You Split Tablets

Elyse Fisher, PharmD Candidate 2010

Bernard J, Dunn School of Pharmacy, Shenandoah University

Prepared during Consumer Health Information Corporation Clerkship
McLean, VA

In this economy, everyone is looking for ways to save money. 

We clip coupons, look at sale ads, and… cut pills? 

More and more people are beginning to cut their prescription medicines in half in order to cut costs and save on their co-pays. Different strengths of the same medicine are often available for about the same price. For example, 40 mg of a generic blood pressure medicine may cost $18.00 for 30 tablets. The 20 mg tablet of the same medication costs $16.00 for 30 tablets.  If you are supposed to take 20 mg every day, you may ask your doctor to write a prescription for 15 of the 40 mg tablets. This way, you can cut these tablets in half, giving you 30 days of medicine for only $9.00.  By cutting the tablets in half, you can save about half on the cost of the medicine. It’s important, though, to know the risks and benefits of splitting tablets before you and your doctor decide this is right for you.

What’s wrong with splitting pills?                                 

Splitting tablets is often not easy to do accurately. Tablets that are very small or those that have an odd shape are difficult to split evenly. This means that you might be taking unequal amounts of medicine. 

For some medicines, it can be dangerous to get different amounts of medicine with each dose. This includes medicines that are used to prevent blood clots and drugs used for thyroid conditions. This can lead to getting too much medicine, which could cause side effects or other problems. You might also get too little medicine, which would not help your condition, and might even make your disease worse.

You must also be physically and mentally able to split tablets.  For example, if you have poor eyesight, it may be difficult to see the tablet well enough to be able to cut it in equal halves.  If you have memory loss, it may be hard to remember whether you split your tablet already.  This could cause you to take a whole tablet rather than half of a tablet and get too much medicine.  It could also lead to you splitting the tablet again, and getting too little medicine.

Is your medicine safe to split?

One of the most important factors to remember is that not all medicines are safe to cut. A medicine that is approved by the Food and Drug Administration (FDA) to be split in half is scored. This means there is an indented line down the middle of the tablet where it can be split.

Medicines that cannot be cut include:

• “Long-acting” medicines
  they might also be called “extended-release” or “sustained-release”. These tablets are made to be released in the body slowly over a certain amount of time. If these tablets are cut in half, the structure of the tablet will be damaged. This would cause your body to get too much of the medicine at one time. This could be very dangerous. Sometimes a long-acting medicine can be split.These tablets will be scored. Your pharmacist will be able to tell you if your long-acting medicine is safe to split. 
• Capsules
  These are pills with an outer shell and the medicine is located in powder or liquid form inside this shell. By cutting through the shell, you would release all the medicine, and it would be impossible to split it equally in half. 
• Enteric-coated tablets
  These tablets have a special coating on them so that they do not dissolve until they get through your stomach. This coating protects the tablet from getting destroyed by the acid in your stomach. It also protects your stomach from becoming upset from the medicine. Cutting these tablets would ruin that protective coating. 

Ask before splitting

Your doctor and pharmacist can tell you if your medicines can be split. If so, it’s important to remember a few tips on how to cut your pills safely so they will still be effective for you.

• When cutting a tablet, use a pill splitter.
• You should not use a kitchen knife or a pair of scissors
  to cut your tablet. This can be dangerous and will not
  be as accurate as a pill splitter. 

• A basic pill splitter can be purchased at your local
  pharmacy for less than $5. They are designed to help
  split your tablets evenly. There are also pill splitters available with a magnifying glass. This helps you see the scored line on the tablet better so you can make an even cut. 
• Always wash your pill splitter to remove any dust or powder from your pills.

• You should cut only one tablet at a time. 
• Cut one tablet and wait until you have taken both halves before you cut the next tablet. If you store several halves of tablets in a prescription bottle, they can crumble and split even more. This would result in you not getting the exact dose that you need.
• Some tablets have a coating on them to protect them from heat or moisture. If these tablets are split, part of the medicine will be exposed to the heat from sunlight or steam from the shower. This could damage the tablet and make it less effective.

 So if you’re looking for ways to cut costs on your prescriptions, cutting pills may be an answer for you.  Talk to your doctor or pharmacist first to make sure it doesn’t “cost” more problems than it’s worth.

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