Pill Splitting: Is It Right For You?

Total prescription drug spending in the United States continues to rise each year and as reported by the Centers for Medicare and Medicaid Services, this trend will only continue, actually rising by about 12% per year into the year 2011. Medicare beneficiaries seem to be the population hardest hit by these increases since they are responsible for almost half, approximately 40%, of prescription drug spending in the United States according to the Congressional Budget Office.

With the projected increases in prescription drug costs, pill splitting seems like a great alternative to help cut the costs. However, there are a few issues that need to be addressed before you can start cutting those pills in half.

• Concerns exist that cutting pills in half can lead to reduced potency of the medication, which can lead to a reduced effect on the disease or condition the drug is treating.

• Not all pills can be cut in half, so a conversation with your doctor and pharmacist must take place before deciding to split the pills.

• Some individuals may not be good candidates to cut pills due to certain disease states that may affect his/her dexterity; a caregiver may need to provide assistance with pill splitting.

• Some drugs may have undesirable properties after splitting in half, such as bitter taste, sharp edges, etc, and each person will have to decide for him/herself whether or not those changes are tolerable.

Some researchers looked at the potential cost-savings involved in splitting pills. Researchers found that the savings associated with splitting some of the most commonly prescribed medications ranged from 23 to 50% depending on which drug was looked at. For example, current drug prices for a commonly prescribed medication for high blood pressure are as follows:

• Lisinopril 10 mg tablets x 1 tablet daily x 365 days/year= approximately $140.00

• Lisinopril 20 mg tablets x ? tablet daily x 365 days/year= approximately $65.00

This example yields a savings of about 50%; splitting other drugs might offer a little less savings, while splitting some drugs could equal this savings or even provide more savings.

Many researchers have looked at the possibility that splitting a tablet could decrease its effectiveness. In a randomized cross-over study, Rindone [and colleagues] evaluated the impact of splitting lisinopril pills in 29 patients with high blood pressure; patients received a full pill for 2 weeks and then a split pill for 2 weeks with no significant differences in systolic and diastolic blood pressures. Researchers from the University of Michigan, involved in another study looked at the impact that splitting pills had on patients taking medications for high cholesterol. They were able to show that there was no decrease in the effectiveness of cholesterol lowering abilities of the drugs once they were split.

More researchers have shown similar results in regards to the safety of splitting pills; however some pills are not made to be split. This is why a conversation with your doctor and pharmacist must precede any pill splitting. Examples of medications that cannot be split include those that are formulated as extended or sustained release (which means they can be taken once or twice daily due to their properties that slowly release the drug in the body over time), tablets that are enteric coated to help reduce stomach irritation, and tablets that are not scored can be hard to cut equally.

As well as the pill itself being difficult to cut, the person splitting the pill may have difficulties. Persons with severe arthritis, Parkinson's disease, or other conditions that affect dexterity may need assistance to ensure they are safely and accurately splitting the pills in half. It is best to use a pill cutter to split pills as equally as possible. Pill splitters are inexpensive and can be purchased at most pharmacies. Ask your pharmacist for help in selecting a pill splitting device.

Sometimes, the cost savings are not enough to convince some people to split their pills. Once split, some pills have altered tastes and textures that can be undesirable. It isn't known until you split a tablet whether or not this will be bothersome, but do not let it keep you from taking your medicines. If you need to, go back to taking full tablets of the appropriate strength. The most important message is to take your medicine daily; how you choose to do so is up to you.

If pill splitting seems like something you could be interested in, talk with your doctor and pharmacist to determine the safest and most cost-effective methods.

Last Updated: February 2008
This content was created by members of the DrugDigest team of experts and is solely under DrugDigest's editorial control.

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