John Tiong Jeh Lung
PhD, MPharm, RPh
Have you ever tried splitting your tablets at home with the intention of adjusting the dose of your medication or to ease swallowing?
This has become a prevalent practice among patients for various reasons including cost-saving (as encouraged by some insurance companies in the US). A tablet dosage form can be manufactured with scoring line to facilitate splitting although in some cases it is merely for cosmetic or marking purposes.
Although tablet splitting allows dose flexibility, splitting of a non-scored tablet is generally not advisable because it is often difficult to obtain evenly split fragments. Furthermore, some tablets may crumble during the splitting process (which may also happen to scored tablets).
This is further compounded by the possibility of non-uniform distribution of active ingredient within each tablet which may affect accurate dose adjustment with risk of over- or under-dosing; imagine cutting a walnut cake into two and expecting both halves to contain exact amount of walnuts!
More importantly, splitting can damage the coating of a tablet meant to protect the active ingredient from degradation outside of its blister pack and/or the coating meant for controlled-release to specific sites in your gastrointestinal tract. In fact, certain tablets may contain active ingredients that are irritant to the oral lining for example risedronate (Actonel®) and alendronate (Fosamax®) which are prescribed for osteoporosis.
In view of this, it makes more sense to try to obtain the right tablet strength whenever possible so you can administer it whole which ensures accurate dosing.
Do check with your pharmacist to see if it is appropriate to split the tablet dosage form you intend to administer. If tablet splitting is deemed appropriate and safe by your healthcare providers, do consider using a tablet splitter (shown below) rather than a kitchen knife.