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Editor, – The response to Professor Tiller's question ('Questions to the PBAC' Aust Prescr 1997;20:60) concluded with general advice from the Director, Pharmacy Restructuring and Legislation Section, Pharmaceutical Benefits Branch on dose adjustment and how it might be achieved by splitting tablets. The advice arose out of a question relating to how a particular daily dose of sertraline might be achieved, so that a recommendation for breaking tablets in half is likely to be taken as applying to Zoloft (sertraline/Pfizer).
Zoloft tablets as currently sold are unscored (although a scored 50 mg tablet is in the process of registration to facilitate initial treatment at a lower dose for the indication of panic disorder which, we hope, will be approved soon). Breaking the present tablets to achieve intermediate doses is not endorsed in the product information and, accordingly, not recommended by the manufacturer even though no problems are likely to result. This is because the tablets are of a conventional formulation with no sustained release properties, and their coating is simple, and not 'enteric'. If the advice is intended to apply generally, the implications are more serious, since splitting tablets that are formulated for sustained release or are dependent on the integrity of a special coating for their designed performance may have serious consequences for patients. As far as Zoloft is concerned, we would have no objections to the writing of two strengths on the same prescription. We would make no more out of it, although the pharmacist would presumably pick up an additional dispensing fee.
Director, Medical Affairs
Pfizer Pty Limited
West Ryde, N.S.W.