Patients split tablets for a variety of reasons, however there are problems associated with this process. Tablet-related factors include inaccuracy in splitting tablets and the resultant dose fluctuations, increased degradation of drug as a result of exposure to air and alterations in the dissolution rate of some formulations. Even when commercial tablet cutters are used the accuracy of splitting may be variable. Patients may experience difficulty in splitting tablets especially if their dexterity, eyesight or cognition is impaired. Compliance is likely to be decreased if the regimen requires tablets to be split. Although splitting tablets may potentially save the patient money the possible impact on the quality of medication use must be considered.
- obtain the required dosage when a dosage form of the required strength is unavailable
- provide appropriate fractional doses in a flexible dosing regimen or in a gradually increasing or decreasing dosage regimen
- begin therapy with the lowest possible dose to decrease the incidence of adverse effects or to gauge an individual patient's response.
Elderly people or children who require reduced doses may not be able to use liquid formulations (or they may not be available on the Pharmaceutical Benefits Scheme). If suitable low-dose tablet formulations are unavailable, these patients may require tablets to be split to obtain the appropriate dosage.
Patients may save money if there is a price differential that makes halving tablets economically attractive. However, the process of splitting tablets causes a number of problems, some of which are patient-related while others are related to the tablet or formulation.
- Check the product information before recommending tablets be split
- In general only scored tablets should be split
- Patients should be assessed for their ability to understand and comply with regimens involving split tablets
- A tablet cutter can be used to improve accuracy, but patients must be instructed in its proper use
- Patients should be advised about appropriate storage of split tablets.
Conflict of interest: none declared
The following statements are either true or false.
1. Splitting tablets can accelerate the degradation of the active ingredient.
2. If a soluble aspirin tablet is split the half which is not used immediately should be discarded.
Answers to self-test questions