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Patients, doctors and even health insurance companies advocate pill splitting as a way patients can reduce health costs and save money. This is the practice of filling prescription tablets at double the needed dose and then cutting the pills in half to get two doses, which essentially cuts the price per dose in half. Some are now questioning whether the practice is safe.
A new study found that pill splitting can be highly inaccurate and potentially dangerous. Medical experts are advising caution after the study found nearly a third of the split fragments deviated from recommended dosages by 15 percent or more. This means pill splitting could have serious clinical consequences for tablets that have a narrow margin between therapeutic and toxic doses.
Researchers from the Faculty of Pharmaceutical Sciences at Ghent University, Belgium, asked five volunteers to split eight different-sized tablets using three techniques commonly used in nursing homes. They found that 31 percent of the tablet fragments deviated from their theoretical weight by more than 15 percent and that 14 percent deviated by more than 25 percent. Even the most accurate method produced error margins of 21 percent and eight percent, respectively.
They split tablets into 3,600 separate quarters or halves using a splitting device, scissors and a kitchen knife. The eight different tablets were different shapes and sizes, three were unscored, three had one score line and the others had two.
The drugs used in this study were prescribed for a range of health conditions, including Parkinson’s, congestive heart failure, thrombosis and arthritis. After splitting, each fragment was weighed to see how much they deviated from the theoretical weight.
The researchers determined that using a splitting device provided the most accurate results, but still resulted in errors. The use of scissors was the least accurate method, followed by the use of a knife.
Recommendations based on the study include the following:
- A splitting device should be used when splitting cannot be avoided, for example when the prescribed dose is not commercially available or where there is no alternative formulation, such as a liquid.
- Clinical staff involved in splitting tablets should receive training to enable them to split as accurately as possible. They should also be made aware of the possible clinical consequences of dose deviations.
The report also calls on drug manufacturers to introduce a wider range of tablet doses or liquid formulations so that tablet splitting becomes increasingly unnecessary. The study, reported in the January issue of the Journal of Advanced Nursing, did not receive funding from any pharmaceutical companies.
Resource:
Tablet-splitting: a common yet not so innocent practice. Verrue et al. Journal of Advanced Nursing. 67.1, pp 26-32. (January 2011). DOI: 10.1111/j.1365-2648.2010.05477.
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