oa SA Pharmaceutical Journal - The appropriateness and risks of tablet splitting : medifile : clinical review
Tablet division is applied where tablets of higher strength are split in half, or quarters, to provide the patient with a lower dose. The exercise is considered compounding by the pharmacist and is mostly used to make the titration of the required dose possible, as well as to save cost where tablets in a product range are flat-priced.
Studies showed that medication cost can be reduced substantially by implementing tablet splitting. Cost of tablet splitters and additional dispensing fees may however reduce savings somewhat, as may possible additional outpatient facility visits, especially in the initial few weeks after introducing tablet division to a medical scheme population.
Splitting scored tablets is approved by the FDA as efficacious and safe, but studies show that the half tablet weights of divided scored tablets often do not pass the dose content uniformity tests. Furthermore, in a recent study the drug content of half tablets, as determined by chemical assay, was not within the USP specifications for nearly 25% of products tested. In these studies, the physical characteristics like scoring and shape did not seem to predict which products would pass the uniformity test.
Certain types of tablets are generally not suitable for splitting, for example extended-release formulations and film or enteric-coated tablets, but there may be exceptions. Tablet size and shape may also play a role in the decision to split a tablet or not. Tablets containing drugs with a wide therapeutic index and long half-life may be more suitable candidates for division. Therefore, some tablets used for depression, hypertension and hyperlipidaemia may be considered for splitting, provided that product and patient characteristics are taken into account. Elderly patients, or those with impaired eyesight, cognition and / or dexterity may find it difficult to split tablets and take them correctly.
Tablet splitting carries a risk of errors due to misinterpretation of the prescription or label instructions by the pharmacist or patient, respectively. Nevertheless, where implemented carefully and with the appropriate counselling, tablet splitting does not compromise patient adherence and satisfaction or clinical outcomes negatively, and this was especially proven for statins.
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