Pill splitting: which ones are safe to divide?

~ Carolyn Thomas

by Carolyn Thomas  ♥  @HeartSisters

pills-1173656_1280Physicians and other prescribers are often frustrated by their non-compliant patients. (Full disclosure: as I’ve written about here and here, for example, even the word non-compliant makes me cranky, as it sounds so much like it has punishment at the end of it). These frustrating patients are generally described as those who are not following doctor’s orders (there’s another patronizing term for you) or more specifically, are not taking the medications prescribed for them.

A Consumer Reports Health prescription drugs survey reported that many people are splitting their pills in half to save money on high-priced prescription drugs. The bad news, however, is that many have also learned to save even more money by taking half-doses of half-a-pill every other day.

But here’s a consumer-friendly example of pill-splitting that makes sense:

   “A bottle of 30 x 100mg pills might cost almost the same as a bottle of 30 x 50mg pills. Cutting the 100mg pills in half could indeed cut your medication bill, but there’s a right way and a wrong way to split pills.”

You can ask your pharmacist to cut pills in half for you. But if you’re considering splitting your pills, these tips from the Consumer Reports Health free pill splitting guide will help make sure that you do it the right way, as the survey report suggests:

Look for this kind of pill splitter
Look for this kind of pill splitter ($3-10)

“First, ask your doctor or pharmacist whether your medication can be safely split. Some medications should not be split (more on that below), but in general, many common ones can, including aspirin, cholesterol-lowering drugs known as statins, and many high blood pressure and depression drugs. Find out which pills are okay to split – and which ones are not.  And always use a pill splitter to ensure you’ve split the medication into equal halves. Pill splitters are widely available from pharmacies.

“Don’t split your pills with a knife. Studies show that doing so too often leads to unequal halves. Pills should only be split in half, not into smaller portions, such as thirds or quarters. The easiest pills to split are relatively flat round ones with a scored center, a slightly indented line that runs across the center of the pill. However, not every pill that has a scored center is meant to be split.

“Don’t split your pills in advance. Some pills may deteriorate when exposed to air and moisture for long periods after being split. So for medications taken on a regular basis, split your pill only on the day you take the first half, and then take the other half on the second day or whenever you are scheduled to take your next dose.

“If your doctor has prescribed half tablets, your pharmacy may split the pills for you. So when you pick up the prescription or a refill, ask if the pills have been split so you don’t inadvertently split them again. Also be aware that the prescription label may refer to “one tablet” even though your doctor has told you to split the pills. If you’re not sure about the label instructions or your doctor’s instructions, check with your physician and your pharmacist before splitting or taking your medication.

“There is no official or complete list of medicines that can be split. And it can actually be dangerous to split some drugs. Generally, the following kinds of pills should not be split:

  • Chemotherapy drugs
  • Anti-seizure medicines
  • Birth control pills
  • Blood thinners (Coumadin, warfarin)
  • Capsules of any kind that contain powders or gels
  • Pills with a hard outside coating
  • Time-release pills designed to release medication over time in your body
  • Pills that are coated to protect your stomach (enteric coating)
  • Pills that crumble easily, irritate your mouth, taste bitter, or contain strong dyes that could stain your teeth and your mouth.
  • Combination tablets that contain two or more medicines, in which the amount of one active ingredient changes from one tablet size to the next, but the amount of the other does not. (You’ll have to ask your doctor or pharmacist.) Here are some examples:
  • amlodipine/atorvastatin (Caduet)
  • amlodipine/olmesartan (Azor),
  • amoxicillin/clavulanic acid (Augmentin, and others),
  • ezetemibe/simvastatin (Vytorin),
  • irbesartan/hydrochlorothiazide (Avalide)
  • oxycodone/acetaminophen (Percocet, and others)
  • sitagliptin/metformin (Janumet)

“Some pills that can be split (but always check first with your doctor or pharmacist beforehand; your situation may require something different):

  • amlodipine (Norvasc)
  • atorvastatin (Lipitor)
  • citalopram (Celexa)
  • doxazosin (Cardura)
  • finasteride (Proscar)    NOTE: Women should NOT handle crushed or broken finasteride tablets if pregnant or possibly pregnant. Broken tablets lose some of the protective outer coating, thus allowing absorption of finasteride through the skin. This drug may cause birth defects.
  • levothyroxine (Synthroid)
  • lisinopril (Zestril)
  • lovastatin (Mevacor)
  • paroxetine (Paxil)
  • quinapril (Accupril)
  • sertraline (Zoloft)
  • simvastatin (Zocor)
  • tadalafil (Cialis)
  • vardenafil (Levitra)

VERY, VERY IMPORTANT!  Talk to your physician or your pharmacist for specific advice on which pills can be safely split.

© Consumer Reports Health, Steve Mitchell, Associate Editor

Q:   Do you split any of your pills?

♥

NOTE FROM CAROLYN: I wrote more about our cardiac meds (and many other issues!) in my book A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017). You can ask for this book at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press (use their code HTWN to save 30% off the list price when you order).

See also:

Therapeutics Initiative was established in 1994 at the University of British Columbia, its mission to provide physicians and pharmacists with up-to-date, evidence-based, practical information on prescription drug therapy.  Here is their March 2020 update called Pill splitting: Making the most of meds in a time of need

What you need to know about your heart meds

Deprescribing: fewer drugs, better health outcomes?

“I’m just not a pill person” – and other annoying excuses

Confessions of a non-compliant patient

Why don’t patients take their meds as prescribed?

Why patients hate the c-word

Medical journalism watchdog slams cardiac ‘polypill’ news hype

Here’s my useful patient-friendly, jargon-free glossary of confusing cardiology terminology

Published by Carolyn Thomas

30 thoughts on “Pill splitting: which ones are safe to divide?”

    1. Hello Jessica – aspirin might be tricky for pregnant women, although researchers have found that the use of low-dose aspirin — 60 to 100 milligrams daily — hasn’t been found to be harmful during pregnancy. For anything beyond those low doses, this Mayo Clinic article suggests:

      “If you need to take a pain reliever during pregnancy, talk to your healthcare provider about the options. He or she might suggest occasional use of acetaminophen (Tylenol and others) instead of aspirin.”

      Best to ask your physician directly about aspirin. Good luck to you and your baby. . .

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    1. I’m not a doctor, Felecia so cannot advise you, but can tell you generally that it’s usually the extended-release capsule form of this drug that carries a warning about the need to swallow it whole. Check with your pharmacist to make sure your 10mg pill isn’t in that category. And ALWAYS check with your pharmacist and your physician before any pill-splitting decisions.

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    1. I don’t know, Roy. I’m not a doctor. If your pharmacist (AND your doctor) say yes, that’s probably a safe bet, but please don’t split anything until you double-check with your doc, especially if you’re splitting your pills to deliberately take less of that medication.

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  6. Thank you for your very useful article on pill splitting. You advised against splitting Janumet pills but what about Januvia pills? Please advise, thank you.

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    1. Hi Larry,

      I’m neither a physician nor a pharmacist, but my best guess is that Januvia has one active ingredient (sitagliptin) while Janumet is one of those combination drugs listed (sitagliptin and metformin) on the Consumer Reports ‘no-no’ list. Double check with your pharmacist just to make sure.

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      1. Thank you Carolyn for your quick reply.
        Both my doctor as well as the pharmacist say it’s okay to split the pill , however FDA reports say it should not be split, crushed or chewed.
        I was hoping you could clear up the confusion and am still hopeful,
        Best regards
        Larry Tay

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        1. Well, we seem to have dueling experts at work here, don’t we? The FDA does indeed say that (but I wonder if they include that disclaimer for all drugs, or perhaps – unlikely – because it’s a film-coated pill?) The manufacturer’s (Merck) site doesn’t contain that warning. You might want to contact them directly. Again, I’m no expert so you’ll have to decide who to trust!

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          1. Thanks again Carolyn for your Super quick response.
            I did contact the local branch of Merck ( they have both offices and manufacturing plants here in Singapore) even before I checked with the FDA, but they refused to comment which to me is both irresponsible as well as strange.

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          2. All drug companies have a 1 800 number to call to ask medical information. The 1 800 number is usually on the package label at least in USA. The med info depts are usually also staffed by nurse or pharmacists at the drug companies.

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  7. This is a very helpful guide Carolyn! Some people might be doing self-medication and thinking that generally, pills can be cut into halves. Good thing is that you have come up with a helpful list which pills can’t be cut into halves. At least now, more readers are aware of that kind of situation. Thank you for sharing!

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    2. I am trying to find out specifically if you can split a tylenol #4 in half, and I have been searching and not one website has said whether I can or cant!

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      1. Check with your doctor before you try this, Lina. Levothyroxine is one of the drugs listed (see above article) that can apparently be safely split, BUT my understanding is that it’s also considered a “critical dose drug” – which means that even small differences in dose or concentration may lead to problems.

        Call your doctor first to double-check.

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  8. Since my tricuspid valve was replaced 5 years ago, I’ve been taking 1/4 of the smallest available dose of a beta blocker. I used a pill splitter for years, never getting neat 1/4s, so trying to alternate days of big pieces with days of small pieces. This year I finally asked the pharmacy to cut them for me. They don’t do any better than I ever did, but it has saved me a lot of fiddling. Yesterday, the cardiologist told me I can stop taking that medication. Hooray!

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    1. Hi Jenn – fiddling with 1/4 of a small pill is a whole different experience – even for the experts, right? It’s a good thing you can just stop taking your beta blockers now, because reducing the fractions any more would mean just a pile of little crumbs.

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  9. Even with a pill splitter I find halves are not quite equal, but usually close enough. Thanks for this news to me: That advance split meds might actually deteriorate. I usually take a certain med at half dose and have been merrily splitting an entire bottle when it arrives.

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    1. I know – I used to do that too! Those halves might not be 100% equal but they are sure better than ending up with one good part and one fractured into four tiny chunks by the kitchen knife I used to use. Thanks, Kathleen…

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  11. What a wonderful ‘reminder’ article on pill splitting. I take the lowest dose of a drug with the pill split in half and can still feel the effects if I don’t take it. Our hearts are so sensitive to any chemical change I can easily see that an unevenly split pill could have some unexpected results, i.e. blood pressure going too low.

    Thanks for keeping us heart smart, Carolyn!

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