Physicians and other prescribers are often frustrated by their non-compliant patients. (Full disclosure: as I’ve written about here and here, 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:
“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. The 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 20% off the list price when you order).
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
Here’s my useful patient-friendly, jargon-free glossary of confusing cardiology terminology